Gray Baby Syndrome
Gray baby syndrome is a condition in which an infant experiences a life-threatening reaction to the antibiotic Chloramphenicol. It is more prevalent in premature infants since an adverse reaction is directly related to the liver’s ability to break down and process the medication. However, it can affect children up to age two.
Causes of Gray Baby Syndrome
Elevated levels of chloramphenicol circulating in the plasma result from two distinct pathophysiologic processes.
A normally functioning liver will metabolize the chloramphenicol parent molecule (primarily by glucuronidation).
The immature neonatal liver is unable to synthesize and recycle the UDP-glucuronyltransferase enzyme efficiently.
Similarly, the neonatal kidneys are unable to excrete chloramphenicol and its metabolites efficiently.
These two deficiencies result in elevated serum levels of chloramphenicol.
The chloramphenicol molecule displaces unconjugated bilirubin from albumin, leading to kernicterus and eventually death if untreated
Symptoms of Gray Baby Syndrome
Irritable and fussy demeanor
Vomiting or diarrhea
Pressure or distension in the abdomen
Loss of appetite
Diagnosis of Gray Baby Syndrome
In the undifferentiated sick neonate presenting with cyanosis, a broad differential diagnosis must be considered, including but not limited to neonatal sepsis, non-accidental trauma, midgut volvulus, congenital heart disease, and inborn errors of metabolism.
Blood work should include glucose, complete blood count with differential, complete metabolic panel, blood gas analysis, serum ammonia, serum lactic acid, serum ketones, and consideration for cardiac biomarkers including troponin and brain natriuretic peptide.
In the setting of chloramphenicol toxicity, serum chloramphenicol levels may be drawn.
Radiologic studies should include chest and abdominal films, and CT head or abdominal ultrasound (depending on the history).
An electrocardiogram should also be obtained
Treatment of Gray Baby Syndrome
When symptoms are identified early, the doctor can get your baby on the road to recovery.
Charcoal hemoperfusion and exchange transfusion are traditionally used to absorb and remove the Chloramphenicol from your infant’s system.
Additionally, other antibiotics are needed to help your baby’s body fight off infection.
Since the decrease in blood flow may lower your baby’s temperature, they may need warming blankets or a heat lamp.
Oxygen is administered, so your baby doesn’t have to work as hard to oxygenate their blood through breathing.
If needed, they will also be intubated.
By stabilizing your baby’s system as quickly as possible using these techniques, additional damage to their body may be prevented.