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Pain relief in neonates: when to use intravenous paracetamol
  1. John N van den Anker1,2,3,4,
  2. Dick Tibboel4
  1. 1Division of Pediatric Clinical Pharmacology, Children's National Medical Center, Washington, DC, USA
  2. 2Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
  3. 3Department of Pharmacology and Physiology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
  4. 4Intensive Care, Erasmus Medical Center–Sophia Children's Hospital, Rotterdam, The Netherlands
  1. Correspondence to John N van den Anker, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010, USA; jvandena{at}

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Adequate management of pain in neonates is a major issue, not only from an ethical perspective, but also to improve short and long term outcomes.1 Paracetamol (N-acetyl-p-aminophenol, acetaminophen) is the most commonly prescribed drug for the pharmacological treatment of mild to moderate pain in neonates and young infants. Although less potent as an analgesic, paracetamol has fewer side effects than opiates. Paracetamol can be administered by the oral, rectal and intravenous routes but is currently primarily prescribed for use by the enteral route. The main indication for intravenous administration is for infants who are not tolerating/not allowed enteral feeds. The use of intravenous preparations of paracetamol has revolutionised the surgical use of this drug. The first preparation available for parenteral use was the prodrug proparacetamol, which required hydrolysis by plasma esterases, such that 1 g of proparacetamol was metabolised to 500 mg paracetamol.2 More recently, an intravenous form of the active form has been made available. Both these preparations have been successfully used for neonatal analgesia and dosing …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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