Melatonin Use and Association With Delirium Burden Among Children Admitted to an Intensive Care Unit Within a Large Pediatric Healthcare Organization

Background: Sleep disruption and delirium are common among children requiring intensive care. Melatonin secretion is altered in critical illness and supplementation may be beneficial. Objective: To characterize melatonin use among children admitted to a pediatric intensive care unit (PICU) within a large pediatric healthcare organization and explore associations with delirium screening scores. Patients and Methods: This was a retrospective, observational study of children (1 month-18 years) admitted to 2 PICUs between January 1, 2021, and January 1, 2023. Results: A total of 642 admissions (556 patients; age = 8.8 ± 5.6 yr.) were included and represented approximately 8% of total PICU admissions during the study period. The mean melatonin dose was 3 ± 2.43 mg. Sixty percent of admits started melatonin within 48 hours of PICU admission. Eighty-three percent continued melatonin after transfer to the floor. An association between melatonin and a reduction in the percent of delirium scores ≥9 was observed in patients receiving melatonin for presumed delirium, with a more robust reduction detected in those receiving at least 7 days of melatonin therapy. Twenty-five percent of admits not on melatonin prior to admission were discharged with a new melatonin prescription. Conclusions: Melatonin, when prescribed in the PICU is typically started within 48 hours of admission at a dose of 3 mg. A reduction in the burden of positive delirium scores was observed after starting melatonin in children using melatonin for presumed delirium. Continuation of therapy after ICU transfer and discharge to home is common.