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Gray syndrome
Definition:
Chloramphenicol is an antibacterial medication used against gram-positive and gram-negative bacteria and is often used for meningitis. If given to a newborn, however, it can be toxic (poisonous) and fatal.

Alternative Names:
Gray baby syndrome; Chloramphenicol toxicity in newborns

Causes, incidence, and risk factors:

"Gray syndrome" occurs if newborns (especially premature babies) are given chloramphenicol for a bacterial infection. Babies at that age do not have the necessary enzymes that allow the liver to be able to metabolize this drug appropriately.

The chloramphenicol accumulates in the baby's blood stream, causing hypotension (low blood pressure), cyanosis (blue coloring of lips, nail beds, and skin from lack of oxygen in the blood), and often death.
Symptoms:

Symptoms usually begin 2 to 9 days after treatment has been started.

  • Vomiting, refusal to suck, passage of loose green stools
  • Baby becomes limp and an ashen gray color
  • Hypotension (low blood pressure)
  • Cyanosis (blue coloring of lips, nail beds, skin from lack of oxygen in the blood)
  • Hypothermia (low body temperature)
  • Cardiovascular collapse
Treatment:

Overdoses can be treated with an exchange transfusion which involves removing aliquots of the baby's blood and replacing it with donated blood.
Prevention:

Chloramphenicol is generally not given to newborns or premature infants. It can be given safely at appropriately adjusted lower doses, however, with newer drugs available for bacterial infections the need for using chloramphenicol has decreased dramatically.

Chloramphenicol may be passed on to an infant through breast milk, and it may be unsafe to take during pregnancy. Do not take it without seeking advice from your physician first if either pregnant or nursing.
Review Date: 2/13/2002
Reviewed By: Elizabeth Hait, M.D., Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH. Review provided by VeriMed Healthcare Network.
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