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Paracetamol and pain in preterm

S Juujärvi, T Saarela, M Hallman, O Aikio
AIM: Symptomatic patent ductus arteriosus may lead to serious complications in extremely preterm and extremely low birth weight infants and is often resistant to medication. We evaluated early intravenous paracetamol for pain prevention during respiratory therapy, in an attempt to understand the ductal treatment of such infants. METHODS: Our cohort were 295 extremely preterm or extremely low birth weight infants, born at less than 28 weeks or 1,000g, respectively, who were treated in the neonatal intensive care unit of Oulu University Hospital from 2002-2015, before and after intravenous paracetamol was introduced in June 2009...
November 4, 2017: Acta Paediatrica
P Mian, C A J Knibbe, E A M Calvier, D Tibboel, K Allegaert
BACKGROUND: Intravenous paracetamol (acetaminophen) has not been licensed for analgesia in preterm neonates or infants < 2 years, respectively, in Europe and the United States. A variety of dosing regimens is therefore used off-label. Because evidence supports the use of the same target mean steady state paracetamol concentration (Cssmean, 9-11 mg/L) for pain relief in neonates compared to older children and adults, dosing regimens based on this Cssmean were evaluated in a two-step approach...
September 21, 2017: Current Pharmaceutical Design
Daniella W E Roofthooft, Sinno H P Simons, Richard A van Lingen, Dick Tibboel, John N van den Anker, Irwin K H Reiss, Monique van Dijk
BACKGROUND: The availability of a safe and effective pharmacological therapy to reduce procedural pain in preterm infants is limited. The effective analgesic single dose of intravenous paracetamol in preterm infants is unknown. Comparative studies on efficacy of different paracetamol doses in preterm infants are lacking. OBJECTIVES: To determine the analgesic effects of different single intravenous paracetamol doses on pain from peripherally inserted central catheter (PICC) placement in preterm infants...
2017: Neonatology
Antti Härmä, Outi Aikio, Mikko Hallman, Timo Saarela
OBJECTIVE: To determine whether intravenous paracetamol therapy is effective in pain therapy in premature infants. STUDY DESIGN: From June 2009 to December 2011, 108 infants born very low gestational age (<32 weeks) (VLGA) were given intravenous paracetamol before the age of 72 hours. The loading dose was 20 mg/kg followed by 7.5 mg/kg every 6 hours. One hundred ten VLGA infants admitted from October 2007 to May 2009 formed the comparison group who received no paracetamol...
January 2016: Journal of Pediatrics
Emrah Utku Kabataş, Arzu Dursun, Serdar Beken, Dilek Dilli, Ayşegül Zenciroğlu, Nurullah Okumuş
OBJECTIVE: To investigate the efficacy of paracetamol in reducing pain during examination for retinopathy of prematurity (ROP) in preterm infants. METHODS: A total of 114 infants undergoing eye examination for retinopathy of prematurity screening were prospectively randomized. Topical anesthetic (Proparacaine; Alcaine® drop 0.5%) was applied 30 s before the eye examination in all the infants. The infants in the intervention group (Group 1, n = 58) received 15 mg/kg of oral paracetamol, 60 min before the examination...
January 2016: Indian Journal of Pediatrics
Gian Maria Pacifici, Karel Allegaert
Paracetamol is commonly used to control mild-to-moderate pain or to reduce opioid exposure as part of multimodal analgesia, and is the only compound recommended to treat fever in neonates. Paracetamol clearance is lower in neonates than in children and adults. After metabolic conversion, paracetamol is subsequently eliminated by the renal route. The main metabolic conversions are conjugation with glucuronic acid and with sulphate. In the urine of neonates sulphated paracetamol concentration is higher than the glucuronidated paracetamol level, suggesting that sulfation prevails over glucuronidation in neonates...
December 2015: Current Therapeutic Research, Clinical and Experimental
C van Ganzewinkel, L Derijks, K J S Anand, R A van Lingen, C Neef, B W Kramer, P Andriessen
AIM: The therapeutic options available to treat neonatal pain are limited, and one alternative for nonopioid systemic treatment is paracetamol. However, pharmacokinetic data from prolonged administration of intravenous paracetamol in neonates are limited. The aim of this study was to present pharmacokinetics after multiple dose of intravenous paracetamol in very preterm infants of <32 weeks' gestation. METHODS: Fifteen very preterm infants received five, six-hourly doses of intravenous paracetamol (7...
June 2014: Acta Paediatrica
Kristin Thiele, Timo Kessler, Petra Arck, Annette Erhardt, Gisa Tiegs
Counter-intuitively, over-the-counter medication is commonly taken by pregnant women. In this context, acetaminophen (APAP, e.g. Paracetamol, Tylenol) is generally recommended by physicians to treat fever and pain during pregnancy. Thus, APAP ranks at the top of the list of medications taken prenatally. Insights on an increased risk for pregnancy complications such as miscarriage, stillbirth, preterm birth or fetal malformations upon APAP exposure are rather ambiguous. However, emerging evidence arising from human trials clearly reveals a significant correlation between APAP use during pregnancy and an increased risk for the development of asthma in children later in life...
March 2013: Journal of Reproductive Immunology
Karel Allegaert, Aida Kulo, Rene Verbesselt, Lynn Hopchet, Jan Deprest, Jan de Hoon, Roland Devlieger, Marc van de Velde
CONTEXT: Pregnancy affects intravenous paracetamol pharmacokinetics, but there are no studies on covariates of intravenous paracetamol pharmacokinetics around delivery. OBJECTIVES: To document the impact of gestational age at delivery on pharmacokinetics of a high intravenous dose of paracetamol. DESIGN: Pharmacokinetic study in women shortly after caesarean delivery. This study is an alternative analysis of a previously published study, using the same cohort but with added participants...
October 2012: European Journal of Anaesthesiology
Laura Cuzzolin, Roberto Antonucci, Vassilios Fanos
Neonates can perceive pain, therefore an adequate analgesic therapy is a major issue not only from an ethical perspective but also to improve short- and long-term outcome. Fever during the neonatal period requires hospitalization and needs a treatment with an antipyretic agent because of the high risk of severe complications. Paracetamol (acetaminophen), the most commonly prescribed drug in paediatric patients for its analgesic and antipyretic effects, is the only agent recommended for use as an antipyretic in the newborn and has been recently proposed as a supplement therapy to opioids for postoperative analgesia...
February 2013: Current Drug Metabolism
Christ-Jan Jlm van Ganzewinkel, Thilo Mohns, Richard A van Lingen, Luc Jj Derijks, Peter Andriessen
INTRODUCTION: Until now, studies on paracetamol given intravenously have mainly been performed with the pro-drug propacetamol or with paracetamol in preterm babies above 32 weeks of gestation. Studies in these babies indicate that intravenous paracetamol is tolerated well, however studies on the efficacy of intravenous paracetamol are lacking. There are no pharmacokinetic data on the administration of multiple doses of paracetamol in preterm babies with a gestational age below 32 weeks...
2012: Journal of Medical Case Reports
Elaine M Wilson-Smith, Neil S Morton
BACKGROUND: The license for i.v. paracetamol has recently been extended to include term neonates and infants aged 1 year, at a uniform dose across this age range of 7.5, total daily dose 30 We were interested to survey current i.v. paracetamol prescribing practices of anesthetists in the UK, in neonates and infants under 1 year of age. METHODS: We conducted an online survey of 94 linkmen of the Association of Pediatric Anesthetists of Great Britain and Ireland Linkmen representing both general and specialist hospitals and 90 members of the British Pediatric Pain Travelling Club representing the pediatric acute pain teams throughout the UK and Ireland...
April 2009: Paediatric Anaesthesia
K Allegaert, J de Hoon, G Naulaers, M Van De Velde
Neonatal drug dosing needs to be based on the physiological characteristics of the newborn, the pharmacokinetic parameters of the drug and has to take maturational aspects of drug disposition into account. We would like to provide the reader with some recently published compound-specific observations (paracetamol, ibuprofen, tramadol, propofol) in neonates of relevance for anaesthesiologists. Age-specific dosing regimes of intravenous paracetamol have been evaluated and were well tolerated, independent of the postnatal age...
2008: Acta Anaesthesiologica Belgica
K Allegaert, J de Hoon, B Van Overmeire, H Devlieger
An integrated approach of neonatal analgesia starts with the systematic evaluation of pain and should be followed by effective interventions, mainly based on the appropriate (i.e. safe and effective) administration of analgesics. In contrast to the more potent opioids, data on the pharmacokinetics and -dynamics of non-opioid analgesics in this specific population are still rare or even lacking. We therefore evaluated various aspects of developmental pharmacology of non-opioid analgesics (paracetamol, ibuprofen, acetylsalicyl acid) in neonates...
2005: Verhandelingen—Koninklijke Academie Voor Geneeskunde Van België
K Allegaert, C D Van der Marel, A Debeer, M A L Pluim, R A Van Lingen, C Vanhole, D Tibboel, H Devlieger
AIM: To investigate the pharmacokinetics and pharmacodynamics of single dose propacetamol in preterm and term infants on the first day of life. METHODS: Neonates were stratified by gestational age. Preterm (< 37 weeks) and term (37-41 weeks) infants received a single dose of propacetamol in the first 24 hours of life when they had minor, painful procedures or as additional treatment in infants receiving opioids. Blood samples were taken from an arterial line, and pain was evaluated by a multidimensional pain scale...
January 2004: Archives of Disease in Childhood. Fetal and Neonatal Edition
R A van Lingen, J T Deinum, J M Quak, A J Kuizenga, J G van Dam, K J Anand, D Tibboel, A Okken
AIM: To investigate the pharmacokinetics, metabolism, and dose-response relation of a single rectal dose of paracetamol in preterm infants in two different age groups. METHODS: Preterm infants stratified by gestational age groups 28-32 weeks (group 1) and 32-36 weeks (group 2) undergoing painful procedures were included in this study. Pain was assessed using a modified facies pain score. RESULTS: Twenty one infants in group 1 and seven in group 2 were given a single rectal dose of 20 mg/kg body weight...
January 1999: Archives of Disease in Childhood. Fetal and Neonatal Edition
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