Remifentanil versus Fentanyl for pain control during elective endotracheal intubation for surfactant administration in preterm infants

Mohammad Bagher Hosseini, Kayvan Mirnia, Morteza Ghojazadeh, Mahin Seyedhejazi, Babak Aharchi Farshi, Meysam Behtari, Faeghe Sheikhalizadeh Nobar


Introduction: Today, the reality of pain in neonates is an undisputed fact, but pain management in clinical practice remains a challenging issue. All neonatal units should have a pain management protocol. The aim of this study was to compare the effectiveness of Remifentanil versus Fentanyl in pain control during elective endotracheal intubation for surfactant administration in preterm infants.

Materials and methods: Preterm infants with gestational age between 28 weeks and 34 weeks + 6 days with Respiratory Distress Syndrome (RDS) who needed surfactant administration were divided into two groups using a random sampling method. Neonates in the first group received 2 μg/kg intravenous Fentanyl infusion and neonates in group 2 received 1 μg/kg intravenous Remifentanil before elective endotracheal intubation for surfactant therapy. The vital signs, including heart rate, oxygen saturation, mean arterial blood pressure and change in facial grimace were documented in an unnamed Premature Infant Pain Profile-Revised (PIPP-R) scoring sheet individually. Video recording was performed in both groups before, during and after the endotracheal intubation. All videos and data were interpreted and scored by two Newborn Individualized Developmental Care and Assessment Program (NIDCAP) professionals.

Results: The mean PIPP-R score in the Fentanyl-treated group was 13.06 ± 3.55 and in the Remifentanil-treated group was 10.75 ± 2.93, with no statistically significant difference (p = 0.054). There was less need for Naloxone use in the Remifentanil group (p < 0.001). Incidence of apnea, severe drop in oxygen saturation, Intra-Ventricular Hemorrhage (IVH) and chest rigidity were not significantly different between the two groups.

Conclusion: Although the difference was not statistically significant, Remifentanil reduced the pain score more than Fentanyl during elective endotracheal intubation in preterm infants. We recommend conducting further studies with larger study populations to determine the better drug and the optimal dosage of these drugs in neonates.


preterm infants; endotracheal intubation; Fentanyl; Remifentanil; Premature Infant Pain Profile – Revised; surfactant

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