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This study evaluated fentanyl use during ECMO and subsequent methadone or buprenorphine treatment among pediatric ECMO survivors in a large multi-center cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included children\u2009&lt;\u200918y treated at 41 U.S. children\u2019s hospitals in the Pediatric Health Information System between 2013 and 2023. Multivariable hierarchical regression was used to assess the relationship between fentanyl exposure on ECMO and likelihood of receiving methadone or buprenorphine after ECMO, adjusting for covariates including other opioid exposures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 4,365 children were included (55.5% male; 47.9% neonatal). Median duration of ECMO was 5 (IQR: 3\u20138) days. Fentanyl exposure was categorized into quartiles:0\u20131 days, 2 days, 3\u20134 days, and \u2265\u20095 days. On multivariable regression, children in the 3\u20134 days quartile (OR 1.32; 95% CI: 1.05\u20131.65) and \u2265\u20095 days quartile (OR 2.21; 95% CI: 1.71\u20132.85) were more likely to receive methadone or buprenorphine after ECMO compared to those in the 0\u20131 days quartile. On bivariate comparison, children who received fentanyl during ECMO were found to have prolonged ventilator dependence, TPN use, and post-ECMO length of stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients receiving fentanyl while on ECMO had an increased risk of receiving methadone or buprenorphine treatment post-ECMO, suggesting a higher risk of opioid withdrawal in patients receiving fentanyl while on ECMO. Our findings underscore a need for expanded opioid stewardship initiatives to utilize alternative pain management and minimize fentanyl prescribing for children undergoing ECMO.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00383-025-06267-5","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T10:05:13Z","timestamp":1780913113000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fentanyl Utilization During Extracorporeal Membrane Oxygenation and Risk of Methadone Treatment Among Pediatric ECMO Survivors"],"prefix":"10.1007","volume":"42","author":[{"given":"Rabab M.","family":"Barq","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shadassa","family":"Ourshalimian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia A.","family":"Keane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara P.","family":"Nelson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwini","family":"Lakshmanan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry C.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan R.","family":"Hintz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asavari","family":"Kamerkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine I.","family":"Kelley-Quon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"6267_CR1","doi-asserted-by":"publisher","unstructured":"Shekar K, Roberts JA, Mcdonald CI, Ghassabian S, Anstey C, Wallis SC et al Protein-bound drugs are prone to sequestration in the extracorporeal membrane oxygenation circuit: results from an ex vivo study 2015. https:\/\/doi.org\/10.1186\/s13054-015-0891-z","DOI":"10.1186\/s13054-015-0891-z"},{"key":"6267_CR2","doi-asserted-by":"publisher","first-page":"S629","DOI":"10.21037\/jtd.2017.09.154","volume":"10","author":"V Cheng","year":"2018","unstructured":"Cheng V, Abdul-Aziz MH, Roberts JA, Shekar K (2018) Optimising drug dosing in patients receiving extracorporeal membrane oxygenation. 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