Gray syndrome

• Alternative Names

  Chloramphenicol toxicity in newborns

• Causes, incidence, and risk factors

  Chloramphenicol is a drug used to fight bacterial infections, including meningitis. If given to a newborn, however, high doses of this drug can trigger a potentially deadly poisonous reaction.

  Babies do not have the enzymes (special proteins in the body) needed to break down this drug. The drug builds up in the baby's bloodstream and can lead to:

  • Blue lips, nail beds, and skin from lack of oxygen in the blood (cyanosis)
  • Death
  • Low blood pressure
• Symptoms

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

  • Body limpness and ashen gray color
  • Cardiovascular collapse
  • Cyanosis
  • Low blood pressure (hypotension)
  • Low body temperature (hypothermia)
  • Vomiting, refusal to suck, passage of loose green stools
• Treatment

  Overdoses can be treated with an exchange transfusion which involves removing portions (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 lower doses. However, with newer drugs available for bacterial infections, chloramphenicol use has decreased dramatically.

  Chloramphenicol may be passed on to an infant through breast milk, and therefore may be unsafe for the mother to take during pregnancy and while breast-feeding. Do not take this drug without seeking advice from your doctor if you are either pregnant or nursing.

• References

  Michelow IC, McCracken GH Jr. Antibacterial therapeutic agents. In: Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 248.

Review Date: 12/7/2009

Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine.