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.cite journal | author = McIntyre J, Choonara I | title = Drug toxicity in the neonate. | journal = Biol Neonate | volume = 86 | issue = 4 | pages = 218–21 | year = 2004 | pmid = 15249753 | doi = 10.1159/000079656]

Pathophysiology

Two pathophysiologic mechanisms are thought to play a role in the development of gray baby syndrome after chloramphenicol exposure: [cite book |title= Goodman & Gilman's The Pharmacological Basis of Therapeutics |last= Brunton |first= Laurence L. (Ed.) |authorlink= |coauthors= |year= 2006 |edition = 11th edition |publisher= McGraw-Hill |location= |isbn= 0071422803 |pages= |chapter= Chapter 46. Protein Synthesis Inhibitors and Miscellaneous Antibacterial Agents]
# The UDP-glucuronyl transferase enzyme system of infants, especially premature infants, is immature and incapable of metabolizing the excessive drug load.
# Insufficient renal excretion of the unconjugated 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, [cite journal | author = Feder H | title = Chloramphenicol: what we have learned in the last decade. | journal = South Med J | volume = 79 | issue = 9 | pages = 1129–34 | year = 1986 | pmid = 3529436] [cite journal | author = Mulhall A, de Louvois J, Hurley R | title = Chloramphenicol toxicity in neonates: its incidence and prevention. | journal = Br Med J (Clin Res Ed) | volume = 287 | issue = 6403 | pages = 1424–7 | year = 1983 | pmid = 6416440 | url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=6416440 | format=Scanned copy & PDF] [cite journal | author = Forster J, Hufschmidt C, Niederhoff H, Künzer W | title = [Need for the determination of chloramphenicol levels in the treatment of bacterial-purulent meningitis with chloramphenicol succinate in infants and small children] | journal = Monatsschr Kinderheilkd | volume = 133 | issue = 4 | pages = 209–13 | year = 1985 | pmid = 4000136] or alternatively, third generation cephalosporins can be effectively substituted for the drug, without the associated toxicity.cite journal
author = Aggarwal, R.
coauthors = Sarkar, N.; Deorari, A.K.; Paul, V.K.
year = 2001
title = Sepsis in the newborn
journal = Indian Journal of Pediatrics
volume = 68
issue = 12
pages = 1143–1147
url = http://www.springerlink.com/index/N7G38R87235Q4246.pdf
accessdate = 2008-05-03
doi = 10.1007/BF02722932]

References