Liu Wei-Li, Peng Ying-Hsuan
Department of Pediatrics, Dalin Tzu Chi Hospital, Dalin, Chiayi County, Taiwan.
Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.
Front Pediatr. 2024 Jul 31;12:1337135. doi: 10.3389/fped.2024.1337135. eCollection 2024.
Neonatal lupus may be associated with severe cardiac conduction problems, including high-degree or complete atrioventricular (AV) block, necessitating immediate pacemaker implantation during the neonatal period. However, cardiac manifestations of neonatal lupus may extend beyond AV block. Our case was a full-term female neonate, who presented with fetal arrhythmia and bradycardia with a heart rate of approximately 70-75 beats per minute after birth. Neonatal lupus was diagnosed later due to positive maternal and neonatal anti-SSA/Ro antibody. High-degree AV block was considered initially but bigeminy premature atrial contractions (PACs) with block was confirmed through a detailed evaluation of an electrocardiogram, which demonstrated unfixed PP intervals and fixed RR intervals. Atrial tachycardia (AT) developed when the neonate was 23 days old. The key point that differentiates high-degree AV block from PACs with block is the PP interval. The PP interval is fixed in high-degree AV block and unfixed in PACs with block. Careful differential diagnosis is required in neonates with bradycardia because it may lead to very different management. Our case presents a good illustration of why these arrhythmias need to be differentiated. Furthermore, our case may be the first of neonatal lupus with AT.
新生儿狼疮可能与严重的心脏传导问题有关，包括高度或完全性房室传导阻滞，这就需要在新生儿期立即植入起搏器。然而，新生儿狼疮的心脏表现可能不止房室传导阻滞。我们的病例是一名足月女婴，出生后出现胎儿心律失常和心动过缓，心率约为每分钟70 - 75次。后来由于母亲和新生儿抗SSA/Ro抗体呈阳性，诊断为新生儿狼疮。最初考虑为高度房室传导阻滞，但通过详细的心电图评估确诊为伴有阻滞的二联律房性早搏（PACs），其显示PP间期不固定而RR间期固定。新生儿23日龄时出现房性心动过速（AT）。高度房室传导阻滞与伴有阻滞的房性早搏的关键区别在于PP间期。高度房室传导阻滞时PP间期固定，而伴有阻滞的房性早搏时PP间期不固定。对于心动过缓的新生儿需要进行仔细的鉴别诊断，因为这可能导致截然不同的治疗方法。我们的病例很好地说明了为什么需要区分这些心律失常。此外，我们的病例可能是首例伴有房性心动过速的新生儿狼疮。
