Gray baby syndrome

[aspiringmd1015]

chloramphenicol as we all know causes GB syndrome, but i wanted to know the exact mechanism. From what i read so far its mostly bc of neonates having decreased glucorynl transferase activity, so they cant conjugate the drug and thus excrete it(as its lipid soluble) but also i read somehwere that its also bc it displaces bilirubin causing kernicterus. It displaces bilirubin because its also very lipid soluble just like bilirubin so they fight for protein binding spots on albumin?

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[stepone2015]

My understanding is that because the baby can't metabolize it with the liver (it does not cause kernicterus, but just can't conjugate it as you said), the chloramphenicol builds up in the rest the of the body, especially the skin where it is broken down there. Those metabolites give the skin a grey color.