title: Paracetamol and morphine for infant and neonatal pain; still a long way to go?
abstract: Pharmacologic pain management in newborns and infants is often based on limited scientific data. To close the knowledge gap, drug-related research in this population is increasingly supported by the authorities, but remains very challenging. This review summarizes the challenges of analgesic studies in newborns and infants on morphine and paracetamol (acetaminophen). Areas covered: Aspects such as the definition and multimodal character of pain are reflected to newborn infants. Specific problems addressed include defining pharmacodynamic endpoints, performing clinical trials in this population and assessing developmental changes in both pharmacokinetics and pharmacodynamics. Expert commentary: Neonatal and infant pain management research faces two major challenges: lack of clear biomarkers and very heterogeneous pharmacokinetics and pharmacodynamics of analgesics. There is a clear call for integral research addressing the multimodality of pain in this population and further developing population pharmacokinetic models towards physiology-based models.
authors: a Intensive Care and department of Pediatric Surgery , Erasmus MC-Sophia Children's Hospital , Rotterdam , the Netherlands.
authors: Manuel A
authors: MA
authors: Baarslag
authors: a Intensive Care and department of Pediatric Surgery , Erasmus MC-Sophia Children's Hospital , Rotterdam , the Netherlands.|b Department of development and regeneration , KU Leuven , Leuven , Belgium.
authors: Karel
authors: K
authors: Allegaert
authors: a Intensive Care and department of Pediatric Surgery , Erasmus MC-Sophia Children's Hospital , Rotterdam , the Netherlands.|c Division of Clinical Pharmacology , Children's National Health System , Washington , DC , USA.|d Division of Pediatric Pharmacology and Pharmacometrics , University of Basel Children's Hospital , Basel , Switzerland.
authors: John N
authors: JN
authors: Van Den Anker
authors: e Department of Clinical Pharmacy , St. Antonius Hospital , Nieuwegein , The Netherlands.|f Division of Pharmacology, Leiden Academic Center for Drug Research , Leiden University , Leiden , the Netherlands.
authors: Catherijne A J
authors: CA
authors: Knibbe
authors: a Intensive Care and department of Pediatric Surgery , Erasmus MC-Sophia Children's Hospital , Rotterdam , the Netherlands.|g Department of Pediatrics, division of Neonatology , Erasmus MC-Sophia Children's Hospital , Rotterdam , the Netherlands.
authors: Monique
authors: M
authors: Van Dijk
authors: g Department of Pediatrics, division of Neonatology , Erasmus MC-Sophia Children's Hospital , Rotterdam , the Netherlands.
authors: Sinno H P
authors: SH
authors: Simons
authors: a Intensive Care and department of Pediatric Surgery , Erasmus MC-Sophia Children's Hospital , Rotterdam , the Netherlands.
authors: Dick
authors: D
authors: Tibboel
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D000367:Age Factors; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology; D000818:Animals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008954:Models, Biological; D009020:Morphine / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D010146:Pain / Q000188:drug therapy*
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D009020:Morphine
keywords: Pain; acetaminophen; analgesia; infants; neonates; opioids; paracetamol; pediatrics; pharmacodynamics; pharmacokinetics