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Case report
Complete heart block in neonatal lupus: a forgotten cause of fetal bradycardia
  1. Sakviseth Bin1,
  2. Rathmony Heng2 and
  3. Sethikar IM1
  1. 1Neonatal Intensive Care Unit, Calmette Hospital, Phnom Penh, Cambodia
  2. 2Cardiology Department, Calmette Hospital, Phnom Penh, Cambodia
  1. Correspondence to Dr Sakviseth Bin; sakviseth_bin{at}yahoo.com

Abstract

The most common cause of congenital heart block (CHB) is neonatal lupus, an acquired autoimmune disease caused by transplacental transfer of maternal antibodies to the fetus. A full-term female neonate was admitted to neonatal intensive care unit for severe bradycardia with stable haemodynamics. The mother, showing no clinical symptoms or any particular history, was transferred to our tertiary centre for profound fetal bradycardia. At birth, the infant’s ECG showed a third-degree atrioventricular block and echocardiography was normal. Cardiac neonatal lupus was confirmed with positive maternal anti-Ro antibodies. Under close monitoring, the infant tolerated the bradycardia well (median 67 beats per minute (bpm)) and was discharged on day 6 of life. There was no indication for pacemaker, but she would be on regular follow-up with a paediatric cardiologist. This article holds an important insight as it is the first confirmed case of autoimmune CHB in Cambodia in which the mother’s antibody was found only after diagnosis on the neonate.

  • neonatal intensive care
  • pregnancy
  • materno-fetal medicine
  • arrhythmias
  • immunology

https://doi.org/10.1136/bcr-2021-246747

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    Footnotes

    • Contributors SB, RH and SI were involved in the patient’s care. SB initiated the idea of submitting. RH collected the data and followed up the case. SI provided supervision. SB performed literature review, drafted the manuscript, and explained and obtained consent from the parents. All the authors read the paper, and revised and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.