Nicklaus Children's Hospital, formerly Miami Children's Hospital
Local: 305-666-6511
Toll Free: 800-432-6837
My Kids Patient Portal
Advanced Search

Pediatric Center
In this section

Gray syndrome

Healthy Lifestyle

     Bookmark and Share


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.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission ( URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial proces and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional 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. ©1997- 2010 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.