Gray baby syndrome

Gray baby syndrome
Classification and external resources
Specialty	pediatrics
ICD-10	P93
ICD-9-CM	779.4
MedlinePlus	007049
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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 accumulation of antibiotic chloramphenicol.

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

Two pathophysiologic mechanisms are thought to play a role in the development of gray baby syndrome after exposure to the anti-microbial drug chloramphenicol. This condition is due to a lack of glucuronidation reactions occurring in the baby, thus leading to an accumulation of toxic chloramphenicol metabolites. :

Due to these two reasons the chloramphenicol level in blood is increased, at higher concentration chloramphenicol blocks electron transport in the liver, myocardium, and skeletal muscles, resulting the above symptoms.

The condition can be prevented by using chloramphenicol at the recommended doses and monitoring blood levels, or alternatively, third generation cephalosporins can be effectively substituted for the drug, without the associated toxicity.

Chloramphenicol therapy should be stopped immediately. Exchange transfusion may be required to remove the drug. Sometimes, phenobarbital (UGT induction) is used.

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