Which drug causes the side effect as 'grey baby' in neonates?

BSF Staff Nurse - 2015

Pharmacology

Easy

Appeared in: BSF Staff Nurse - 2015

Explanation

Chloramphenicol is the drug responsible for causing 'Gray Baby Syndrome', a severe adverse reaction in newborns.
The syndrome is a direct result of the neonate's immature liver, which has insufficient levels of the enzyme UDP-glucuronyltransferase required for the metabolism of chloramphenicol.
This metabolic failure leads to the accumulation of the drug to toxic levels.
High levels of chloramphenicol inhibit mitochondrial protein synthesis, impairing cellular respiration and leading to circulatory collapse, shock, and the characteristic ashen-gray skin color.

Option B: Amikacin is an aminoglycoside antibiotic. Its primary toxicities are damage to the kidneys (nephrotoxicity) and the inner ear (ototoxicity), not Gray Baby Syndrome.
Option C: Domperidone is a prokinetic agent. Its use in neonates is cautioned due to the risk of cardiac side effects, particularly prolongation of the QT interval, which can lead to arrhythmias. It does not cause Gray Baby Syndrome.
Option D: PCM, or paracetamol (acetaminophen), is a common pain and fever reducer. Its primary toxicity, which occurs with overdose, is severe liver damage (hepatotoxicity). It is not associated with Gray Baby Syndrome.

Clinical Relevance

Nursing practice connection: Knowing Adverse drug reactions in neonates, specifically Gray Baby Syndrome helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
This is a classic example of why pediatric and neonatal pharmacology is a specialized field. Nurses must be vigilant about contraindications and dose adjustments for this population.
A key nursing responsibility is to monitor for early signs of drug toxicity. In the case of Gray Baby Syndrome, this includes observing for poor feeding, vomiting, limpness, and any grayish discoloration of the skin.
Prompt recognition and immediate cessation of the drug, along with supportive care, are critical to prevent a fatal outcome.

How to Approach the Question

First, identify the key terms in the question: 'grey baby' and 'neonates'. This points to a specific, well-known adverse drug reaction in a particular patient group.
This is a direct recall question from pharmacology. Access your knowledge about major drug side effects, especially those unique to pediatric or neonatal populations.
Systematically review the options. Think about the classic toxicity associated with each drug.
Chloramphenicol is famously linked to Gray Baby Syndrome. This is a strong candidate.
Consider the other options to confirm. Amikacin is known for kidney/ear toxicity, Domperidone for cardiac issues, and PCM for liver toxicity in overdose.
Since Chloramphenicol is the only drug that matches the specific syndrome mentioned, select it as the correct answer.

Concept Tested & Keywords

Concept Tested: Adverse drug reactions in neonates, specifically Gray Baby Syndrome.
Stem keywords: drug, side effect, grey baby, neonates
Lead-in keywords: Which
Clinical cues: The patient population 'neonates' is a critical cue, as their immature organ systems, particularly the liver, affect drug metabolism.

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E6 Pharmacology KD Tripathi Essentials 9e Part 3 pp. 72-74, 71-73

E6 Pharmacology Katzung 16e p. 1639-1641