A 6-week-old female infant has an annular, scaling, mildly raised plaque around the eyes and scalp with no significant scale elsewhere. Her mother reports a photosensitive facial rash during her own previous pregnancy. Anti-Ro (SSA) antibodies are detected in the infant's blood. Besides sun protection and topical steroids for the rash, what additional screening is essential?

• A Hearing assessment is unnecessary unless rash persists beyond 6 months
• B Renal ultrasound for glomerulonephritis
• C Echocardiography to detect congenital complete heart block ✓
• D Liver biopsy for neonatal cholestasis

Explanation

Neonatal lupus erythematosus is caused by transplacental transfer of maternal anti-Ro and/or anti-La antibodies, producing annular scaly plaques in a photodistributed pattern. The skin rash resolves within months as maternal antibody clears, but the same antibodies attack the fetal cardiac conduction system, so echocardiography is mandatory to exclude congenital complete atrioventricular block, the most serious manifestation. Hepatitis and cytopenias can occur but liver biopsy is never indicated, and sensorineural hearing loss also warrants evaluation regardless of rash duration.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.