623 Melatonin Use in the Pediatric Intensive Care Unit: 5 year single center experience

Abstract

Introduction Pediatric patients requiring intensive care are at risk for unavoidable sleep and circadian disturbances because of the frequency and nature of delivering care for severe illness in this setting. There is growing appreciation for sleep as an essential component for neuropsychological and physical health. While exogenous influences (light and noise) and endogenous evaluation (melatonin levels) have been evaluated in this setting, there has not yet been investigation of current practice for exogenously administered melatonin in the pediatric intensive care unit (PICU). We aimed to evaluate baseline practice and changes in melatonin administration after implementation of delirium education. Methods In 2018, pediatric delirium education was implemented and included identification of sleep disturbance. A 5-year retrospective chart review (3-years baseline and 2-years after delirium education) was completed based on a pharmacy database that identified all patients who had melatonin administration while in PICU. Each admission was counted as an unique encounter. Data collection included patient age, date of admission, and length of stay (LOS). Data for melatonin included dose, starting date, duration of treatment (number of days), and indication. Indications for melatonin were (1) delirium, (2) insomnia, (3) circadian sleep wake disorder, (4) previous home medication, and (5) unable to determine from chart review. Results Over 5 years (2015 – 2020), 182 (6.0%) patients admitted to PICU (average age 9.3 +/- 5.8 years, average LOS 24.9 +/- 56.3 days) were given melatonin (average dose 4.0 +/- 2.3 mg). The most frequent indication for melatonin administration was continuation as a home medication (45.9%) and least frequent was sleep-wake disturbance (3.9%). The percentage of patients given melatonin as compared to total PICU admissions, nearly doubled from 4.4% in baseline group to 8.2% in post-delirium-education group. Further, “delirium” as indication for melatonin increased from 5.2% (baseline) to 15.4% (post-education). There were no notable changes for administration indication “insomnia” (18.2% vs 19.2%) or “unknown” (22.1% vs 19.2%). Conclusion This is the first exploratory study to evaluate frequency and indication of melatonin use in the PICU and changes in practice after implementing delirium education. Delirium education that includes sleep disturbance has had significant impact on frequency of melatonin administration. Support (if any):