Gray baby syndrome

Gray baby syndrome (also termed Gray or Grey syndrome) is a rare but serious side effect that occurs in newborn infants (especially premature babies) following the intravenous administration of the antibiotic chloramphenicol.^[1]

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Pathophysiology

Newborn infants are predisposed to this condition because they do not yet have fully functional liver enzymes, nor do they have enough enzymes to handle the drug.^[2]

Clinical features

Toxic levels of chloramphenicol after 2–9 days result in:

• Vomiting
• Ashen gray colour of the skin
• Limp body tone
• Hypotension (low blood pressure)
• Cyanosis blue discolouration of lips and skin.
• Hypothermia
• Cardiovascular collapse

Treatment

Chloramphenicol therapy is discontinued immediately; exchange transfusion may be required to remove the drug.

Prevention

The condition can be prevented by using chloramphenicol at the recommended doses and monitoring blood levels.^[3][4][5]