Effect of Fentanyl Boluses on Cerebral Oxygenation and Hemodynamics in Preterm Infants: A Prospective Observational Study

Neonatology. 2020;117(4):480-487. doi: 10.1159/000508555. Epub 2020 Jul 8.


Background: Fentanyl is a commonly used off-label medication for pain control and sedation in preterm infants. Yet, the effect of fentanyl on cerebral hemodynamics in preterm neonates remains unexplored.

Objective: To evaluate the effect of a bolus dose of fentanyl on the regional cerebral oxygen saturation (RcSO2), cerebral fractional tissue oxygen extraction (cFTOE) and left ventricular output (LVO) as compared with pre-administration baseline in preterm infants.

Methods: This was a prospective observational study conducted in a level III Canadian NICU from September 2017 to February 2019. Preterm infants born <37 weeks of gestation and scheduled to receive a fentanyl bolus (1-2 μg/kg/dose) were eligible. Infants with major congenital anomalies, medically unstable and those who had received fentanyl in the previous 48 h were excluded.

Outcomes: The primary outcome was the difference between RcSO2 measured 5 min prior to and RcSO2 measured at defined time points after administration of fentanyl.

Results: Twenty-eight infants were enrolled during the study period (median gestational age 28 weeks; interquartile range [IQR] 25-29 weeks; median birth weight 1,035 g [IQR 830-1,292 g]; median age 4 days [IQR 3-7 days]). Mean (±standard deviation) baseline RcSO2 was 73.6% (±11.8), cFTOE was 21.9 (±11.2) and LVO was 380 (±147) mL/kg/min prior to fentanyl infusion. One-way ANOVA showed no statistically significant difference between baseline and any of the post-fentanyl cerebral oxygenation, tissue oxygen extraction or cardiac output measures (p > 0.05).

Conclusion: Administration of fentanyl bolus for procedural pain and sedation was not shown to significantly affect cerebral oxygenation, cerebral tissue oxygen extraction or cardiac output in stable preterm infants.

Keywords: Cerebral oxygen saturation; Fentanyl; Near-infrared spectroscopy; Non-invasive cardiac output monitoring; Preterm.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain
  • Canada
  • Cerebrovascular Circulation
  • Child, Preschool
  • Fentanyl*
  • Hemodynamics
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature*
  • Oxygen / analysis
  • Spectroscopy, Near-Infrared


  • Oxygen
  • Fentanyl