Gray baby syndrome

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Gray baby syndrome
ICD-10 P93
ICD-9 779.4
MedlinePlus 007049

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.[1]


Newborn infants are predisposed to this condition because they do not yet have fully functional liver enzymes, nor do they have enough enzymes to handle the drug.[2]

Clinical features

Toxic levels of chloramphenicol after 2–9 days result in:


Chloramphenicol therapy is discontinued immediately; exchange transfusion may be required to remove the drug.


The condition can be prevented by using chloramphenicol at the recommended doses and monitoring blood levels.[3][4][5]


  1. McIntyre J, Choonara I (2004). "Drug toxicity in the neonate". Biol Neonate. 86 (4): 218–21. PMID 15249753.
  2. Piñeiro-Carrero V, Piñeiro E (2004). "Liver". Pediatrics. 113 (4 Suppl): 1097–106. PMID 15060205.
  3. Feder H (1986). "Chloramphenicol: what we have learned in the last decade". South Med J. 79 (9): 1129–34. PMID 3529436.
  4. Mulhall A, de Louvois J, Hurley R (1983). "Chloramphenicol toxicity in neonates: its incidence and prevention" (Scanned copy & PDF). Br Med J (Clin Res Ed). 287 (6403): 1424–7. PMID 6416440.
  5. Forster J, Hufschmidt C, Niederhoff H, Künzer W (1985). "[Need for the determination of chloramphenicol levels in the treatment of bacterial-purulent meningitis with chloramphenicol succinate in infants and small children]". Monatsschr Kinderheilkd. 133 (4): 209–13. PMID 4000136.