Update on the use of melatonin in pediatrics

Abstract

: Melatonin, an endogenously produced indoleamine, is a highly effective antioxidant, free radical scavenger, and a primary circadian regulator. Melatonin has important antioxidant properties owing to direct and indirect effects. It directly scavenges reactive oxygen and reactive nitrogen species, prevents molecular oxidation, improves mitochondrial physiology, and restores glutathione homeostasis. Its indirect antioxidant effects stem from its ability to stimulate the activities of the enzymes involved in the glutathione cycling and production. Melatonin, by reducing free radical damage, may be an effective protective agent for the fetus as it is in adults. Several clinical studies on melatonin have shown that it reduces oxidative stress in human newborns with sepsis, hypoxic distress, or other conditions, where there is excessive free radical generation. A role of melatonin in infant development has also been suggested. Pineal dysfunction may be associated with deleterious outcomes in infants and may contribute to an increased prevalence of sudden infant death syndrome. Delayed melatonin production is evident in infants who had experienced an apparent life‐threatening event. Melatonin has been used as a pharmacologic treatment for insomnias associated with shift work, jet lag, and delayed sleep onset in adults for decades. In children as well, melatonin has value as a sleep‐promoting agent. Evidence suggests that melatonin has utility as an analgesic agent presumably related to its ability to release β‐endorphin. The data support the notion that melatonin, or one of its analogs, might find use as an anesthetic agent in children.

Comparison of Effects of Melatonin and Gabapentin on Post Operative Anxiety and Pain in Lumbar Spine Surgery: A Randomized Clinical Trial

“…The analgesic, anti-inflammatory, anti-anxiety, and anti-agitation effects of melatonin have been shown in several studies (10). Several studies have reported that melatonin, given as preoperative premedication, is associated with sedation and preoperative anxiolysis without mental dysfunction including the memory recall and driving performances or the quality of recovery.…”

Melatonin Protects the Heart, Lungs and Kidneys from Oxidative Stress under Intermittent Hypobaric Hypoxia in Rats

“…It is a highly effective antioxidant, scavenging hydroxyl radicals and inhibiting the production of nitric oxide (Gitto et al, 2011;Serel et al, 2004) and other antioxidants like vitamins E and C (Kücükakin et al, 2009). The ability of melatonin to counteract ROS formation is due to the special characteristic of this substance to cross morpho and physiological barriers distributed in tissues, cells and sub-cellular compartments due to its distinct physical and chemical properties (Costa et al, 1995;Tomás-Zapico et al, 2005).…”

Consenso sobre el uso de melatonina en niños y adolescentes con dificultades para iniciar el sueño

“…Dosis de 1-5 mg producen en 1 h concentraciones plasmáticas que son 10-100 veces mayores que las del pico máximo nocturno, para descender a los valores normales en 4-8 h 35,36 .…”

“…Basándonos en las series de casos y ensayos clínicos publicados (todos en mayores de un año), debe administrarse a la misma hora y entre 30-60 min antes de la hora habitual de ir a dormir 35 .…”