Treatment with paracetamol in infants

Arana, A.; Morton, N.S.; Hansen, Tom Giedsing

doi:10.1034/j.1399-6576.2001.450104.x

Cited by 124 publications

(84 citation statements)

References 51 publications

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“…116 Acetaminophen should not be used alone for severe pain but can be considered for use during the later postoperative period, after minor procedures, or as an adjunct to other measures. Dosing guidelines based on extensive literature review have been developed, 117 and a population kinetic study with a large sample size produced similar guidelines. 118 However, rectal acetaminophen should be used cautiously because of erratic absorption.…”

Section: Reducing Pain From Surgerymentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

418

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The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures. INTRODUCTION ObjectivesThis updated statement is intended for health care professionals who care for neonates (preterm to 1 month of age). The objectives are to:1. emphasize that despite increased awareness of the importance of pain prevention, neonates in the NICU continue to be exposed to numerous painful minor procedures daily as part of their routine care;2. present objective means of assessing neonatal pain by health care professionals;3. describe effective strategies to prevent and treat pain associated with routine minor procedures; and 4. review appropriate methods to prevent and treat pain associated with surgery and other major procedures. BackgroundThe prevention of pain in neonates is an expectation of parents. 1 However, there are major gaps in our knowledge regarding the most effective way to accomplish this. Although it may not be possible to completely eliminate pain in neonates, much can be done to reduce the amount and intensity of pain. The prevention of www.pediatrics.org/cgi

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Section: Reducing Pain From Surgerymentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

418

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“…The average elimination half-life in infants is prolonged and is reported to be 3.5 vs 1.9-2.2 h in adults. 6 Because of the prolonged half-life leading to accumulation of the drug, repeated doses of acetaminophen in short intervals are of particular concern. 6 Hepatotoxicity from an acetaminophen overdose is mediated by the reactive metabolic intermediate N-acetyl-p-benzoquinoneimine (NAPQI), which is normally detoxified by reduced glutathione.…”

Section: Discussionmentioning

confidence: 99%

“…6 Because of the prolonged half-life leading to accumulation of the drug, repeated doses of acetaminophen in short intervals are of particular concern. 6 Hepatotoxicity from an acetaminophen overdose is mediated by the reactive metabolic intermediate N-acetyl-p-benzoquinoneimine (NAPQI), which is normally detoxified by reduced glutathione. 3 The reserves of glutathione needed for detoxification of NAPQI may be depleted after supratherapeutic or repeated therapeutic doses of acetaminophen.…”

Section: Discussionmentioning

confidence: 99%

“…3 The reserves of glutathione needed for detoxification of NAPQI may be depleted after supratherapeutic or repeated therapeutic doses of acetaminophen. 6 NAC is thought to have a therapeutic effect in acetaminophen toxicity by regeneration of reduced glutathione. 3 Complete recovery following treatment with NAC in this case also highlights the fact that newborns and young children are more resilient to hepatic necrosis and failure than older children and adults.…”

Section: Discussionmentioning

confidence: 99%

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Acetaminophen-induced hepatic failure with encephalopathy in a newborn

2007

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We report a case of oral acetaminophen toxicity in a term newborn infant successfully treated with a 20 h intravenous N-acetylcysteine infusion protocol without any adverse effects. This case report supports the use of N-acetylcysteine to treat neonatal acetaminophen toxicity and highlights the need for better education of parents regarding the appropriate use and dosage of acetaminophen in newborns. Journal of Perinatology (2007Perinatology ( ) 27, 133-135. doi:10.1038 Keywords: Neonatal acetaminophen toxicity; hepatic failure; N-acetylcysteine IntroductionAcetaminophen is an efficacious and safe analgesic used often in newborns. 1 Although it is relatively safe, acetaminophen toxicity is well documented and can lead to liver failure and even death. The risk of developing toxicity is, in general, thought to be lower in children than in adults. N-acetylcysteine (NAC) is the treatment of choice for acetaminophen overdose in older children and adults. To date, there are no documented neonatal cases of oral acetaminophen toxicity with hepatic encephalopathy. We report a case of oral acetaminophen toxicity presenting with hepatic encephalopathy and oliguric renal failure in a term newborn infant successfully treated with intravenous NAC without observable adverse effects.Case report A four day-old term male infant was brought to the emergency department after episodic emesis and decreased level of arousal. He was born to a 24 year-old mother following an uncomplicated pregnancy by normal spontaneous vaginal delivery at 41 weeks gestational age. Apgar scores were 9 at 1 min and 9 at 5 min. He was discharged on the second postnatal day after circumcision.One day later he became sleepy, fed poorly and vomited approximately 10 times in 24 h. The baby was evaluated by a visiting nurse, who sent him to the emergency department. On examination he was moderately dehydrated, lethargic and poorly responsive to stimulation. Gastric lavage produced blood-tinged aspirates. Significant laboratory findings included glucose 27 mg/dl (normal: 45 to 120 mg/dl), Na 149 mEq/l (normal: 135 to 148 mEq/l), K 5.9 mEq/l, Cl 110 mEq/l (normal: 91 to 111 mEq/l), CO 2 18 mEq/l, BUN 40 mg/dl, creatinine 3.2 mg/dl (normal: 0.3 to 1 mg/dl), total serum bilirubin 9 mg/dl with a conjugated fraction of 1.4 mg/dl, serum ammonia 114 mmol/l (normal: 56 to 92 mmol/l), AST 718 IU/l (normal: 20 to 65 IU/l), ALT 978 IU/l (normal: <54 IU/L), PT 51.9 s (normal; 10.1 to 15.9 s), PTT 45.7 s (normal: 31.3 to 54.3 s), INR 5.4 (normal: 0.96 to 1.04), D-dimer 5.9 mg/l, factor V assay 57% and fibrinogen 61 mg/dl (normal: 1.67 to 3.09 g/l). A complete blood count revealed a WBC count of 13 600/mm, 2 hematocrit 66.4% and platelets of 154 000/mm. 3 Cerebral spinal fluid analysis was normal. The baby received intravenous volume expansion, dextrose and ampicillin and cefotaxime. He was admitted to the neonatal intensive care unit with a presumptive diagnosis of sepsis with renal failure, liver failure and coagulopathy. An arterial blood gas analysis after fluid boluses ...

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“…Rektal parasetamol önceden tahmin edilemeyen değişken plazma konsantrasyonundan dolayı hızlı başlangıçlı bir analjezi için etkin olamamaktadır 14 . Rektal ve oral uygulama yöntemlerine göre iv uygulama daha tahmin edilebilir plazma konsantrasyonuna ve biyoyararlanıma sahiptir ve emilim kinetiği daha az değişkendir 15,16 . Yapılan çalışmalarda parasetamolün rektal, oral ve iv uygulamaları sonrası pik plazma konsantrasyonlarına ulaşma süreleri sırasıyla 2-3 saat, 30 dakika-1 saat ve 15 dakika (infüzyonun bitiminde) olarak saptanmıştır.…”

Section: Materyal Ve Metodunclassified

Major Abdominal Cerrahi Uygulanacak Çocuklarda İntravenöz Parasetamol ve İntravenöz Tramadolün Karşılaştırılması

Değmez¹,

Türktan²,

Karacaer³

et al. 2015

Cukurova Medical Journal

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Purpose: Postoperative pain and pain related hemodynamic instability are frequently observed problems in children undergoing major abdominal surgery. In our study, we aimed to comparison of the effect intravenous paracetamol and tramadol on postoperative analgesia and tramadol consumption. Material and Methods: After approval of faculty ethical committee and parents consent, 90 children aged 3-14 years undergoing major abdominal surgery were included in this study. Patients randomly divided into two groups. Forty five minutes before the end of surgery, Group P patients were given intravenously paracetamol (15 mg/kg, in 15 minutes) and Group T patients were given intravenously tramadol(1 mg/kg). Parent controlled analgesia with tramadol (bolus dose 0.2 mg/kg, lock out 20 minutes) was started in both groups. Postoperatively, patients' systolic and diastolic blood pressures, heart rates, oxygen saturation values, pain scores, total tramadol consumption and side effects were recorded. Results: Demographic data, duration of surgery and hemodynamic parameters were similar between the groups. Total tramadol consumption were recorded 76.11 ± 105.65 mg in Group P and 83.50 ± 97.35 mg in Group T for 24 hours(p>0.05). There was not any significantly difference in side effects and pain scores between the groups (p > 0.05). Conclusion: It was concluded that, intravenous paracetamol was provided effective analgesia but it was not superior to intravenous tramadol in children undergoing major abdominal surgery. Key words: Children, parent controlled analgesia, paracetamol, postoperative pain, tramadol.

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Treatment with paracetamol in infants

Abstract: The pharmacokinetics and pharmacodynamics of paracetamol differ substantially in neonates and infants from those in older children and adults; hence, dosing should be adjusted accordingly.

Cited by 124 publications

References 51 publications

Prevention and Management of Pain in the Neonate: An Update

Prevention and Management of Pain in the Neonate: An Update

Acetaminophen-induced hepatic failure with encephalopathy in a newborn

Major Abdominal Cerrahi Uygulanacak Çocuklarda İntravenöz Parasetamol ve İntravenöz Tramadolün Karşılaştırılması

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