From the Guidelines
Yes, Acetaminophen (Tylenol) is used to alleviate pain in neonates.
Recommended Pain Relief Medications
- Paracetamol/Acetaminophen is recommended as a first-line medication for pain relief in neonates, especially for degloved wounds, as stated in the clinical practice guideline for neonatal epidermolysis bullosa 1.
- Other first-line medications include sucrose and oral morphine/oxycodone.
Important Considerations
- It is essential to refer to country- or region-specific neonatal prescribing guidelines to ensure a safe and legal dosage, monitoring, and weaning of pain relief medications, including acetaminophen 1.
- Medical monitoring and resuscitation equipment should be available when administering pain relief medications to neonates 1.
- Non-medication-based pain relief strategies, such as swaddling, patting, rocking, calm music, and singing, can be used as standalone relief or in conjunction with medication 1.
From the Research
Efficacy of Acetaminophen in Neonates
- The efficacy of acetaminophen (paracetamol) in alleviating pain in neonates is a topic of ongoing research and debate 2, 3, 4, 5, 6.
- A critical review of paracetamol for procedural pain management in neonates suggests that it has opioid-sparing effects for major pain syndromes and is effective for minor to moderate pain syndromes, but fails to provide effective procedural pain management in neonates 2.
- Another study found that paracetamol does not significantly reduce pain associated with heel lance or eye examinations, and may even increase the response to later painful exposures 4.
- However, paracetamol may reduce the total need for morphine following major surgery, and further research is needed to fully understand its effects in this context 4.
Safety and Dosage of Acetaminophen in Neonates
- The safety and dosage of acetaminophen in neonates are important considerations, with guidelines recommending cautious use, particularly in extremely preterm neonates 5.
- A study on intravenous paracetamol dosing guidelines for pain management in (pre)term neonates found that a loading dose of 20 mg/kg, followed by 10 mg/kg/6h, is recommended for 32-44 weeks' neonates, while a loading dose of 12 mg/kg and a maintenance dose of 6mg/kg/6h may be suitable for neonates < 32 weeks 6.
- However, more research is needed to fully understand the safety and efficacy of acetaminophen in neonates, particularly in terms of its potential hepatotoxicity and unique characteristics of the newborn patient 5, 6.
Clinical Uses of Acetaminophen in Neonates
- Acetaminophen is commonly used as an analgesic and antipyretic in neonates, with oral or rectal administration being the most common routes of administration 5.
- Intravenous administration of paracetamol is also used in anesthesia for postoperative analgesia and painful procedures in Neonatal Intensive Care Units 5, 6.
- However, the use of acetaminophen in neonates should be guided by careful consideration of its potential benefits and risks, as well as the availability of alternative treatments 2, 3, 4, 5, 6.