Neonatal lupus erythematosus is an autoimmune disease in an infant born to a mother with anti-Ro/SSA and with or without anti-La/SSB antibodies. The disease most commonly presents with a rash resembling subacute cutaneous lupus erythematosus and can have systemic abnormalities such as complete heart block or hepatosplenomegaly. Neonatal lupus is usually benign and self-limited. Many of the clinical manifestations are transient, but certain heart problems can be permanent. Diagnosis is based on maternal antibodies and clinical manifestations. Treatment and management is mainly supportive and focused on preventing complete heart block if possible. Pathogenesis
Ro/SSA and La/SSB are proteins found inside cells. Anti-Ro/SSA and anti-La/SSB are antibodies that form against these proteins. These antibodies can be seen in autoimmune diseases, the most common being Lupus and Sjögrens. Mothers can have these antibodies circulating in their blood without having any signs or symptoms of an autoimmune disease. Babies born to mothers with these antibodies have a chance of developing neonatal lupus erythematosus. This occurs when maternal anti-Ro/SSA and anti-La/SSB antibodies enter fetal circulation and affect neonatal organs by crossing the placenta using FcRn receptors. The mechanism in which the antibodies affect organs is not yet completely understood. For the heart, it is thought that these antibodies bind to cells in the heart that go through physiologic cell death during embryogenesis. This leads to heart cell injury which causes secondary fibrosis in the conduction system, ultimately causing heart block. These antibodies can also affect calcium channels which are needed to initiate action potentials.
Step-siblings are children born of two different families who have been joined by marriage, A male step-sibling is a stepbrother and a female is a stepsister. The step-siblings relationship is connected through law and is not a blood relation. Step-siblings are sometimes abbreviated informally as stepsibs. Culture
In many fairy tales, the central character has a stepmother and the step-siblings serve as an extension of their mother. Cinderella and Mother Hulda features wicked stepsisters who take after their parents. The story Kate Crackernuts serves as a counterexample where the daughter of the evil stepparent is a loving stepsisters.Many romance novels feature heroes who are the stepbrother of the heroine. The step-relationship generally stems from a marriage when the hero and heroine are at least in their adolescence.Some family films and television sitcoms feature a blended nuclear family including siblings as the center premise. In many cases, the step-family is large and full of children causing situations such as sibling rivalry, rooming, falling in love, and getting along amongst the children as popular plot-lines. This premise gained traction with the 1968 films Yours, Mine and Ours and With Six You Get Eggroll and the 1969 launch of the television sitcom The Brady Bunch. Some contemporary family sitcoms have made the blended family sitcom more popular with the TGIF show Step by Step bringing about other shows such as Aliens in the Family, Life with Derek, Drake & Josh, and the short-lived NBC family sitcom Something So Right.