Dear Editor

Dr Alur’s response [1] to Catherine Hall's paper mentions that preparations of a number of drugs available in the USA and commonly used in neonatology contain benzyl alcohol as an excipient. I would like to point out that this is not necessarily true of preparations of the same drugs in the Europe. For example - to take some of the drugs he mentions - in Europe (including the UK) the commonly available preparations of Vitamin K, pancuronium bromide, and midazolam do NOT contain benzyl alcohol whereas their counterparts in the USA do.

Reference

(1) Pradeep A. Benzyl alcohol [electronic response to Hall et al. Probable adverse reaction to a pharmaceutical excipient] archdischild.com 2004http://adc.bmjjournals.com/cgi/eletters/fetalneonatal;89/2/F184#357

Dear editor

It was interesting to read the case report on Clindamycin associated adverse reaction.

Though Benzyl alcohol containing fluids should be avoided for possible association with IVH and kernicterus. One may be surprised to learn that Vitamin K that is commonly used in every newborn has 9 mgs of benzyl alcohol. Quite a few commonly used medications such as pancuronium bromide, aminophylline, lorazepam, midazolam and Multivitamin IV used in parenteral nutrition have benzyl alcohol. Interestingly, paralysis induced by pancuronium bromide (which is known to contain benzyl alcohol)is actually associated with reduced incidence of Severe IVH.[1]

Moreover, it is not known if other interventions had resulted in decrease in IVH in those studies which blamed benzyl alcohol. For these reasons, AAP policy guidelines stated that amount of benzyl alcohol present in medications may be safer to use in newborns. But, solutions containing benzyl alcohol should be avoided.

Reference

(1) Cools F, Offringa M. Neuromuscular paralysis for newborn infants receiving mechanical ventilation. Cochrane Database Syst Rev. 2000;(4):CD002773. Review).