Gray baby syndrome

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Not to be confused with Bronze baby syndrome. ‹See Tfd›
Gray baby syndrome
Classification and external resources
ICD-10 P93
ICD-9 779.4
MedlinePlus 007049

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 antimicrobial chloramphenicol.[1]

Pathophysiology[edit]

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. :[2]

  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[edit]

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

Treatment[edit]

Chloramphenicol therapy is discontinued immediately; exchange transfusion may be required to remove the drug. Sometimes, phenobarbital (UGT induction) is used.

Prevention[edit]

The condition can be prevented by using chloramphenicol at the recommended doses and monitoring blood levels,[3][4][5] or alternatively, third generation cephalosporins can be effectively substituted for the drug, without the associated toxicity.[6]

References[edit]

  1. ^ McIntyre J, Choonara I (2004). "Drug toxicity in the neonate.". Biol Neonate 86 (4): 218–21. doi:10.1159/000079656. PMID 15249753. 
  2. ^ Brunton, Laurence L. (Ed.) (2006). "Chapter 46. Protein Synthesis Inhibitors and Miscellaneous Antibacterial Agents". Goodman & Gilman's The Pharmacological Basis of Therapeutics (11th ed.). McGraw-Hill. ISBN 0-07-142280-3. 
  3. ^ Feder H (1986). "Chloramphenicol: what we have learned in the last decade.". South Med J 79 (9): 1129–34. doi:10.1097/00007611-198609000-00022. PMID 3529436. 
  4. ^ Mulhall A, de Louvois J, Hurley R (1 January 1983). "Chloramphenicol toxicity in neonates: its incidence and prevention". British medical journal (Clinical research ed.) 287 (6403): 1424–7. doi:10.1136/bmj.287.6403.1424. PMC 1549666. PMID 6416440. 
  5. ^ Forster J, Hufschmidt C, Niederhoff H, Künzer W (1985). "[Need for the determination of chloramphenicol levels in the treatment of bacterial-purulent meningitis with chloramphenicol succinate in infants and small children]". Monatsschr Kinderheilkd 133 (4): 209–13. PMID 4000136. 
  6. ^ Aggarwal, R; Sarkar, N; Deorari, AK; Paul, VK (Dec 2001). "Sepsis in the newborn". Indian journal of pediatrics 68 (12): 1143–1147. doi:10.1007/BF02722932. PMID 11838570. 

Further reading[edit]

  • Krasinski, K; Perkin, R; Rutledge, J (1 September 1982). "Gray Baby Syndrome Revisited". Clinical Pediatrics 21 (9): 571–572. doi:10.1177/000992288202100910. PMID 7105617. 
  • Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL, ed. (2009). "Ch.248. Antibacterial therapeutic agents". Feigin & Cherry's textbook of pediatric infectious diseases (6th ed.). Philadelphia, PA: Saunders/Elsevier. ISBN 1416040447.