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Gray syndrome


Gray syndrome is a dangerous condition that occurs in newborns (especially premature babies) who are given the drug chloramphenicol.

Alternative Names:

Chloramphenicol toxicity in newborns

Causes, incidence, and risk factors:

Chloramphenicol is a drug used to fight bacterial infections, including meningitis. If given to a newborn, however, high doses of this drug can trigger a potentially deadly poisonous reaction.

Babies do not have the enzymes (special proteins in the body) needed to break down this drug. The drug builds up in the baby's bloodstream and can lead to:

  • Blue lips, nail beds, and skin from lack of oxygen in the blood (cyanosis)
  • Death
  • Low blood pressure

Symptoms usually begin 2 to 9 days after treatment has been started. They include:

  • Body limpness and ashen gray color
  • Cardiovascular collapse
  • Cyanosis
  • Low blood pressure (hypotension)
  • Low body temperature (hypothermia)
  • Vomiting, refusal to suck, passage of loose green stools

Overdoses can be treated with an exchange transfusion, which involves removing portions (aliquots) of the baby's blood and replacing it with donated blood.


Chloramphenicol is generally not given to newborns or premature infants. It can be given safely at lower doses. However, with newer drugs available for bacterial infections, chloramphenicol use has decreased dramatically.

Chloramphenicol may be passed on to an infant through breast milk, and therefore may be unsafe for the mother to take during pregnancy and while breast-feeding. Do not take this drug without seeking advice from your doctor if you are either pregnant or nursing.


Michelow IC, McCracken GH Jr. Antibacterial therapeutic agents. In: Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 248.

Review Date: 12/7/2009
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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