Breakthrough Findings from the PIPPA Tamariki Study

The University of Auckland's PIPPA Tamariki study has delivered reassuring results for parents worldwide, confirming that paracetamol and ibuprofen are safe for babies in their first year of life when used as directed. This landmark randomized controlled trial, published in The Lancet Child & Adolescent Health on January 28, 2026, addresses longstanding concerns about potential links between these common pain relievers and conditions like eczema or bronchiolitis.

Conducted across New Zealand, the study involved nearly 4,000 infants, making it the largest paediatric trial ever undertaken in the country. Researchers from the University of Auckland, in collaboration with the Medical Research Institute of New Zealand (MRINZ), randomized babies to receive either paracetamol or ibuprofen as needed for fever or pain during their first 12 months. The findings show no significant differences in adverse outcomes, providing high-quality evidence from a gold-standard design.

Addressing Decades of Uncertainty in Infant Pain Management

Prior to this research, observational studies had raised alarms about paracetamol (also known as acetaminophen), suggesting it might increase risks of eczema, wheeze, asthma, and even neurodevelopmental issues like autism or ADHD in later childhood. These associations prompted hesitation among some parents and clinicians regarding its routine use for infant fever or pain relief. Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), was sometimes preferred, but evidence gaps persisted on comparative safety.

The PIPPA Tamariki study—standing for Paracetamol and Ibuprofen in the Primary Prevention of Asthma in Tamariki (children)—was designed to resolve these uncertainties through rigorous experimentation. By providing definitive data, it empowers families and healthcare providers with confidence. In New Zealand, where asthma affects one in four children, such insights are particularly vital for public health strategies.

Study Design: A Model of Rigorous Paediatric Research

This multicentre, open-label, parallel-group randomized controlled trial enrolled newborns from three major hospitals: Auckland City, Middlemore, and Wellington. Inclusion focused on healthy term infants under 8 weeks old, born in New Zealand, ensuring a representative sample.

• Randomization: 1:1 allocation to paracetamol (15 mg/kg every 6 hours under 1 month, adjusting to age-appropriate dosing) or ibuprofen (only from 3 months per guidelines, 5-10 mg/kg).
• Duration: Medication provided as required for fever/pain in first 12 months.
• Follow-up: Parental reports at intervals, verified against hospital and prescription records.
• Outcomes measured: Eczema (diagnosed via symptoms), bronchiolitis/wheeze/asthma at 1 year.
• Power: Planned for 3,922 participants to detect meaningful differences.

The trial's scale and methodology exemplify excellence in clinical research at the University of Auckland, setting a benchmark for future studies.Explore research positions driving such innovations.

Key Results: No Safety Signals Detected

At one year, eczema prevalence was 16% in the paracetamol group and 15% in ibuprofen (no significant difference). Bronchiolitis rates were approximately 5% in both arms. Serious adverse events were exceedingly rare, with none attributable to the study drugs. Statistical analysis confirmed no important risk elevation, debunking prior observational links.

These outcomes held across subgroups, reinforcing broad applicability. For context, New Zealand's high childhood respiratory illness burden makes these null findings profoundly reassuring.Read the full University of Auckland press release.

Spotlight on University of Auckland Researchers

Leading the charge is Professor Stuart Dalziel, Cure Kids Chair of Child Health Research in the Department of Paediatrics: Child and Youth Health at Waipapa Taumata Rau, University of Auckland. A paediatrician at Starship Children’s Hospital and expert in emergency paediatrics, Prof Dalziel stated: “Our study found that paracetamol and ibuprofen are incredibly safe to use in young children. These results give parents and health professionals high confidence.”

Co-author Dr Eunicia Tan, a senior lecturer at the University and emergency physician at Middlemore Hospital, emphasized long-term goals: “Ultimately, the study will provide important evidence regarding links to asthma, eczema, hayfever, and developmental disorders.” Their academic prowess underscores UoA's role in advancing child health.Learn about thriving in paediatric research roles.

Photo by Kinga Lopatin on Unsplash

Funding and New Zealand's Research Ecosystem

Funded by the Health Research Council of New Zealand (HRC) and Cure Kids, the trial highlights robust support for investigator-led science. Collaboration with MRINZ in Wellington amplified its reach, demonstrating inter-institutional synergy crucial for large-scale trials. This model fosters training for the next generation of researchers, with opportunities in clinical trials and epidemiology.View research assistant jobs in NZ.

The Liggins Institute at UoA, known for perinatal and child health breakthroughs, hosted study elements, reinforcing its global stature.

Implications for Parents and Clinicians in Aotearoa

New Zealand parents can now administer these medications confidently for teething, vaccinations, or illnesses, following KidsHealth NZ guidelines: paracetamol from birth (15 mg/kg/dose), ibuprofen from 3 months (5-10 mg/kg). No evidence supports withholding paracetamol due to allergy fears. Clinicians benefit from local RCT data, reducing reliance on international guidelines.

• Step 1: Assess pain/fever need.
• Step 2: Dose by weight/age.
• Step 3: Max 4 doses/24h; consult if persistent.
• Benefits: Effective relief, anti-inflammatory (ibuprofen).
• Risks: Rare GI upset; avoid dehydration.

Contrasting with Observational Data

Unlike prior cohort studies linking paracetamol to 20-50% higher asthma odds, PIPPA's RCT eliminates confounding (e.g., sicker kids get more meds). This causality test is pivotal, influencing global reviews like those from WHO or NICE. UoA's evidence shifts paradigms in pharmacoepidemiology.

Future Horizons: Tracking to Age Six

Participants continue follow-up to age 6 for asthma diagnosis (true prevalence ~10-15% NZ kids), hayfever, and neurodevelopment. Age-3 data forthcoming. These will inform prevention, potentially reshaping infant care worldwide.

UoA's Leadership in Paediatric Innovation

This trial cements University of Auckland's preeminence in child health, alongside feats like neonatal hypoglycaemia guidelines. It attracts talent, funding, and collaborations, boosting NZ's research GDP contribution (1.5% economy).Discover university opportunities in New Zealand. For aspiring academics, such projects offer PhD/postdoc paths in trials.Postdoc positions available.

Photo by Yves Scheuber on Unsplash

Actionable Insights and Next Steps

Parents: Stock safe formulations, track weights. Providers: Educate on evidence. Researchers: Build on this for combination therapies. Engage with UoA's ecosystem via Rate My Professor, higher ed jobs, career advice, or university jobs. This study exemplifies research translating to lives saved.