Intranasal fentanyl for pain management during screening for retinopathy of prematurity in preterm infants: a randomized controlled trial

J Perinatol. 2020 Jun;40(6):881-887. doi: 10.1038/s41372-020-0608-2. Epub 2020 Feb 13.


Objective: To study the efficacy of intranasal fentanyl as an adjunct for pain management during screening for retinopathy of prematurity (ROP) in preterm infants.

Study design: In this single center, double blinded, randomized controlled trial, preterm neonates between 30 and 34 weeks postmenstrual age received either intranasal fentanyl (2 mcg/kg) or intranasal normal saline through a mucosal atomization device 5 min prior to the first ROP-screening examination. Both the groups received standard pain relief strategies (oral sucrose, 0.5% proparacaine eye drops and physical containment). The primary outcome was premature infant pain profile-revised (PIPP-R) score during the screening.

Results: A total of 111 infants were enrolled. PIPP-R score during the retinal examination was significantly lower in the fentanyl group (8.3 versus 11.5, mean difference: 3.2 (2.46-4.06), P < 0.001). There was no significant difference in the incidence of adverse effects.

Conclusion: Intranasal fentanyl significantly reduced the pain associated with retinal examination without increasing the risk of respiratory depression. Large RCTs are required to verify the efficacy and safety of intranasal fentanyl for acute procedural pain in neonates.

Clinical trial registration: CTRI/2017/12/011016.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Fentanyl
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Pain Management
  • Pain Measurement
  • Retinopathy of Prematurity* / diagnosis
  • Retinopathy of Prematurity* / drug therapy


  • Fentanyl

Associated data

  • CTRI/2017/12/011016