Effective and safe
pain relief in neonates matters. This is not only because of ethical constraints or human empathy, but even more because
pain treatment is an important and crucial part of contemporary medical, paramedical, and
nursing care to improve the outcome in
neonatal intensive care graduates.
Paracetamol (
acetaminophen) is likely one of the pharmacological tools to attain this, with data on prescription practices suggesting that
paracetamol is somehow the "rising star" in neonatal
pain management. Besides very rare topical clinical scenarios like peripartal
asphyxia and subsequent whole body
hypothermia or the use of cardiorespiratory support devices, data on
paracetamol pharmacokinetics and metabolism were reported throughout neonatal age or weight ranges, and we have summarized these data. In this review, we subsequently aimed to provide the reader with the currently available observations on the use of
paracetamol as
analgesic for different
pain syndromes (major
surgery, minor surgery or
trauma, and
procedural pain), with focus on the limitations of
paracetamol when prescribed for neonatal
procedural pain management. We hereby intentionally will not discuss other indications (
patent ductus arteriosus and
fever) for
paracetamol administration in neonates. Based on the available evidence,
paracetamol has
opioid-sparing effects for major
pain syndromes, is effective to treat minor to moderate
pain syndromes, but fails for effective
procedural pain management in neonates. This efficacy failure for
procedural pain management should stimulate us to continue to search for more effective interventions, including non-pharmacological interventions and preventive strategies. Furthermore, there are also upcoming association type of epidemiological studies on the relation between exposure to
analgesics-including
paracetamol-and the negative short- or long-term outcome characteristics (neuro-behavioral, atopy, and fertility). Consequently and in addition to the search for effective alternatives to prevent or treat
pain, studies on long-term outcome following
paracetamol exposure are needed to inform all stakeholders on the full effect-side effect balance of the different strategies to treat
pain.