This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Go to /pro/cpd-dashboard page

This page is worth 0.05 CPD credits. CPD dashboard

Go to /account/subscription-details page

This page is worth 0.05 CPD credits. Upgrade to Pro

Grey baby syndrome

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Chloramphenicol reaches toxic levels more readily and less predictably in neonates, causing cardiovascular collapse. This is referred to as the grey baby syndrome.

  • grey baby syndrome is a type of circulatory collapse that can occur in premature and newborn infants and is associated with excessively high serum levels of chloramphenicol
    • 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) - however an immature neonatal liver is unable to synthesize and recycle the UDP-glucuronyltransferase enzyme efficiently
      • neonatal kidneys are unable to excrete chloramphenicol and its metabolites efficiently
      • these two deficiencies result in elevated serum levels of chloramphenicol
      • chloramphenicol molecule displaces unconjugated bilirubin from albumin, leading to kernicterus and eventually death if untreated

  • characterized by an ashen-grey color ("grey baby syndrome"), abdominal distention, vomiting, flaccidity, cyanosis, circulatory collapse, and death
    • chloramphenicol parent molecule also displaces unconjugated bilirubin from albumin, giving way to kernicterus and eventually death or permanent neurological sequelae if left untreated

  • usually starts 2 to 9 days after treatment is started
    • syndrome is a result of chloramphenicol impairing myocardial contractility
    • believed to occur more often in neonates due to their diminished ability to conjugate chloramphenicol and to excrete the active form in the urine
    • also been reports in small children and adults that have had accidental overdoses of the drug


  • primarily aimed towards direct removal of the parent chloramphenicol molecule
    • use of modalities such as charcoal hemoperfusion and exchange transfusion
    • also been reports of phenobarbital being used for induction of the UDP-glucuronyltransferase enzyme
    • cardiopulmonary bypass including extracorporeal membrane oxygenation may also be considered


Related pages

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.