Home Health A-Z Gray Baby Syndrome : Symptoms, Causes and Treatment

Gray Baby Syndrome : Symptoms, Causes and Treatment

Verified By Apollo General Physician December 1, 2022 2404 0
Gray Baby Syndrome : Symptoms, Causes and Treatment
Gray Baby Syndrome : Symptoms, Causes and Treatment


All pregnant women want their babies to be healthy. Therefore, they need to receive prenatal care from doctors. They should also take other measures to ensure a healthy pregnancy, including regular exercise, maintaining a healthy diet, and quitting alcohol, drugs, and tobacco. 

Some medicines can still put the baby’s health at risk even if women can take preventive measures. So, if a woman is pregnant or decides to get pregnant, they must consult the doctor before taking any new medication. Several prescriptions and over the counter (OTC) medicines are safe to consume during pregnancy, whereas others can cause severe disabilities or health issues for the baby. It includes gray baby syndrome, a rare disorder that occurs because of high levels of chloramphenicol in premature babies. Doctors use chloramphenicol as an antibiotic for treating bacterial infections, including meningitis, cholera, and typhoid fever. 

This blog is a comprehensive understanding of the gray baby syndrome, its causes, symptoms, risk factors, complications, treatment and prevention.

What is gray baby syndrome?

Gray baby syndrome is a rare and fatal health condition that can develop in babies up to 2 years . It is likely a side effect of the antibiotic chloramphenicol, used to treat different health conditions, including bacterial meningitis, cholera, and typhoid fever. This antibiotic may be used if the infection does not respond to other antibiotics, such as penicillin.

Chloramphenicol is harmful to babies due to its high toxicity level. Babies do not have the liver enzymes necessary to break down large doses of this antibiotic. Due to this, toxic levels of chloramphenicol could build up in their bloodstream. 

Babies may develop gray baby syndrome when chloramphenicol is given directly to them. Their risk for the condition can also increase when women are prescribed chloramphenicol during labour or at some point in their pregnancy.

What are the symptoms of gray baby syndrome?

When toxic levels of chloramphenicol collect in the baby’s bloodstream, they can develop the gray baby syndrome. Babies usually display symptoms within two to nine days after the doctor begins the chloramphenicol treatment. The symptoms may differ. However, one may observe the following:

  • Vomiting
  • Limp body
  • Greyish skin colour
  • Low blood pressure
  • Hypothermia (low body temperature)
  • Blue lips and skin
  • Abdominal swelling
  • Green stools
  • Difficulty breathing
  • Irregular heartbeat

When should women seek medical advice?

When the baby displays symptoms after exposure to chloramphenicol, women must consult the doctor immediately. Gray baby syndrome may lead to death in hours when left untreated.

What are the causes of gray baby syndrome?

Chloramphenicol use is the leading cause of the gray baby syndrome. Newborn babies, particularly premature ones, cannot process or expel high amounts of chloramphenicol. As a result, toxic levels of chloramphenicol can collect in the bloodstream, which can be life-threatening. 

Doctors can also prescribe chloramphenicol to pregnant women to treat certain bacterial infections, which can pass on to the fetus. When doctors administer chloramphenicol to nursing mothers, they can pass it on to their babies through breast milk.

What are the complications of gray baby syndrome?

The complications of gray baby syndrome include:

  • Bleeding
  • Infection
  • Renal and liver failure
  • Cardiovascular collapse or shock
  • Anaemia
  • Brain damage
  • Vision problems
  • Weakness

How is gray baby syndrome treated?

Doctors can treat gray baby syndrome if parents immediately seek treatment after they notice the symptoms. Initially, women must stop giving the baby chloramphenicol. They must stop breastfeeding if they are consuming this medication for an infection.

The doctor can diagnose gray baby syndrome after they perform a physical examination and notice symptoms, including greyish-coloured skin and blue lips. The doctor can also ask women if they or their babies were exposed to chloramphenicol.

Babies probably will be hospitalised after doctors diagnose them with the gray baby syndrome. The doctor can suggest different treatments after discontinuing the use of chloramphenicol, including:

1. Exchange transfusion

In this procedure, the doctors remove some of the baby’s blood and replace it with freshly donated blood or plasma. 

2. Haemodialysis

In this procedure, the doctor filters the toxins from the baby’s bloodstream with a dialysis machine. Haemodialysis also balances potassium and sodium levels and aids in controlling the baby’s blood pressure.

Additionally, the doctor can give oxygen therapy to the baby to improve breathing and oxygen delivery to the body. The doctor can also suggest hemoperfusion, which is similar to dialysis and filters the toxins from the blood. The doctor examines the baby’s blood during treatment.

How is gray baby syndrome prevented?

Doctors must prescribe chloramphenicol since it is not an OTC medication. Women must thoroughly read the warning labels before they consume medication or give it to their babies, even if they have a prescription. If women have any worries regarding the medicines, they can speak to the doctor.

After giving a new medication to the baby, women must look out for signs of an adverse reaction. They must immediately seek medical attention if they observe any gray baby syndrome symptoms since it can be fatal if left untreated.


Chloramphenicol may rarely become necessary, if a baby has an infection that does not respond to other types of antibiotics. If it becomes necessary, this medicine should only be given to young children and babies under the close supervision of a physician, and it should not be the primary treatment. 

Usually, gray baby syndrome can be avoided when chloramphenicol is given in low doses and also when blood levels are monitored. A doctor will monitor your blood, if you are pregnant or breast-feeding and taking chloramphenicol. 

Frequently Asked Questions (FAQs)

1. How is gray baby syndrome diagnosed?

The doctor reviews the baby’s medical history and questions the woman about using chloramphenicol and other medicines. Additional tests such as a chest and abdominal x-ray, CT scans, ultrasounds, and an electrocardiogram may be used .

2. What are the side effects of chloramphenicol?

Besides gray baby syndrome, chloramphenicol can lead to severe and mild side effects in older children and adults. They include vomiting, headache, fever and body rash.

It can also cause more severe side effects, including confusion, blurry vision, mouth sores, infection, anaemia, unusual bleeding and weakness.

Verified By Apollo General Physician

Our expert general medicine specialists verify the clinical accuracy of the content to deliver the most trusted source of information, making the management of health an empowering experience.

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