Children and adolescents
Neonatal lupus
From maternal anti-SSA/Ro (± SSB/La): congenital heart block, rash, cytopenias or hepatitis in the infant.
What to look for
- Congenital heart block (about 2% of first pregnancies with anti-Ro; higher if a previous child was affected)
- Annular, photosensitive rash, cytopenias, or raised liver tests in the first months
- The mother may have no known autoimmune disease
What to do
- Fetal bradycardia or heart block needs urgent fetal cardiology or MFM.
- Rash and cytopenias usually resolve by 6–9 months as maternal antibodies clear.
- Anti-Ro-positive pregnancies are monitored with fetal echocardiography, typically from about 16 to 26 weeks. Hydroxychloroquine lowers recurrence risk.
About this urgency level
Early specialist assessment changes outcomes. Send the usual workup with the referral, but don't hold the referral while waiting for results.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.