• Shruti GOCHHWAL

Grey Baby Syndrome: Causes, Symptoms, Diagnosis And Treatment

If chloramphenicol is given to infants for bacterial infections in excess, then a side effect called as grey baby syndrome occurs. It can cause many harmful signs and symptoms in infants but is totally preventable.

Aggressive supportive measures, termination of chloramphenicol therapy, and exchange transfusion did not improve the clinical status. Charcoal hemoperfusion also effectively removes chloramphenicol from serums and could possibly have benefited our patient, but was not available in our institution. While exchange transfusion should be considered a therapeutic modality for this condition, it cannot be regarded as a safe or innocuous procedure in a patient with cardiovascular collapse.

A new generation of physicians, nurses, and hospital pharmacists must be aware of appropriate indications and dosage schedules of chloramphenicol for infants and neonates. Careful clinical monitoring of patient status and the timely therapeutic monitoring of serum chloramphenicol levels in any neonate receiving the drug are essential, even when it is administered at recommended dosage. SPITE the well-known toxic effects of chloramphenicol, especially the grey syndrome of infants and children, errors in prescription and administration of this drug continue to occur.

What is Grey Baby Syndrome caused by?

Neonatal and fetal ability to glucuronidate chloramphenicol is unpredictable and diminished when compared with older children and adults, making the newborn especially susceptible to chloramphenicol toxicity. The fetus is also at risk because chloramphenicol concentrations in fetal serum are 30 to 80 per cent of the concurrent maternal serum concentration.

The neonate loses the ability to clear the drug via the placenta at the time of birth. If the patients are exposed to chloramphenicol in the perinatal period as well as in the newborn period, received 10 times the recommended dose of 25 mg/kg/day, then it is said to cause this syndrome. Within 24 hours of life the child will develop abdominal distention, vomiting, progressive cyanosis, irregular respiration, hypothermia, and vasomotor collapse. These findings are typical of the grey syndrome which is the direct result of toxic levels of chloramphenicol.  Levels more than 50mcg/ml are fatal. It can lead to collapse of the circulatory system imparting a ash or grey color to the skin.

If the liver of the newborn cannot utilize chloramphenicol effectively then this syndrome can occur. If the kidney’s of the neonates are not capable of excreting chloramphenicol. But if the baby is healthy and full term then it might not affect them. It affects the premature ones more.

Causes For Grey Baby Syndrome

grey baby syndrome cause

Smiling Baby


Below mentioned risk factors can lead to grey baby syndrome

  1. Ineffective liver and kidney

  2. Excess chloramphenicol

  3. Increased duration of treatment with chloramphenicol

  4. Premature or underweight infants

Chloramphenicol dose is based on the age of the neonates. For different age and weight, different doses of chloramphenicol is given.

Breastfeeding mothers should not take this as they might pass it to their babies.

Symptoms Of The Grey Baby Syndrome

symptoms of grey baby syndrome

Playing Baby


The severity of the disease will depend on the status of liver and kidney and how much dose is given .

Grey baby syndrome symptoms are listed below:

  1. Tiredness

  2. Weak feeling

  3. Nausea and vomiting

  4. Less mental alertness

  5. Grey skin color

  6. Tender abdomen

  7. Distended abdomen

  8. Blue nails and skin

  9. Respiratory problems

  10. Temperature of the body is low

Immediate medical help should be taken if these symptoms are seen.

Complications Of The Grey Baby Syndrome

The complications of grey baby syndrome are listed below:

  1. Liver fail

  2. Kidney fail

  3. Anemia

  4. Inflammation in the nerves

  5. Shock

  6. Sepsis

Chloramphenicol could displace bilirubin and cause jaundice

Diagnosis Of Grey Baby Syndrome

If the skin color is ash grey and the patient has been taken chloramphenicol then grey baby syndrome is diagnosed. The doctor will search for signs and symptoms related to its toxicity.

Following tests can be done to diagnose grey baby syndrome

Ct scans, x-rays, ultrasound, ECG. Blood test scan also be done to detect chloramphenicol. Cardiac tests to detect issues related to the heart. Trauma, shock, infections can also be looked out for.

Grey Baby Syndrome treatment

Chloramphenicol treatment should not be given to the babies. Babies should receive full support in the Neonatal ICU. Proper oxygen, ventilation etc. should be given. Hypoglycaemia or hypothermia might develop and should be treated.

Chloramphenicol should be removed from the blood directly by the following:

  1. Cephalosporins can be given to treat grey baby syndrome

  2. Charcoal hemoperfusion: this a method carried outside the body to eliminate the toxins from the blood.

  3. Transfusion: babies blood can be replaced by fresh blood or plasma.

Prognosis Of Grey Baby Syndrome

If the chloramphenicol treatment is immediately stopped or it is removed from the blood, then situation can be prevented from becoming worse. If it becomes severe then death or organ failure could occur.

Prevention Of Grey Syndrome

The best way is not to prescribe chloramphenicol at all by the concerned doctor.

The doctors for babies should choose safer antibiotics. Avoid prescribing it to new mothers or breast feeding mothers. Give them safer antibiotics.

If in any case it has to be given, then give it in low doses to avoid toxicity. Blood levels should be tracked and closely monitored. This drug should be used as a last resort and should be avoided to treat bacterial infections. You should know its benefits and harms before consuming it. if you take chloramphenicol for long or excessively then it results in toxicity in the body.

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