{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:41:26Z","timestamp":1791819686741,"version":"4.3.4"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The objective of this review was to evaluate the effectiveness and safety of intranasal fentanyl for the management of procedural pain in infants aged 0 to 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Procedural pain in early infancy is frequently undertreated, with limitations in both pharmacological and non-pharmacological interventions. Retinopathy of prematurity screening is a painful procedure for infants, and although sucrose and topical anesthetics are standard, their analgesic effect is often inadequate. Intranasal fentanyl may offer an effective adjunct; however, its use in infants under 6 months has not been systematically reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria:<\/jats:title>\n                    <jats:p>This review included randomized controlled trials evaluating intranasal fentanyl in infants \u22646 months of corrected age undergoing painful procedures, compared with placebo, no treatment, or alternative analgesics. Studies with &lt;20% of infants in this age range or that focused on chronic pain were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This systematic review followed JBI methodology and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A 3-step search strategy was performed in MEDLINE (Ovid), Embase, CINAHL (EBSCOhost), Scopus, and Cochrane CENTRAL, with a final search date of February 2025, with no date or language restrictions in the search. The studies were selected and critically appraised by 2 reviewers independently. Data were extracted and synthesized using a meta-analysis or narrative summary, as appropriate. The certainty of the evidence was assessed using a standardized approach. No deviations from the protocol were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Two randomized controlled trials (n=153 preterm infants) evaluated intranasal fentanyl (2 mcg\/kg) during retinopathy of prematurity screening. In one trial, adding intranasal fentanyl to sucrose (plus topical anesthetic and physical containment) reduced pain scores on the Premature Infant Pain Profile-Revised scale vs sucrose alone, whereas another trial found that intranasal (2 mcg\/kg) and intravenous (1 mcg\/kg) fentanyl without routine sucrose did not outperform sucrose. Serious adverse events were not observed; transient apnea\/desaturation resolved with minimal stimulation. Certainty was low to moderate due to imprecision and inconsistency. Findings were specific to preterm infants undergoing retinopathy of prematurity screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Intranasal fentanyl may reduce procedural pain in stable preterm infants, with no serious safety concerns. However, the findings are based on 2 small trials with methodological limitations and moderate risk of bias. Further high-quality research is needed to confirm the efficacy, optimize dosing, and assess the safety in broader infant populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Review registration:<\/jats:title>\n                    <jats:p>PROSPERO CRD42024551524<\/jats:p>\n                  <\/jats:sec>","DOI":"10.11124\/jbies-25-00349","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T07:00:19Z","timestamp":1776150019000},"page":"1346-1367","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness and safety of intranasal fentanyl for pain management in infants aged 0 to 6 months: a systematic review"],"prefix":"10.11124","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4002-1770","authenticated-orcid":false,"given":"Helen","family":"McCord","sequence":"first","affiliation":[{"name":"Faculty of Health, School of Nursing, Dalhousie University, Halifax, NS, Canada"},{"name":"Division of Neonatology, Department of Pediatrics, IWK Health, Halifax, NS, Canada"},{"name":"MOM-LINC Lab, IWK Health, Halifax, NS, Canada"},{"name":"IWK Health, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0958-5758","authenticated-orcid":false,"given":"Cameron","family":"Bruce","sequence":"additional","affiliation":[{"name":"MOM-LINC Lab, IWK Health, Halifax, NS, Canada"},{"name":"IWK Health, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3745-1277","authenticated-orcid":false,"given":"Nadeana","family":"Norris","sequence":"additional","affiliation":[{"name":"Faculty of Health, School of Nursing, Dalhousie University, Halifax, NS, Canada"},{"name":"Division of Neonatology, Department of Pediatrics, IWK Health, Halifax, NS, Canada"},{"name":"MOM-LINC Lab, IWK Health, Halifax, NS, Canada"},{"name":"IWK Health, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3994-4192","authenticated-orcid":false,"given":"Lior","family":"Goldchtaub","sequence":"additional","affiliation":[{"name":"MOM-LINC Lab, IWK Health, Halifax, NS, Canada"},{"name":"IWK Health, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5491-1299","authenticated-orcid":false,"given":"Daria","family":"Hughes","sequence":"additional","affiliation":[{"name":"MOM-LINC Lab, IWK Health, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7529-9789","authenticated-orcid":false,"given":"Melissa","family":"Rothfus","sequence":"additional","affiliation":[{"name":"W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada"},{"name":"JBI Aligning Health and Evidence for Transformative Change, School of Nursing, Dalhousie University, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9594-2763","authenticated-orcid":false,"given":"Karlee","family":"Jones","sequence":"additional","affiliation":[{"name":"IWK Health, Halifax, NS, Canada"},{"name":"College of Pharmacy, Dalhousie University, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Disher","sequence":"additional","affiliation":[{"name":"IWK Health, Halifax, NS, Canada"},{"name":"Sandpiper Analytics, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7477-7264","authenticated-orcid":false,"given":"Souvik","family":"Mitra","sequence":"additional","affiliation":[{"name":"Division of Neonatology, 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