Neonatal paracetamol poisoning: treatment by exchange transfusion

The metabolism and excretion of paracetamol was studied in an infant of 29 weeks' gestation who was exposed to the drug when his mother ingested 32.5 g 16 hours before delivery. We have confirmed that sulphation is the major pathway and that the mixed function oxidase system is sufficiently active at this gestational age to produce hepatotoxic metabolic products. As most of the recognised drug treatments for paracetamol poisoning seemed unsuitable in this case, the infant was treated with exchange transfusions.