Gray Baby Syndrome – Causes, Symptoms & Treatment

Having a healthy baby is something that every mother desires. This is why it is important to take care of yourself throughout your pregnancy with the right diet, exercise, and medical care. You should remember not to take any new medicines without consulting your doctor as certain medications can cause serious birth defects or other health complications for your child. Gray Baby Syndrome is one such condition. It is a rare but serious condition that primarily affects newborns, particularly premature infants, following exposure to the antibiotic chloramphenicol. In this article, we will explain what Gray Baby Syndrome is, why it happens, what signs to look out for, and how it can be prevented.

What Is Grey Baby Syndrome?

This is a potentially fatal health complication that can occur in newborn or premature babies as a result of an overdose of the antibiotic chloramphenicol administered either to the infant or the mother. Since babies cannot break down high dosages of this drug, it can accumulate in the bloodstream leading to cardiovascular collapse (1). The fatality rate stands at 40% of all untreated cases or late identified cases.

Other Names of Gray Baby Syndrome

Gray Baby Syndrome is also known as

• Chloramphenicol Toxicity in Newborns,
• Chloramphenicol Toxicity in Neonates, and
• Gray Syndrome from Chloramphenicol Administration in Newborn.

Who Can Get This Syndrome (Sex and Age-wise Distribution)

This syndrome usually appears soon after the birth of the baby and has been found to occur equally in both genders. Babies which are born prematurely are at higher risk of developing the complication due to immaturity of body organs involved in the metabolism of medicine and its removal from body Children up to the age of two years are more vulnerable to this condition though less than newborns. Studies have not indicated any kind of racial or ethnic predilections.

What Is Chloramphenicol?

Chloramphenicol is an antibiotic used to treat bacterial infections such as meningitis when other medications have failed to work. Owing to the influx of newer medicines and due to the risk of Gray Baby Syndrome, use of chloramphenicol use has reduced over the years. The drug, found in eye drops and ointments used to treat bacterial conjunctivitis is also known to cause bone marrow toxicity. It is usually administered orally or intramuscularly or intravenously to patients (2).

Causes of Gray Baby Syndrome

Use of chloramphenicol is the primary cause of Gray Baby Syndrome (3). Newborns especially those born prematurely cannot process or excrete high amounts of chloramphenicol and as a result, it can build up to toxic levels in the bloodstream which can prove fatal. Chloramphenicol might also be given to pregnant women for the treatment of certain bacterial infections and this can then get passed on to the foetus. Nursing mothers who have been administered chloramphenicol can pass this on to their children through breast milk (4).

Symptoms of Gray Baby Syndrome

The symptoms of this condition are likely to surface anywhere between two to nine days after treatment begins. These can include (4) (5):

• Vomiting
• lethargy
• Low blood pressure
• Low body temperature
• Bluish tinge to the lips and skin
• Decreased blood circulation to the skin giving it an ash-grey colour
• Jaundice
• Abdominal distension
• Green coloured stools
• Irregular heartbeat
• Difficulty breathing and refusal to breastfeed

Risk Factors for Gray Baby Syndrome

When a newborn is given chloramphenicol within the first three days of birth without monitoring of the drug levels in the blood, it puts them at risk of this condition. Premature infants and undernourished or underweight babies are at a greater risk of developing Gray Baby Syndrome (5). Babies of pregnant or lactating women who have been administered this drug are also at risk (6).

How the Diagnosis Is Done?

The signs and symptoms are seen after 2-9 days of administering the medicine to the baby. A thorough physical examination, as well as the analysis of the medical treatments provided to the infant and its mother, is essential for arriving at a diagnosis. The levels of chloramphenicol in the blood will have to be measured at regular intervals and additional tests performed before your doctor can arrive at a definitive diagnosis.

What Are the Possible Complications?

If there is a delay in starting the treatment or diagnosing the illness, different type of complications can result. They are (7):

• Problems with blood circulation that can bring about cardiovascular collapse. This can result in generalised weakness, shock, organ failure, confusion or death also.
• Bone marrow depression where the body stops production of new platelets and other blood cells leading to bleeding and infections (8).
• Secondary disorders or infections can worsen the situation especially in babies which are undernourished or born pre-term.
• Long term complication could be anaemia or vision problems.

Treatments for Gray Baby Syndrome

Early treatment is the best way to win against this disease and the first step would be to discontinue the medication if it is being given to the baby. If you are being medicated with chloramphenicol, then the first thing to do is to stop breastfeeding. The baby will have to be hospitalised for treatment which can include the following procedures:

• Exchange Transfusion: Here, a major part of your baby’s blood will be removed and replaced with fresh blood group matched blood or plasma using a catheter (9).
• Haemodialysis: With this, the toxins are removed from your baby’s bloodstream and a balance is achieved in potassium and sodium levels to stabilise the baby’s blood pressure (10).

Besides these, oxygen therapy or hemoperfusion may also be done to help your baby recover.

How to Prevent This Condition?

Avoiding chloramphenicol as a medication for infants and not using it when pregnant or lactating is the best way of preventing this condition. Ask your doctor for alternate medication if chloramphenicol is prescribed when you are at risk (4).

Prognosis of Gray Syndrome

There is a good prognosis for gray baby syndrome. Chloramphenicol is the culprit and discontinuing this medication immediately on early diagnosis can result in a complete recovery. But the slightest of delays in detecting the presence of this drug can prove fatal. The prognosis might change depending on the overall health and well-being of the child. Preterm babies and malnourished children may not do as well as healthy and full-term infants.

FAQs

1. Can older children or adults get Gray Baby Syndrome?

No, older children and adults have fully developed livers that can properly break down chloramphenicol, so they are not at risk for this specific syndrome.

2. Can Gray Baby Syndrome cause long-term problems?

If treated early, most babies recover without long-term effects. However, if left untreated, the condition can lead to serious complications, including organ failure or even death, making early intervention very important.

Though chloramphenicol can be dangerous, taking it under the guidance of a doctor and only in the prescribed dosage usually does not lead to Gray Baby Syndrome. In such instances, blood levels will be constantly monitored to ensure the drug is not present in excess in the bloodstream. The use of chloramphenicol has declined significantly with the emergence of other safer alternatives.

Disclaimer: This information is just a guide and not a substitute for medical advice from a qualified professional.

References/Resources:

1. National Library of Medicine – Gray Baby Syndrome(Archived)

2. National Library of Medicine – Chloramphenicol

3. Indian Journal of Pharmacy Practice – Drug Induced Syndromes: An Overview

4. Endocrinology & Metabolic Syndrome – A Note on Gray baby syndrome

5. Encyclopædia Britannica – Gray baby syndrome

6. Apollo Hospitals Group – Gray Baby Syndrome: Symptoms, Causes, and Treatment

7. International Programme On Chemical Safety – CHLORAMPHENICOL

8. The New England Journal of Medicine – Chloramphenicol-Induced Bone-Marrow Aplasia

9. National Library of Medicine – Exchange Transfusion

10. Cleveland Clinic – Hemodialysis

Also Read:

Blue Baby Syndrome
Shaken Baby Syndrome
Baby with Down Syndrome
Charge Syndrome in Babies
Edward’s Syndrome in Babies

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