UMEM Educational Pearls

Category: Pediatrics

Title: Ibuprofen use and infants

Keywords: Fever, pain control, ibuprofen, acetaminophen (PubMed Search)

Posted: 9/21/2018 by Jennifer Guyther, MD
Click here to contact Jennifer Guyther, MD

Ibuprofen is an effective antipyretic and analgesic and children.  In the US, ibuprofen is not used in children less than 6 months due to safety concerns involving adverse GI effects, risk of renal failure, increased risk of necrotizing infections and Rey syndrome.   The British National Formulary, however, does provide dosing guidance for infants aged 1-3 months.
This study was a retrospective review looking at infant's age less than 6 months who were prescribed ibuprofen or acetaminophen.  The rate of adverse GI and renal events were compared between both the ibuprofen and acetaminophen group. 
GI adverse events were mild including vomiting, moderate with abdominal pain and gastritis. Renal adverse events included acute or chronic renal failure.
GI and renal adverse events were not higher in infants younger than 6 months who are prescribed ibuprofen compared to those age 6-12 months.  Adverse events were increased in children younger than 6 months to her prescribed Motrin compared to acetaminophen alone.
Bottom line: Remain cautious about adverse GI and renal events in children age less than 6 months when using ibuprofen compared to acetaminophen.  However, there is no difference in adverse events when ibuprofen is used in children younger than 6 months compared with those older than 6 months.

References

Walsh P, Rothenberg S, Bang H.  Safety of ibuprofen and infants younger than 6 months: A retrospective cohort study. PLos ONE 13 (6):e019493.