Evaluation of Melatonin Practices for Delirium in Pediatric Critically Ill Patients

To determine the use of melatonin and its role in therapy for pediatric delirium (as either prophylaxis or treatment for delirium) in an academic medical center's PICU.

This retrospective, single-center study reviewed patients between 1 and 18 years of age admitted to the PICU between April 1, 2014, and February 29, 2019. Patients were included if they were admitted for greater than 48 hours and received melatonin for the indication of "delirium." Patients were excluded if melatonin was a home medication. Data collected included baseline characteristics, sedation and antipsychotic usage, assessment scores, and admission overview data. Descriptive statistics were used to report categorical data as percentages.

A total of 63 patients were included. Thirty-nine patients (62%) required antipsychotics post-melatonin exposure, with risperidone being the most frequently used agent. The average cumulative antipsychotic exposure pre- and post-melatonin initiation was 2 versus 13 days. The average cumulative exposure to sedating agents, including opioids, benzodiazepines, ketamine, dexmedetomidine, and propofol, pre- and post-melatonin initiation was 13 versus 10 days. The average hospital and PICU lengths of stay were 54 and 39 days, respectively. The initiation of melatonin was also associated with lighter levels of sedation and decreased pain scores.

Although the initiation of melatonin does not appear to decrease antipsychotic use, the results of this study may suggest a potential prophylactic effect in reducing the days of sedation the patient receives while inpatient.