Gray Baby Syndrome(Archived)

Excerpt

Chloramphenicol is a bacteriostatic man-made antibiotic that was discovered in 1947. Initially designed for the treatment of typhoid fever, it has fallen out of favor due to the ubiquity of antibiotic-resistant Salmonella typhi. It was also historically used for the empiric treatment of pediatric patients presenting with petechial rash and fever for its excellent coverage of meningococcal sepsis and rickettsial disease. Due to its low-cost, wide spectrum of coverage, and low incidence of toxicity, chloramphenicol has been added to the World Health Organization’s List of Essential Medicines, and the growing problem of antimicrobial resistance to current broad-spectrum antibiotics has brought back interest in its use worldwide. Twelve years after its discovery, the first case report of a potentially fatal adverse reaction to chloramphenicol was discovered in neonates, with a predilection towards preterm infants. Neonates born at less than 37 weeks gestation were given chloramphenicol in an intravenous or oral formulation within two days of birth when they began to develop abdominal distention, vomiting, hypothermia, cyanosis, and cardiovascular instability. Vasomotor collapse resulting in mottling of skin and eventual ashen-gray skin discoloration led to the naming of this reaction as "gray-baby syndrome."