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Outcome in Infants of Mothers with Systemic Lupus Erythematosus

Journal of the Korean Pediatric Society 1993;36(6):791-804.
Published online June 15, 1993.
Outcome in Infants of Mothers with Systemic Lupus Erythematosus
Chang Ryul Kim1, Young Pyo Chang1, Hee Seop Kim1, Mi Jung Kim1, Byung Il Kim1, Jung-Hwan Choi1, Chong Ku Yun1, Bo Hyun Yoon2, Hee Chul Syn2, Syng Wook Kim2, Seon Yang Park3, Hahng Lee4
1Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Korea
2Department of Obstetrics, Seoul National University, College of Medicine, Seoul, Korea
3Department of Internal Medicine, Seoul National University, College of Medicine, Seoul, Korea
4Department of Pediatrics, Hanyang University, College of Medicine, Seoul, Korea
전신성 홍반성 낭창 산모에서 태어난 신생아의 예후
김창렬1, 장영표1, 김희섭1, 김미정1, 김병일1, 최중환1, 윤종구1, 윤보현2, 신희철2, 김승욱2, 박선양3, 이항4
1서울대학교 의과대학 소아과학교실
2서울대학교 의과대학 산부인과교실
3서울대학교 의과대학 내과학교실
4한양대학교 의과대학 소아과학교실
Abstract
A large proportion of patients with systemic lupus erythematosus(SLE) are women of reproductive age. Their fetal outcome is undoubtedly less favourable than in haelthy women. Although there is no evidence of an increase in congenital anomalies, increased frequencies of miscarriage, stillbirth, growth retardation, and preterm delivery are recognized It mainly depends on the compromise of uteroplacental circulation such as renal disease, hypertension and thrombopoitetic action of antiphos phoipid antibody. Besides a small proportion of the newborn infants get a neonatal lupus syndrome, the most serious component being congenital heart block. This coplication occurs almost exclusively in the offsprint of women with anti-Ro/SSA anibodies. In order to find out the effect on fetus and newborn infants born to SLE mother, we reviewed clinical records of 11 infants born to 9 moters with confiremed or suspected SLE at Seoul National University Hospital between June 1981 and May 1991 The results obtained were as follows: 1) Seven mothers among 9 were confirmed as SLE and 2 were suspected 2) There were 6 spontaneous abortions(20.0%)and 5 stillbirths(16.7%) in 5 mothers among thirty pregnacies of 9 mothers 3) Among 11 newborns, 4(36.4%) were premature and 2(18.2%) were small for gestational age. 4) Six mothers had proteinuria, over 4+, in Albustix. Four of these, including 3 preeclampsia mothers, delivered preterm babies. Two of premature babies were born through Cesarean section due to fetal distress and expierd of hyaline membrane and its complications. The other 2 had therombocytopenia and leukocytopenia at birth. One of these had intractranial hemorrhage at birth and seizure. 5) Ther were 2 mothers who had positive anticardiolipin antibody with SLE or without SLE, One with SLE was continuing positivity of the antibody during pregnancy and delivered premature body who expired of HMD and PDA. The other who had seroconversion to negativity during the first trimester developed intermittently sinus bracycardia without apnea for 3 days 6) Two of 11 newborns had only talipes equinovarus. 7) One mother who had anti-Ro/SSA antibody delivered monozygotic twin. The first baby was neonatal lupus erythematosus with complete heart block and skin pigmentation. All of them were suspected to right aortic arch and Kommerell뭩 diverticulum on echocardiogram. As the above results, SLE mothers can cause serious effect on fetus and newborn when acompanied with active rnal impairment, hypertension and positive antiphospholipid antibody. So we should treat mother with SLE veen during pregnancy and it may give better outcome to mother and fetus. I will be useful for diagnosis and treatment of neonatal lupus erythenatosus that the prenatal test for anti-Ro/SSA antibody, fetal monitoring, fetal echocradiogrma and postnatal close observeation for skin are taken.
Key Words: SLE mother, Fetus, Newborn


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