Chloramphenicol toxicity in newborns

Definition

Gray syndrome is a dangerous condition that occurs in newborns (especially premature babies) who are given the drug chloramphenicol.

Alternative Names

Causes

Chloramphenicol is a drug used to fight bacterial infection, including meningitis. If given to a newborn, however, this drug can cause a poisonous reaction that can be fatal. This reaction is called Gray syndrome.

Young babies do not have the enzymes (special proteins in the body) needed to break down this drug. The drug accumulates in the baby's blood stream, causing hypotension (low blood pressure), cyanosis (blue coloring of lips, nail beds, and skin from lack of oxygen in the blood), and often death.

Symptoms

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

• Vomiting, refusal to suck, passage of loose green stools
• Body limpness and ashen gray color
• Hypotension (low blood pressure)
• Cyanosis (blue coloring of lips, nail beds, skin from lack of oxygen in the blood)
• Hypothermia (low body temperature)
• Cardiovascular collapse

Treatment

Overdoses can be treated with an exchange transfusion which involves removing aliquots (portions) 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 appropriately adjusted 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. Do not take it without seeking advice from your physician if you are either pregnant or nursing.

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