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Postnatal acetaminophen exposure and neurodevelopmental outcomes at 18–21 months corrected gestational age in preterm infants <29 weeks gestation: a retrospective cohort study

Pediatric Research (2023)Cite this article

Abstract

Background

Studies have reported prenatal acetaminophen exposure is associated with abnormal neurodevelopment. There is limited and conflicting data on neurodevelopmental outcomes following postnatal acetaminophen exposure. Our objective was to investigate the neurodevelopmental outcomes of preterm infants < 29 weeks gestation postnatally exposed to acetaminophen.

Methods

Retrospective cohort study of infants born between 2008 and 2017 at a tertiary care perinatal center. Exclusion criteria included chromosomal disorders, major congenital abnormalities, and congenital infections. The primary outcome was a composite score of <85 on the cognitive, language, or motor components of the Bayley Scales of Infant and Toddler Development, 3rd edition, assessed at 18 to 21 months corrected gestational age. Multivariate logistic regression was used to assess confounders.

Results

Of the 945 infants included in the study, 120 were in the acetaminophen group. There was no difference in any of Bayley-III cognitive, language or motor composite scores of < 85 between the two groups for postnatal acetaminophen exposure, adjusted odds ratios (aORs) 1.03, 95% CI 0.60–1.78, or days of acetaminophen use, aORs 1.10, 95% CI 0.93–1.29.

Conclusions

There was no difference in neurodevelopmental outcome between the acetaminophen exposed and non-exposed groups. Our results need validation in larger cohorts.

Impact

  • Animal research and cohort studies have suggested that prenatal acetaminophen exposure may be associated with an elevated risk of neurobehavioral abnormalities. However, there is limited and conflicting research on the impact of postnatal acetaminophen on neurodevelopment.

  • The results of this study suggest that postnatal acetaminophen does not negatively impact neurodevelopment at 18 to 21 months in preterm infants born at <29 weeks gestational age.

  • While these results need validation in larger and more longitudinal studies, this study provides reassurance for the use of postnatal acetaminophen in extremely preterm infants.

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Data availability

The data generated for the current study are not publicly available due to data transfer agreements and approvals that specifically indicate that the data will not be distributed outside the Alberta Health Services. The datasets used for the current study are available from the corresponding author on reasonable request.

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Author contribuations

K.Y.: Concept and design, supervised and revised the proposal, drafting of the manuscript, revision of the manuscript. A.S.: Wrote the first draft of the manuscript, interpreted data, revision of the manuscript. S.R.: wrote the proposal, revision of the manuscript. S.T.: Statistical analysis, revision, and critical appraisal of the manuscript. S.M.: Reviewed proposal, interpreted data, revision, and critical appraisal of the manuscript. L.H.: Reviewed proposal, interpreted data, revision, and critical appraisal of the manuscript. S.H.: Reviewed proposal, interpreted data, revision, and critical appraisal of the manuscript. B.A.: Reviewed proposal, interpreted data, revision, and critical appraisal of the manuscript.

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Authors and Affiliations

  1. Department of Obstetrics & Gynecology, University of Calgary, Calgary, AB, Canada

    Amelia Srajer

  2. Department of Paediatrics, McMaster University, Hamilton, ON, Canada

    Smita Roychoudhury

  3. Alberta Health Services, Calgary, AB, Canada

    Selphee Tang

  4. Section of Neonatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Shabih U. Hasan, Sarfaraz Momin, Leonora Hendson, Belal Alshaikh & Kamran Yusuf

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Correspondence to Kamran Yusuf.

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A retrospective cohort study using a large, anonymized dataset and was approve by the Conjoint Health Research Ethics Board of the University of Calgary (REB 19-0192).

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Srajer, A., Roychoudhury, S., Tang, S. et al. Postnatal acetaminophen exposure and neurodevelopmental outcomes at 18–21 months corrected gestational age in preterm infants <29 weeks gestation: a retrospective cohort study. Pediatr Res (2023). https://doi.org/10.1038/s41390-023-02901-x

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