Intranasal Fentanyl in Preterm Infants Undergoing Peripherally Inserted Central Catheter Placement

Inclusion Criteria: * Infants with a gestational age at birth \< 32 weeks or birth weight \< 1.5 kg * Infants considered medically appropriate for the study by the most responsible physician Exclusion Criteria: * Infants with choanal atresia, nasal mucosal erosion, or epistaxis * Infants with facial anomalies * Infants diagnosed with genetic conditions known to affect neurological development or severe (grade ≥ III) intraventricular hemorrhage * Infants receiving continuous intravenous infusions or scheduled enteral doses of opioids or sedatives within 12 hours of PICC placement * Infants with cardiopulmonary instability managed with inotropes, vasopressors, phosphodiesterase enzyme inhibitors, or neuromuscular blocking agents at the time of PICC placement * Infants prescribed strong CYP3A4 inhibitors (clarithromycin, itraconazole, ketoconazole, posaconazole, ritonavir, voriconazole) at the time of PICC placement * Infants diagnosed with bronchopulmonary dysplasia (need for supplemental oxygen or need for ventilatory support at 36 weeks corrected gestational age) * Infants with a previous documented adverse reaction to any formulation of fentanyl Each eligible infant will be enrolled for one PICC placement only during the study period