The Dangers of Gray Baby Syndrome in Infants

Medically reviewed by Laura Marusinec, MD on April 29, 2016Written by Valencia Higuera on April 29, 2016

Every expecting mother wants her baby to be healthy. This is why they get prenatal care from their doctors and take other precautions to ensure a healthy pregnancy. These precautions include maintaining a healthy diet, regular exercise, and avoiding alcohol, illegal drugs, and tobacco.

But even if you take the above measures, exposure to certain medications may put your baby’s health at risk. This is why it's important to speak with your doctor before taking any new medication if you're pregnant or thinking about getting pregnant. Many prescription and over-the-counter medications are safe to take while pregnant. Other medications, however, may cause serious birth defects or health problems for your baby. That includes gray baby syndrome.

You may not be familiar with this illness, but it can be extremely dangerous for premature babies and infants. It’s important to understand the causes of gray baby syndrome, as well as ways to protect your baby.

What is gray baby syndrome?

Gray baby syndrome is a rare, life-threatening condition that can develop in babies and children up to the age of 2. The condition is a potential side effect of the antibiotic chloramphenicol. This medication is used to treat a variety of infections, such as bacterial meningitis. Some doctors recommend this treatment when an infection doesn't respond to other antibiotics, like penicillin.

This antibiotic is dangerous for babies because of its high toxicity level. Unfortunately, infants and babies don’t have the liver enzymes needed to metabolize large doses of this medication. Since their little bodies can’t break down the drug, toxic levels of the antibiotic can build up in their bloodstreams. Gray baby syndrome can develop if the antibiotic is given directly to babies. They may also be at risk for this condition if the antibiotic is given to their mother during labor or at some point during the pregnancy.

Gray baby syndrome isn’t the only side effect of chloramphenicol. In adults and older children, the medication may cause other serious and mild side effects, including:

  • vomiting
  • fever
  • headache
  • body rash

It can also cause more serious side effects, including:

  • unusual weakness
  • confusion
  • blurry vision
  • mouth sores
  • unusual bleeding
  • anemia (decreased red blood cells)
  • infection

It’s important to notify your doctor if you or your baby experiences any side effects from this medication.

Symptoms of gray baby syndrome

If toxic levels of chloramphenicol accumulate in your baby’s bloodstream and your baby develops gray baby syndrome, symptoms typically show within two to nine days of beginning treatment. Symptoms can vary, but you may notice:

  • vomiting
  • grayish skin color
  • limp body
  • low blood pressure
  • blue lips and skin
  • hypothermia (low body temperature)
  • abdominal swelling
  • green stools
  • irregular heartbeat
  • difficulty breathing

If your baby has any symptoms of gray baby syndrome after exposure to chloramphenicol, seek immediate medical attention. If left untreated, gray baby syndrome can cause death within hours.

How to treat gray baby syndrome

The good news is that gray baby syndrome is treatable if you seek treatment at the first sign of the illness. The first course of treatment is to stop giving your baby the medication. If you’re taking the medication for an infection, you’ll need to stop breast-feeding.

Your baby’s doctor can diagnose gray baby syndrome after a physical examination and observing symptoms of the condition, such as grayish-colored skin and blue lips. Your doctor may also ask whether you or your baby were exposed to chloramphenicol.

Understand that your baby will likely be hospitalized after being diagnosed with gray baby syndrome. This is necessary so doctors can closely monitor your baby’s condition.

After discontinuing use of chloramphenicol, your baby’s doctor may recommend a variety of treatments.

Exchange transfusion

This lifesaving procedure involves removing some of your baby’s blood and replacing the blood with freshly donated blood or plasma. The procedure is completed using a catheter.

Haemodialysis

This procedure uses a dialysis machine to cleanse toxins from your baby’s bloodstream. It also balances potassium and sodium levels and helps control your baby’s blood pressure.

In addition to the above treatments, your baby may be given oxygen therapy to improve breathing and oxygen delivery to the body. Your baby’s doctor may also recommend hemoperfusion. This treatment is similar to dialysis and helps remove toxins from the blood. Your baby’s blood will be monitored during treatment.

The takeaway

Gray baby syndrome is preventable. The best way to avoid this complication is to not give this medication to premature infants and children under the age of 2.

It’s also important for expecting and breast-feeding mothers to avoid this medication. Chloramphenicol can pass through breast milk. In low doses, this antibiotic may not have a toxic effect on babies. But it's better to be safe than sorry. If your doctor suggests this drug for you or your baby, ask for a safer antibiotic.

If your baby has an infection that doesn't respond to other types of antibiotics, use of chloramphenicol may rarely become necessary. If so, this medication should only be given to babies and young children under the close supervision of a doctor, and it shouldn’t be the primary treatment. Gray baby syndrome can usually be avoided when chloramphenicol is administered in low doses and when blood levels are monitored. If you're pregnant or breast-feeding and taking chloramphenicol, a doctor will monitor your blood level.

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