Table II.
Overview on the cases of newborns exposed to potential toxic doses of paracetamol as published in the literature41–48
| Author | Clinical characteristics and dose | Management and outcome |
|---|---|---|
| Isbister et al, 200141 | Former preterm newborn, 37 wk PMA | N-acetyl cysteine IV + activated charcoal transient increase in prothrombin time, no hepatic enzymatic abnormalities, full recovery |
| 55 days postnatal age, 2.2 kg | ||
| Oral paracetamol, 136 mg/kg | ||
| de la Pintiére et al, 200342 | Term newborn, in early neonatal life | N-acetyl cysteine IV |
| 2 x intravenous (pro)pacetamol, 307 mg/kg | No adverse effects were observed, Discharge Day 7 | |
| Walls et al, 200843 | Term newborn, early neonatal life (Day 4) | N-acetyl cysteine IV, renal and hepatic failure (liver enzymes, INR abnormalities, hypoglycemia) |
| Following circumcision, emesis and lethargic | ||
| Oral paracetamol, 156 + 78 + 78 mg/kg/d | Full recovery, with discharge after 1 wk | |
| Nevin et al, 200944 | preterm newborn, 35 weeks PMA | N-acetyl cysteine IV, normal liver enzymes |
| 7 weeks postnatal age, 2.6 kg | Transient INR abnormalities (1.27–1.04), vitamin K | |
| Intravenous paracetamol, 146 mg/kg | Full recovery, discharge on Day 5 | |
| MHRA, 201045 | 23 cases (worldwide) <1 jr | No data on management reported |
| Intravenous paracetamol overdose | one case (1 out of 23) died | |
| Most common error: 10-fold error | ||
| Porta et al, 201246 | Extreme preterm newborn, 27 weeks PMA | N-acetyl cysteine IV. No changes in liver enzymes, bilirubin, or prothrombin time. Full recovery |
| 12 d postnatal age, 940 g | ||
| Indication: Abdominal distention, sepsis | ||
| Intravenous paracetamol, 446 mg/kg | ||
| Campbell et al, 201347 | Former preterm newborn, 40 wk PMA | N-acetyl cysteine IV. No changes in liver enzymes, bilirubin, or prothrombin time. Full recovery |
| Postnatal age 3 mo, 2.3 kg | ||
| Indication: retinal laser surgery | ||
| Intravenous paracetamol, 75 mg/kg | ||
| Bucaretchi et al, 201448 | 26 days old, term newborn, 3.125 kg | Volume replacement, plasma, inotropics, and ventilation |
| Indication: “feverish and weepy” | N-acetyl cysteine IV. 34 days of hospitalization | |
| Oral, 180 mg/kg (3 d 10 mg/kg, q4h) | ||
| Not yet reported, Leuven, 2014 | 3-wk old term newborn, 3.5 kg | N-acetyl cysteine IV. No changes in liver enzymes, bilirubin, or prothrombin time. Full recovery |
| Indication: pain, posttraffic accident (cranial, thoracic injuries) | ||
| Intravenous paracetamol: 200 mg/kg |
IV = intravenous, PMA = postmenstrual age; INR = intranational normalized ratio; blood clotting test.