Intranasal Fentanyl in Preterm Infants Undergoing Peripherally Inserted Central Catheter Placement

Exclusion Criteria

• •Infants with choanal atresia, nasal mucosal erosion, or epistaxis
• •Infants with facial anomalies
• •Infants diagnosed with genetic conditions known to affect neurological development or severe (grade ≥ III) intraventricular hemorrhage
• •Infants receiving continuous intravenous infusions or scheduled enteral doses of opioids or sedatives within 12 hours of PICC placement
• •Infants with cardiopulmonary instability managed with inotropes, vasopressors, phosphodiesterase enzyme inhibitors, or neuromuscular blocking agents at the time of PICC placement
• •Infants prescribed strong CYP3A4 inhibitors (clarithromycin, itraconazole, ketoconazole, posaconazole, ritonavir, voriconazole) at the time of PICC placement
• •Infants diagnosed with bronchopulmonary dysplasia (need for supplemental oxygen or need for ventilatory support at 36 weeks corrected gestational age)
• •Infants with a previous documented adverse reaction to any formulation of fentanyl
• •Each eligible infant will be enrolled for one PICC placement only during the study period