Rectal paracetamol in newborn infants after assisted vaginal delivery may increase pain response.
OBJECTIVE
To assess the efficacy of paracetamol (acetaminophen) for neonatal pain relief.


METHODS
Randomized, double-blind placebo-controlled trial in 3 Swiss university hospitals. Term and near-term infants (n = 123) delivered by forceps or vacuum were randomized to receive 2 suppositories with paracetamol (60/80/100 mg in infants <3000 g/3000-4000 g/>4000 g birth weight) or placebo at 2 and 8 hours of life. Pain and discomfort during the first 24 hours was assessed by the échelle de douleur et d'inconfort du nouveau né [neonatal pain and discomfort scale] score. The response to the subsequent heel prick for metabolic screening at days 2-3 of life was investigated by the Bernese Pain Scale for Neonates (BPSN).


RESULTS
The échelle de douleur et d'inconfort du nouveau né [neonatal pain and discomfort scale] pain scale ratings after assisted vaginal delivery were low and declined within 4 hours of life (P < .01) irrespective of paracetamol administration. At 2-3 days of life, BPSN scores after heel prick were significantly higher in infants who had received paracetamol, compared with controls, both when BPSN were scored by nurses at the bedside (median [IQR] 4 [2-7] vs 2 [0-5], P = .017) or off-site from videos (4 [2-8] vs 2 [1-7], P = .04). Thirty-five of 62 (57%) infants treated with paracetamol cried after heel prick, compared with 25 of 61 (41%) controls (P = .086).


CONCLUSIONS
Infants born by assisted vaginal delivery have low pain scores in the immediate period after birth. Paracetamol given to newborns soon after birth may aggravate a subsequent stress response.
Department of Pediatrics, Insel Hospital, University of Bern, Bern, Switzerland.
Eva Maria
EM
Tinner
Irene
I
Hoesli
Kerstin
K
Jost
Nina
N
Schöbi
Yvonne
Y
Ulrich Megged
Tilo
T
Burkhardt
Alexander
A
Krafft
Hans Ulrich
HU
Bucher
Daniel
D
Surbek
Mathias
M
Nelle
Christoph
C
Bührer
D000082:Acetaminophen / Q000008:administration & dosage* / Q000009:adverse effects*; D000285:Administration, Rectal; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000009:adverse effects*; D004311:Double-Blind Method; D005113:Extraction, Obstetrical / Q000009:adverse effects; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced*; D007231:Infant, Newborn; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D011446:Prospective Studies
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen