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Exogenous melatonin was detected in seven pediatric postmortem investigations in North Carolina. These findings highlight the need for increased awareness and toxicological screening for melatonin in infant and toddler deaths.

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Area of Science:

  • Forensic Toxicology
  • Pediatric Medicine
  • Neuroendocrinology

Background:

  • Melatonin, a neurohormone regulating circadian rhythms, is widely available in over-the-counter supplements marketed for children.
  • Endogenous melatonin production in infants begins around 3 months of age, with plasma concentrations peaking at approximately 0.2 ng/mL during darkness.
  • Commercial melatonin supplements can result in exogenous levels significantly exceeding natural endogenous concentrations.

Purpose of the Study:

  • To report on postmortem findings of exogenous melatonin in infant and toddler deaths investigated by the North Carolina Office of the Chief Medical Examiner.
  • To examine the implications of these findings concerning regulatory control of supplements and potential impacts on sleep-related infant deaths.

Main Methods:

  • Toxicological analysis of postmortem whole blood samples from seven pediatric cases (2 months to 3 years) investigated since 2015.
  • Review of case circumstances and classification of cause and manner of death.

Main Results:

  • Exogenous melatonin was detected in all seven cases, with concentrations ranging from 3 to 1,400 ng/mL.
  • The cause and manner of death for all seven cases were classified as undetermined.
  • Findings are considered noteworthy given the substantial elevation above endogenous melatonin levels.

Conclusions:

  • The presence of exogenous melatonin in pediatric postmortem cases warrants attention and further investigation.
  • Minimal regulatory oversight of commercial melatonin products and potential associations with hazardous sleeping conditions require consideration.
  • Forensic toxicology laboratories should consider testing for exogenous melatonin in relevant pediatric postmortem cases.