Gray baby syndrome

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 antibiotic chloramphenicol.

Pathophysiology
Newborn infants are predisposed to this condition because they do not yet have fully functional liver enzymes, nor do they have enough enzymes to handle the drug.

Clinical features
Toxic levels of chloramphenicol after 2–9 days result in:
 * Vomiting
 * Ashen gray colour of the skin
 * Limp body tone
 * Hypotension (low blood pressure)
 * Cyanosis blue discolouration of lips and skin.
 * Hypothermia
 * Cardiovascular collapse

Treatment
Chloramphenicol therapy is discontinued immediately; exchange transfusion may be required to remove the drug.

Prevention
The condition can be prevented by using chloramphenicol at the recommended doses and monitoring blood levels.