Abstract
BackgroundDespite the availability of evidence-based analgesic strategies, neonatal pain management continues to be suboptimal. Intranasal (IN) fentanyl is an alternative pharmacotherapy for procedural pain in neonatal units. The objective was to evaluate the effectiveness and safety of IN fentanyl for procedural pain in preterm infants.MethodsA retrospective cohort study was conducted in infants who received IN fentanyl between May 2019 and December 2020 at an academic neonatal intensive care unit. Main outcome measures were pain responses, physiological parameters before and up to 60 min after IN fentanyl administration, and adverse events. Paired t-test and analysis of variance were used to compare pain scores and physiological parameters, respectively.ResultsThirteen infants received IN fentanyl on 22 occasions. Median (interquartile range [IQR]) gestational age and birthweight were 27 (25, 27.6) weeks and 850 (530, 1,030) grams, while median (IQR) post-menstrual age and weight were 30.9 (28.9, 32.9) weeks and 1,280 (945, 1,623) grams at the time of IN fentanyl administration. IN fentanyl was most used for lumbar puncture (55%) followed by insertion of epicutaneo-caval catheters (27%). There was a difference between the mean pre- and post-procedure Premature Infant Pain Profile scores of 1.3 (95% CI = 0.07, 2.5; p = 0.04). Physiological parameters did not differ before and up to 60 min post IN fentanyl administration (p > 0.05). Two adverse events (one apnea and one desaturation) were noted.ConclusionIn our limited experience, IN fentanyl appears to be an alternative pharmacotherapy for procedural pain management in the absence of intravenous access in preterm infants.
Highlights
Infants admitted to the neonatal intensive care unit (NICU) experience as many as 7 to 17 painful procedures per day, with preterm infants (< 37 weeks) at the highest risk of being exposed to greater numbers of painful procedures [1]
Intranasal Fentanyl in Preterm Infants regarding the adverse effects of analgesics, especially opioids [8, 9]
IN fentanyl could be used for procedural pain management and for palliative care when IV access was not established or analgesia was needed for a short period of time
Summary
Infants admitted to the neonatal intensive care unit (NICU) experience as many as 7 to 17 painful procedures per day, with preterm infants (< 37 weeks) at the highest risk of being exposed to greater numbers of painful procedures [1]. Repeated or cumulative exposure to pain is associated with alteration in pain sensitivity and behavioral responses, sub-optimal brain development, and adverse neurodevelopmental outcomes [2, 3]. Despite these adverse consequences of pain and the availability of evidence-based non-pharmacological and pharmacological strategies to prevent and minimize pain, their use in the NICUs remains variable and suboptimal [4,5,6,7]. In the absence of IV access, the intranasal (IN) route is an alternative mode to deliver opioids It offers rapid and reliable systemic drug absorption with minimal discomfort to patients [10, 11]. The objective was to evaluate the effectiveness and safety of IN fentanyl for procedural pain in preterm infants
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