Background: Managing pain is challenging, especially in neonates. Uncontrolled pain and opioid exposure are associated with short- and long-term adverse events. Adequately controlling pain while reducing opioid exposure is paramount in the neonatal population. This thesis presents three studies, all aiming to determine if IV acetaminophen is an appropriate adjunct to current opioid-based postoperative pain regimens. The population of interest is neonates admitted to the neonatal intensive care unit (NICU) treated with major abdominal and thoracic surgery. Chapter 1 provides the scientific framework underpinning this work and the rationale for performing the included studies. Chapter 2 presents the results of a systematic review and meta-analysis assessing the effect of IV acetaminophen on postoperative pain in pediatric patients. This chapter further expands on gaps and opportunities for future research. Chapter 3 reports the results of a national survey in which pediatric surgeons, anesthesiologists, and neonatologists reported their postoperative pain prescribing practices in the NICU and their perspectives on the use of IV acetaminophen. Chapter 4 describes the protocol for a pilot randomized controlled trial (RCT). This study will assess the feasibility of a multicenter RCT to evaluate the effectiveness of IV acetaminophen for postoperative pain in neonates recovering from major abdominal and thoracic surgery. Chapter 5 summarizes the results of the studies in context and details how the results of each study informed the others. It also discusses areas of future research. / Thesis / Master of Science (MSc) / All patients experience some amount pain after major surgery. Babies who are born too early (i.e., preterm) may experience more pain than babies those who are born close to their due date. Opioid drugs such as Fentanyl are commonly used to manage pain after surgery, but they have side effects, such as slowing down breathing and causing problems with gut function. Using non-opioid drugs (such as acetaminophen) and opioid drugs together may reduce the amount of opioids needed. This combination may also help with pain control. We want to know if using intravenous (IV) acetaminophen will reduce the rate of side effects, decrease the amount of opioids given, and still control pain well. To answer this question, we completed three studies. The first study reviewed all the published data on IV acetaminophen in children who need surgery. In the second study, we surveyed pediatric surgeons, anesthesiologists, and neonatologists to see how they manage pain after surgery and what they thought about IV acetaminophen. The last study is the plan for our pilot trial, where we will see if giving IV acetaminophen and opioids together is better than opioids alone.

Johnson & Johnson (J&J) has been viewed as a role model by many organizations for its successful handling of a 1982 crisis involving cyanide-laced Tylenol capsules that resulted in seven deaths. The public relations community applauded J&J for a swift response and for promptly implementing actions to prevent a similar crisis from occurring in the future. However more recently, J&J has become a poster child for poor crisis communications amidst a flood of recalls that started in November 2009. The present study used concepts from Coombs’ (2004) Situational Crisis Communication Theory (SCCT) and media framing research to develop a coding scheme for a content analysis of newspaper coverage surrounding the 1982 Tylenol recall as well as current recalls issued by J&J from November 2009 through April 2012. The samples included newspaper articles from New York Times and Chicago Tribune. Results showed that most of the stories in both samples did not evaluate J&J’s operational response or reputation overall. However, when the news coverage did evaluate J&J, coverage from the 1982 sample was positive and evenly balanced between favorable and unfavorable, compared to negative and unfavorable in the current sample. Additionally, when crisis type was mentioned in the coverage, the 1982 crisis was more likely described as a victim crisis while the current crises were more likely described as an accident or preventable crisis. When the 1982 sample was examined for mentions of previous recalls there were none compared to 80.5% of the current sample mentioning a previous recall. The results support the tenets of SCCT, information giving strategies and reputation management strategies. Additionally, the results provide valuable iii information for crisis managers regarding the media’s inclusion or, lack thereof, organizations’ controlled media such as news releases.