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Melatonin Administration Patterns for Pediatric Inpatients in a Tertiary Children's Hospital
David E Procaccini1, Sapna R Kudchadkar2
1Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland dprocac1@jhmi.edu.
Insights
Pediatric inpatient melatonin use surged over four years, shifting from intensive care units to general care. Most prescriptions were for nighttime sleep regulation, but further research is needed for optimal pediatric dosing.
Area of Science:
- Pediatric Pharmacology
- Sleep Medicine
- Critical Care Pediatrics
Background:
- Melatonin use is increasing for sleep issues and delirium prevention in adults.
- Data on melatonin use in hospitalized children is limited.
- Anecdotal observations suggested increased melatonin prescribing in a pediatric hospital.
Purpose of the Study:
- To retrospectively characterize melatonin prescribing practices in pediatric inpatients.
- To analyze trends in melatonin administration over a four-year period.
Main Methods:
- Extracted melatonin dispensing data over four years.
- Categorized doses by ICU/non-ICU and daytime/nighttime administration.
- Used descriptive statistics and chi-squared tests for analysis.
Main Results:
- Melatonin administration increased by 246.2% between years 1 and 3.
- There was a significant shift from ICU to non-ICU administration (P < .0001).
- Most doses (98%) were for nighttime administration; 5 mg was the most frequent dose.
Conclusions:
- Pediatric inpatient melatonin prescribing has significantly increased.
- Current research on pediatric dosing and best practices is insufficient.
- Further studies are required to establish optimal melatonin prescribing guidelines for hospitalized children.
Objectives:
Melatonin has been trialed with reported increasing use for sleep dysregulation and prevention of ICU delirium in critically ill adults; however, reports of use in hospitalized pediatric patients are limited. We anecdotally observed an increase in prescribing of melatonin in our tertiary care children's hospital and therefore aimed to retrospectively characterize prescribing practices over time.
Methods:
Melatonin dispensing data over a 4-year time frame were extracted. Melatonin doses were categorized as being either ICU or non-ICU administered and dosed during daytime versus nighttime, respectively. Descriptive statistics were used to characterize patients who were administered melatonin, dosing information, and quantitative change in annual melatonin orders between areas. The comparison of daytime versus nighttime melatonin administrations and ratio of administrations between ICU and non-ICU areas for each study year were compared via χ2 test.
Results:
Administration of melatonin increased 246.2% between years 1 and 3, with a shift from predominance in ICU to non-ICU areas over the study period (P < .0001). The average dosing varied by age, with the most frequent dose being 5 mg (28.3%), predominantly in patients ≥12 years of age. Ninety-eight percent (n = 9434) of doses were scheduled for nighttime administration, suggesting an indication of sleep regulation. There were significantly more daytime administrations of melatonin in non-ICU areas (P < .0001).
Conclusions:
Prescribing of melatonin for pediatric inpatients has increased substantially over a 4-year period, despite limited research on dosing, in this single-center. Further research is needed to determine best practices for melatonin prescribing for hospitalized children.
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