Table 2.
Studies on the relevance of paracetamol on pain during minor to moderate pain syndromes in neonates (53–57).
| Reference | Study design, pain model | Paracetamol dosing | Results |
|---|---|---|---|
| Van Lingen et al. (53) | RCT, 122 term neonates following instrumental vaginal delivery Facies pain scale + “gestalt” assessment |
Rectal (20 mg/kg, q6h) for 24 h, either paracetamol or placebo after delivery | Similar Facies pain scores, objective clinical symptoms (nurse assessment) similar, except for the paracetamol group 1 h after first administration (better “gestalt” assessment) |
| Tinner et al. (54) | RCT, EDIN (Echelle de douleur et d'inconfort du nouveau né) score in the 24 h following instrumental vaginal delivery in 123 (near) term neonates. BPSN (Bernese pain score) following heel lancing on day 2–3 in the same neonates, with 0.2 ml sucrose in all cases. |
Rectal paracetamol (20–25 mg/kg) 2 and 8 h after delivery | No differences in mean EDIN score, no differences in EDIN score ≥5. BPSN after heel prick higher in the “former” paracetamol group [5 (3–9) vs. 3 (0–6)] |
| Howard et al. (55) | RCT in 44 healthy term neonates that underwent neonatal circumcision (Gomco). Post-operative comfort score |
Oral paracetamol 15 mg/kg, q6h for 24 h start 2 h before surgery |
No effects during and immediately following circumcision. Post-operative score similar until 6 h, but paracetamol group scored better afterwards (>6 h). |
| Allegaert et al. (56) | Open-label intravenous paracetamol (19/60 mono-therapy). Instrumental vaginal delivery or bruising with Leuven Neonatal Pain Score (LNPS) indicating pain | Loading dose intravenous Paracetamol (20 mg/kg) |
Decrease in LNPS from 0.5 h onwards, with a trend to return to these baseline scores at 5 h |
| Höck et al. (57) | Retrospective study design. Prophylactic paracetamol use in preterm (≤32 weeks, n = 221 vs. 228), in the first days of life, prophylactic to induce patent ductus arteriosus closure vs. historical data. Clinical pain assessment based on BNPS | Intravenous paracetamol (10 mg/kg, q8h) | Less 33% glucose use (protocol = to treat mild to moderate pain, mean 13.48 vs. 8.71 doses) in exposed cases, but no impact on the prescription of systemic analgesics |
RCT, randomized controlled trial; EDIN, Echélle de douleur en d'inconfort du nouveau-né; BPSN, Bernese pain score.