In cases of "gray baby syndrome," which antibiotic is likely responsible?

Gray baby syndrome is a condition that affects newborns, particularly those who are premature or have low birth weight. This syndrome is primarily associated with the use of chloramphenicol in pregnant women or in neonates. Chloramphenicol has the ability to cross the placenta and affect fetal circulation, leading to toxic levels in infants who lack the metabolic ability to clear the drug effectively. This results in symptoms such as a grayish discoloration of the skin, respiratory distress, and hypotension.

The mechanism behind this syndrome involves the glucuronyl transferase enzyme, which is not sufficiently developed in newborns to metabolize chloramphenicol, leading to a toxic buildup. In contrast, the other antibiotics listed typically do not exhibit the same risk profile when used in similar populations or do not impact neonates in this specific manner. Thus, chloramphenicol is recognized as the antibiotic that directly relates to the onset of gray baby syndrome.