Original ArticleHigh Endogenous Melatonin Levels in Critically Ill Children: A Pilot Study
Section snippets
Methods
This prospective study was conducted in the PICU at University Hospital of Messina between November 2010 and August 2011. Inclusion criteria were as follows: age >1 month, estimated need for invasive mechanical ventilation >2 days. The risk of mortality was assessed by the Pediatric Risk of Mortality (PRISM) score16 and was used to evaluate indirectly the severity of the illness and the need for mechanical ventilation. Children were excluded if their legal guardian refused to participate in the
Results
Sixteen critically ill patients were enrolled. All children were prepuberal. Patients’ characteristics are presented in Table I. All patients were mechanically ventilated and sedated with midazolam (2.3 ± 1.7 μg/kg/min) and fentanyl (2.1 ± 1.7 μg/kg/h).
Melatonin serum peaks in 14 of the 16 patients studied were greater compared with the values reported in the literature for healthy age-matched children.18 As expected, melatonin peaks were greater, although not significantly, in subjects 1-5
Discussion
Melatonin secretion exhibits a strong circadian periodicity closely related to the normal cyclic change between daytime activity and sleep during night.19 Our data confirm that in patients in the ICU, this physiologic pattern is grossly disturbed or is even completely absent. The mechanism behind the disturbed melatonin secretion rhythm in patients in the ICU is unknown but likely depends on various environmental factors as well as factors related to drug therapy and possibly the
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2021, Handbook of Clinical NeurologyCitation Excerpt :In our report, infants maintained in constant light conditions (249 ± 11 lux), melatonin levels remained low and constant, while infants exposed to a cycle of illumination of 249 ± 11 lux during the day and 27 ± 0.8 lux at night exhibited a daily rhythmicity of salivary melatonin. These observations are supported by a previous study in which high levels of melatonin and rhythm disturbance were observed in newborns admitted to the NICU in constant light conditions (Marseglia et al., 2013). This finding indicates that a well-established alternation of an LD cycle condition is beneficial for the maturation of the baby's physiology and for the circadian system.
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The authors declare no conflicts of interest.