Gray baby syndrome has been noted to be dose-dependent as it typically occurs in neonates who have received a daily dose greater than 200 milligrams.When chloramphenicol is necessary, the condition can be prevented by using chloramphenicol at the recommended doses and monitoring blood levels, or alternatively, third generation cephalosporins can be effectively substituted for the drug, without the associated toxicity. Also, repeated course of administration and prolonged treatment should be avoided as much as possible. In terms of hepatic development in neonates, it take only weeks from birth for them to develop their UDPGT expression and function to be at an adult-like level, while the function is only about 1% in the late pregnancy, even right before birth-giving. According to MSD Manuals, chloramphenicol should not be given to neonates with younger than 1 month of age with more than a dose of 25 mg/kg/day to start with. The serum concentration of the medication should be monitored to titrate to a therapeutic level and to prevent toxicity. Medication reconciliation of other medications that neonates may be taking that can decrease blood cell count should be monitored because of this medications ability to suppress bone marrow activity. Rifampicin and trimethoprim are examples of medications with bone marrow suppression abilities and are contraindicated for concomitant use with chloramphenicol. In regards to bone marrow suppression, chloramphenicol has two major etiological manifestations. The first mechanism of bone marrow suppression affects the formation of blood cells such as erythrocytes, and this can be reversible since it is an early sign up toxicity.
In addition, the presence of chloramphenicol weakens the binding of bilirubin and albumin, so increased levels of the drug can lead to high levels of free bilirubin in the blood, resulting in brain damage or kernicterus. If left untreated, possible bleeding, renal (kidney) and/or hepatic (liver) failure, anemia, infection, confusion, weakness, blurred vision, or eventually death are expected. Additionally, chloramphenicol is significantly insoluble due to an absence of acidic and basic groups in its molecular compound. As a result, larger amounts of the medication are required to achieve the desired therapeutic effect. High volumes of a medication that can cause various toxicities is another avenue how chloramphenicol can potentially lead to grey baby syndrome. Diagnosis
Gray baby syndrome should be suspected in a new born with abdominal distension, progressive pallid cyanosis, irregular respirations, and refusal to breastfeed. The cause of gray baby syndrome can come from the direct use of intravenous or oral chloramphenicol in neonates. Direct chronological relation between the use of the medication and signs and symptoms of the syndrome should be found in the previous medical history. In terms of the possible route of chloramphenicol, gray baby syndrome may not come from the mothers use of chloramphenicol during pregnancy or breastfeeding. According to the Drug and Lactation database (LactMed), it states that "milk concentrations are not sufficient to induce gray baby syndrome". It is also reported that the syndrome may not develop in infants when their mothers use the medication in their late period of pregnancy.