Select the appropriate diagnosis or diagnostic indicator for the sonographic image shown below.
The ultrasound shows splaying of the lumbar spine consistent with spina bifida.
At 1 year of age, a child has six deciduous teeth, which are discolored and have hypoplasia of the enamel.
Which antibiotic most likely responsible for the clinical findings presented.
The teratogenicity of antibiotics after fetal exposure depends on many factors such as gestational age, protein binding, lipid solubility, pH, molecular weight, degree of ionization, and concentration gradient. Some antibiotics are even concentrated in the fetal compartment. Tetracycline is contraindicated in all three trimesters. It has been associated with skeletal abnormalities, staining and hypoplasia of budding fetal teeth, bone hypoplasia, and fatal maternal liver decompensation. Sulfonamides are associated with kernicterus in the newborn. They compete with bilirubin for binding sites on albumin, thereby leaving more bilirubin free for diffusion into tissues. Sulfonamides should be withheld during the last 2 to 6 weeks of pregnancy. With prolonged treatment of tuberculosis (TB) in pregnancy, streptomycin has been associated with fetal hearing loss. Its use is restricted to complicated cases of TB. Nitrofurantoin can cause maternal and fetal hemolytic anemia if glucose 6-phosphate dehydrogenase deficiency is present. Chloramphenicol is noted for causing the gray baby syndrome. Infants are unable to properly metabolize the drug, which reaches toxic levels in about 4 days and can lead to neonatal death within 1 to 2 days.
A 1-week-old baby boy is brought in to the emergency department by his mother. For the past few days he has been lethargic. The day before he did not eat well and in the morning of the day of presentation he started vomiting. On the way to the hospital the baby had a seizure. On examination, the baby is jaundiced.
During routine auditory testing of a 2-day-old baby, the baby failed to respond to high-pitched tones.
A 2-week-old neonate who was delivered at 28 weeks’ gestation developed pallid cyanosis, abdominal distension, and vascular collapse after exposure to an antibiotic. A few days later the baby died.