Division of Child and Adolescent Neurology, McGovern Medical School, UTHealth, Houston, Texas.
Division of Child and Adolescent Neurology, McGovern Medical School, UTHealth, Houston, Texas.
Pediatr Neurol. 2018 Feb;79:65-68. doi: 10.1016/j.pediatrneurol.2017.11.010. Epub 2017 Nov 22.
Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is an autoimmune disorder that often affects women of childbearing age, and maternal-fetal transfer of anti-NMDAR antibodies during pregnancy has been documented in both symptomatic and asymptomatic women. The effects of these antibodies on the fetus, however, are incompletely understood.
This term infant exhibited depressed respiratory effort, poor feeding, and abnormal movements after birth. Magnetic resonance imaging revealed diffuse cerebral edema with ischemic and hemorrhagic injury. Her mother had experienced anti-NMDAR encephalitis secondary to an ovarian teratoma 18 months earlier. The baby's serum NMDAR antibody titer was elevated at 1:320. Intravenous immunoglobulin did not result in clinical improvement, and care was withdrawn on day of life 20. Her mother had an elevated serum NMDAR antibodies (1:80), positive CSF antibody titers, and a new ovarian teratoma.
Routine testing of NMDAR antibodies in pregnant women with a previous history of anti-NMDAR encephalitis may be warranted. Infants born to these mothers should be closely monitored throughout pregnancy and after birth.
抗 N-甲基-D-天冬氨酸受体（NMDAR）脑炎是一种自身免疫性疾病，常影响育龄期妇女，有症状和无症状妇女在怀孕期间均可发生抗 NMDAR 抗体向胎儿转移。然而，这些抗体对胎儿的影响尚不完全清楚。
这名足月产婴儿出生后出现呼吸努力减弱、喂养不良和运动异常。磁共振成像显示弥漫性脑水肿伴缺血性和出血性损伤。她的母亲在 18 个月前因卵巢畸胎瘤发生抗 NMDAR 脑炎。婴儿血清 NMDAR 抗体滴度为 1:320。静脉注射免疫球蛋白治疗后未出现临床改善，出生后第 20 天停止治疗。其母亲血清 NMDAR 抗体升高（1:80），脑脊液抗体滴度阳性，且有新的卵巢畸胎瘤。
对于有抗 NMDAR 脑炎既往史的孕妇，常规检测 NMDAR 抗体可能是必要的。这些母亲所生的婴儿应在整个孕期和出生后进行密切监测。
