Gray baby syndrome

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Not to be confused with Bronze baby syndrome.
Gray baby syndrome
Classification and external resources
Specialty pediatrics
ICD-10 P93
ICD-9-CM 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]

Signs and symptoms[edit]

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. :[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.

Due to this 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,[3][4][5] or alternatively, third generation cephalosporins can be effectively substituted for the drug, without the associated toxicity.[6]


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


  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.; Lazo, John S.; Parker, Keith, eds. (2005). "Chapter 46. Protein Synthesis Inhibitors and Miscellaneous Antibacterial Agents". Goodman & Gilman's The Pharmacological Basis of Therapeutics (11th ed.). New York: 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" (PDF). 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.