Article Text

  1. C van Ganzewinkel1,
  2. P Andriessen1,
  3. T Mohns1,
  4. R A van Lingen2
  1. 1Department of Neonatology, Máxima Medical Centre, Veldhoven, The Nehterlands
  2. 2Department of Neonatology, Isala Klinieken, Zwolle, The Netherlands


Objective Based on recently published data, a local initiative in our neonatal intensive care unit has led to a pain protocol, in which preterm infants experiencing pain are treated with paracetamol intravenously. We present a case series of nine preterm infants with a gestational age below 32 weeks, in whom paracetamol serum concentrations were determined after prolonged administration of paracetamol 15 mg/kg at 6-h intervals intravenously.

Methods Nine infants (mean gestational age 28.6 weeks, range 25.9–31.6) received 15 mg/kg paracetamol at 6-h intervals.

Results Adequate analgesia with paracetamol monotherapy as measured by a PIPP score below 12 was attained in seven infants. The serum concentration was determined after 2–3 days of therapy. The median interval between drug administration and serum level was 4 h (range 1–20). The median level of paracetamol was 29 mg/l (range 8–61). During or after paracetamol therapy the median serum levels of alanine aminotransferase and gamma glutamyl transferase were 7 U/l (range 5–15) and 52 U/l (range 26–140), respectively.

Conclusions To our knowledge we are the first to report on paracetamol intravenously in preterm infants. The highest paracetamol concentration (64 mg/l) was far below 150 mg/l, which is reported as the toxic value in children. During paracetamol therapy we found no indications of liver failure. This case series of preterm infants with a gestational age below 32 weeks indicates that paracetamol intravenously with a maintenance dose of 15 mg/kg per day is well tolerated while achieving an adequate analgesic effect.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.