Gray baby syndrome is a rare but serious side effect that occurs in newborn infants (especially premature babies) following the intravenous administration of the antimicrobial chloramphenicol

Chloramphenicol

Chloramphenicol is a bacteriostatic antimicrobial that became available in 1949. It is considered a prototypical broad-spectrum antibiotic, alongside the tetracyclines, and as it is both cheap and easy to manufacture it is frequently found as a drug of choice in the third world.Chloramphenicol is...

.

Pathophysiology

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 glucoronidation reactions occurring in the baby, thus leading to an accumulation of toxic chloramphenicol metabolites. :

1. The UDP-glucuronyl transferase enzyme system of infants, especially premature infants, is immature and incapable of metabolizing the excessive drug load.
2. Insufficient renal excretion of the unconjugated drug.

Clinical features

Toxic levels of chloramphenicol

Chloramphenicol

Chloramphenicol is a bacteriostatic antimicrobial that became available in 1949. It is considered a prototypical broad-spectrum antibiotic, alongside the tetracyclines, and as it is both cheap and easy to manufacture it is frequently found as a drug of choice in the third world.Chloramphenicol is...

 after 2–9 days result in:

• Vomiting
• Ashen gray color of the skin
• Limp body tone
• Hypotension
  Hypotension
  In physiology and medicine, hypotension is abnormally low blood pressure, especially in the arteries of the systemic circulation. It is best understood as a physiologic state, rather than a disease. It is often associated with shock, though not necessarily indicative of it. Hypotension is the...
  
   (low blood pressure)
• Cyanosis
  Cyanosis
  Cyanosis is the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen. The onset of cyanosis is 2.5 g/dL of deoxyhemoglobin. The bluish color is more readily apparent in those with high hemoglobin counts than it is...
  
   blue discolouration of lips and skin.
• Hypothermia
  Hypothermia
  Hypothermia is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as . Body temperature is usually maintained near a constant level of through biologic homeostasis or thermoregulation...
  
  
• Cardiovascular collapse
  Cardiogenic shock
  Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively....
  
  

Treatment

Chloramphenicol

Chloramphenicol

Chloramphenicol is a bacteriostatic antimicrobial that became available in 1949. It is considered a prototypical broad-spectrum antibiotic, alongside the tetracyclines, and as it is both cheap and easy to manufacture it is frequently found as a drug of choice in the third world.Chloramphenicol is...

 therapy is discontinued immediately; exchange transfusion

Exchange transfusion

An exchange transfusion is a medical treatment in which apheresis is used to remove one person's red blood cells or platelets and replace them with transfused blood products...

 may be required to remove the drug. Sometimes, phenobarbital (CYP450 induction) is used.

Prevention

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.