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Updated: Dec 20, 2025
Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
Published on: March 14, 2013
Subgroup analysis of the early paracetamol trial to preterm infants found haemodynamic changes and improved
Antti Härmä1, Outi Aikio1, Pia Härkin1
1PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
Insights
Early intravenous paracetamol in preterm infants improved oxygenation and closed the ductus arteriosus. This treatment had minor effects on blood pressure but enhanced brain tissue oxygenation.
Area of Science:
- Neonatalogy
- Pharmacology
- Pediatric Critical Care
Background:
- Previous randomized trials indicated early intravenous paracetamol accelerates ductus arteriosus contraction in very preterm infants (<32 weeks gestation).
Purpose of the Study:
- To sequentially monitor the effects of paracetamol on blood pressure and brain tissue oxygenation in very preterm infants participating in a randomized trial.
Main Methods:
- A double-blind trial involving 48 very premature infants receiving intravenous paracetamol or placebo within 24 hours of birth for four days.
- Systematic measurements included blood pressure, peripheral oxygen saturation (SpO2), regional cerebral oxygen saturation (rcSO2), and cerebral fractional tissue oxygen extraction (cFTOE).
Main Results:
- Paracetamol loading dose transiently decreased arterial blood pressure.
- Paracetamol-treated infants showed higher SpO2 and rcSO2 compared to placebo.
- Lower cFTOE was observed in the paracetamol group, though not statistically significant. Infants with a closed ductus arteriosus exhibited higher tissue oxygenation and lower cFTOE.
Conclusions:
- Paracetamol demonstrated modest hemodynamic effects and increased cerebral oxygenation, primarily attributed to early ductus arteriosus contraction.
- Potential direct drug effects on the brain cannot be excluded.
Background:
We previously reported in a randomised trial that early intravenous paracetamol accelerated contraction of ductus arteriosus in very preterm infants (<32 gestation weeks).
Aims:
To monitor sequentially paracetamol effects on the blood pressure and brain tissue oxygenation in the infants participating the trial.
Methods:
In a double-blind trial, intravenous paracetamol or placebo was infused to 48 very premature infants starting within 24 h of birth for four days. Besides the ductus arteriosus, we systematically measured blood pressure, peripheral (spO2) and regional cerebral oxygen saturation (rcSO2), and cerebral fractional tissue oxygen extraction (cFTOE) during the study period.
Results:
Compared to the placebo, the paracetamol loading dose transiently decreased the arterial blood pressure. During treatment, the paracetamol-treated infants had higher spO2 (p = .042) and rcSO2 (p = .036) values than the placebo group infants. Additionally, the cFTOE values were lower in the paracetamol group during the study without statistical significance. All infants with closed ductus had higher tissue oxygenation and a lower cFTOE than infants with open ductus.
Conclusions:
Paracetamol caused modest haemodynamic effects and increased cerebral oxygenation. They were mostly due to early contraction of ductus. Additional direct drug-effects in brain are not ruled-out.
