321 - Melatonin Use for Chronic Pain Management in Infants with Severe BPD in a Level IV NICU

Publication Number: 4315.321

Amber Walters, Phoenix Children's Hospital, Phoenix, AZ, United States; Anya R. Khurana, Creighton University School of Medicine, Phoenix, AZ, United States; Emily Koe, Creighton University School of Medicine, Phoenix, AZ, United States; Ian Kloehn, UT-Austin/Dell Medical School, Austin, TX, United States; Rhonda Kurz, Phoenix Children's Hospital, Phoenix, AZ, United States; Sheralyn Kaprolet, Phoenix Children's Hospital, Phoenix, AZ, United States; Andrew Ritchey, Phoenix Children's Hospital, Phoenix, AZ, United States; Lucia Mirea, Phoenix Children's, Scottsdale, AZ, United States; Landon Mattingly, Phoenix Children's Hospital, Phoenix, AZ, United States; Pamela Griffiths, Phoenix Children's Hospital, Gilbert, AZ, United States; Mohammed Elkhwad, Phoenix Children's Hospital, Phoenix, AZ, United States; Navin Bhopal, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Melatonin has been shown to reduce inflammation and oxidative injury in neonates, but limited data exist on its effects on pain and sedation in severe bronchopulmonary dysplasia (BPD).

Objective: To evaluate associations between melatonin use and pain scores, analgesia use and respiratory severity in severe BPD.

Design/Methods: In this retrospective case-control study, infants with grade 2-3 BPD admitted to the NICU between 2016-2022 were included. Patients who received melatonin were compared to matched controls. Baseline demographics, daily Neonatal Pain, Agitation, and Sedation Scale (NPASS) scores, respiratory severity score (RSS), and opioid/benzodiazepine exposure were analyzed between 42-50 weeks postmenstrual age. The highest (NPASS-max) and lowest (NPASS-min) daily scores were recorded. Subgroup analyses were performed for infants with tracheostomies. Continuous variables were compared using the Kruskal-Wallis test and categorical variables with Fisher's exact test. A p-value < 0.05 was considered significant.

Results: Baseline characteristics were similar between groups (table 1). NPASS-min and NPASS-max were higher in melatonin-treated infants (table 2). Mean opioid use was lower in melatonin-treated infants than in controls, while benzodiazepine use and RSS did not differ (table 2). Among tracheostomy patients, melatonin exposure was associated with lower opioid (0.035 ± 0.093 vs 0.157 ± 0.379 mg/kg/day, p< 0.0001), benzodiazepine (0.04 ± 0.10 vs 0.11 ± 0.19 mg/kg/day, p< 0.0001), and RSS values (5.54 ± 2.65 vs 8.37 ± 3.65, p< 0.0001).

Conclusion(s): In infants with severe BPD, melatonin use was associated with reduced opioid requirements, particularly in those with tracheostomies, along with decreased benzodiazepine use and improved respiratory scores. NPASS differences were not clinically significant. These findings suggest melatonin may reduce analgesic and sedative needs and improve respiratory status in this high-risk population. Results should be interpreted cautiously given the retrospective design and potential confounding variables.

Baseline Demographics
Table 1. Baseline demographics of controls and subjects treated with melatonin. Continuous variables are shown as medians (IQR) and categorical variables as counts (%).

NPASS scores, opiate requirements, benzodiazepine requirements and RSS
Table 2: Comparison of daily NPASS scores, opiate requirements, benzodiazepine requirements and RSS in patients treated with and without melatonin for all patients (left side of table) and for patients with tracheostomies (right side of table). Values are expressed as mean +/- standard deviation.