Melatonin in Pediatric Critical Care: From Physiology to Bedside Roles

Melatonin is an endogenous indoleamine synthesized by the pineal gland. Though melatonin is best known for its chronobiologic effects, regulating the circadian rhythm and sleep, it might play a wider role in critical illness. It has been proposed for use as an analgesic and sedative, an antihypertensive, an anti-inflammatory, and for the prevention of delirium. Melatonin use in children has increased dramatically over the years, but the evidence on its use in critically ill children remains limited. This review article aimed to describe the basic physiology and biology of melatonin, including its production and functions, dosing, and side effects, and provide current evidence on its potential roles in critically ill children.