Melatonin Supplementation in Undetermined Pediatric Deaths

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.