Paracetamol serum concentrations in preterm infants treated with paracetamol intravenously: a case series

Abstract

IntroductionUntil now, studies on paracetamol given intravenously have mainly been performed with the pro-drug propacetamol or with paracetamol in preterm babies above 32 weeks of gestation. Studies in these babies indicate that intravenous paracetamol is tolerated well, however studies on the efficacy of intravenous paracetamol are lacking. There are no pharmacokinetic data on the administration of multiple doses of paracetamol in preterm babies with a gestational age below 32 weeks.Case presentationWe present a case series of nine Caucasian preterm babies, six boys and three girls, with a mean gestational age of 28.6 weeks (range 25.9 to 31.6 weeks). Case one, a girl with a gestational age of 25 weeks and six days, presented with necrotizing enterocolitis. In the second case, a female baby with a gestational age of 26 weeks and two days presented with hematoma. In case three, a female baby with a gestation of 26 weeks and one day developed intraventricular hemorrhage. In case four, a male baby with a gestational age of 31 weeks and four days presented with pain after vacuum delivery. Case five, a female baby born after a gestation of 29 weeks and six days presented with hematoma. In case six, a male baby with a gestation of 30 weeks and six days presented with hematoma. In case seven, a male baby, born with a gestational age of 30 weeks and six days, presented with caput succedaneum and hematoma. In case eight, a male baby, born after a gestation of 28 weeks and four days, developed abdominal distention. Case nine, a female baby, born with a gestational age of 27 weeks and three days presented with hematoma. These babies were treated with intravenous paracetamol 15 mg/kg every six hours. Serum concentrations and aspartate transaminase were determined after prolonged administration. Pain scores were assessed using the Premature Infant Pain Profile.ConclusionParacetamol serum concentrations ranged from 8 to 64 mg/L after eight to 12 doses of intravenous paracetamol. Adequate analgesia was obtained in seven babies. During paracetamol therapy the median serum level of aspartate transaminase was 20 U/L (range 12 to 186 U/L). This case series indicates that prolonged intravenous administration of paracetamol in preterm babies with a gestational age of less than 32 weeks is tolerated well in the first days after birth. However, in the absence of proper pharmacokinetic data in this age group we cannot advocate the use of paracetamol intravenously.

Case series and literature review of multiple nodular sarcoidosis

“…Two of our patients underwent VATS biopsy and one had a CT-guided lung biopsy. A similar case was reported by Margaritopoulos et al where radiological findings of a soft tissue mass at the hilum with bilateral diffuse lymphadenopathy in a 65 year old Caucasian female was highly suggestive of bronchogenic carcinoma which later turned out to be sarcoidosis [16]. In one of our patients, lung biopsy showed chronic granulomatous inflammation with central necrosis raising a possibility of necrotising sarcoid granulomatosis (NSG) although histopathology lacked vasculitis.…”

Multiple intravenous doses of paracetamol result in a predictable pharmacokinetic profile in very preterm infants

“…In a previously reported case series of nine infants <32 weeks' gestation, we used a twofold higher maintenance dose of 15 mg/kg at 6‐h interval. This resulted in a median serum paracetamol level of 29 mg/L (IQR, 24–46 mg/L) and adequate pain management in the majority of cases . The serum paracetamol data from the case series study (validation set) were correctly predicted using the pharmacokinetic population parameters of the present study (training set).…”

MRSA induced pulmonary-renal syndrome

“…MRSA associated with microscopic polyangitis with P-ANCA is reported [2], as well as post MRSA infection IgA glomerulonephritis [2]. MRSA carriage or infection has been associated with cases of C-ANCA vasculitis (Wegener granulomatosis) [12], [13], [14]. We have not identified a case with the synchronous evolution of MRSA induced glomerulonephritis and DAH.…”