Pain Managment in Preterm Neonates

• Intra nasal fentanyl group: will receive intranasal fentanyl using nasal dose of INF is 1.5µg/kg/dose, and typically, one dose is given

• After 5minutes, a second dose could be administrated based on the clinical assessment (maximum two doses per procedure)
• Intravenous fentanyl group: will receive intravenous fentanyl(1 µg/kg/dose) and typically, one dose is given •After 5minutes, a second dose could be administrated based on the clinical assessment (maximum two doses per procedure) Measure MDA (Malondialdehyde ) level as oxidative stress marker in pain response , venous blood sample 0.5 ml will be collected twice, just before and 30 minutes after the procedure Monitor adverse events after fentanyl use as apnea (cessation of breathing for >20 s), bradycardia (heart rate < 100 beats/minute), desaturation (oxygen saturation < 80%), and chest wall rigidity associated with laryngospasm (Pacifici, 2015) for 60 min after IN fentanyl administration.

Inclusion criteria

• Preterm neonates during endotracheal intubation

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Exclusion criteria

o Contraindication of fentanyl use as hypersensitivity.

• Contraindication of nasal administration of drugs as bilateral occluded nasal passage as choanal atresia and Epistaxis.
• Surgical patients.