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Effect of Fentanyl for Preterm Infants on Mechanical Ventilation: A Systematic Review and Meta-Analysis

Yosuke Sudo1, Junko Seki-Nagasawa2, Daigo Kajikawa3

  • 1Department of Pediatrics, Yamagata University Faculty of Medicine, Yamagata, Japan.

Neonatology
|March 29, 2023
PubMed

Insights

Fentanyl did not show benefits for preterm infants on mechanical ventilation, with no impact on mortality or common morbidities. Further research is needed on long-term neurodevelopmental outcomes for these vulnerable infants.

Area of Science:

  • Neonatal Intensive Care
  • Pediatric Pharmacology
  • Evidence-Based Medicine

Background:

  • Mechanical ventilation in preterm neonates presents challenges in managing pain and discomfort.
  • Fentanyl is commonly used for pain relief, but evidence from systematic reviews is lacking.
  • This study addresses the need for a consensus on fentanyl's efficacy and safety in this population.

Approach:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed.
  • Searches were conducted across major scientific databases (MEDLINE, Embase, CENTRAL, CINAHL).
  • Inclusion criteria focused on preterm infants receiving mechanical ventilation and randomized to fentanyl versus control.

Key Points:

  • Fentanyl use was not associated with increased mortality risk (RR 0.72, 95% CI 0.36-1.44).
  • No significant differences were observed in ventilation duration (MD 0.04) or hospital stay length (MD 4.00).
  • Fentanyl did not affect major morbidities, including bronchopulmonary dysplasia, IVH, sepsis, or necrotizing enterocolitis.

Conclusions:

  • This systematic review found no demonstrable benefits of fentanyl for preterm neonates on mechanical ventilation regarding mortality or morbidities.
  • The findings highlight the need for further investigation into the long-term neurodevelopmental effects of fentanyl in this population.
Abstract

Keywords:
FentanylMechanical ventilationPreterm infantsSystematic review

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