OBJECTIVES Melatonin has been trialed with reported increasing use for sleep dysregulation and prevention of ICU delirium in critically ill adults; however, reports of use in hospitalized pediatric patients are limited. We anecdotally observed an increase in prescribing of melatonin in our tertiary care children’s hospital and therefore aimed to retrospectively characterize prescribing practices over time. METHODS Melatonin dispensing data over a 4-year time frame were extracted. Melatonin doses were categorized as being either ICU or non-ICU administered and dosed during daytime versus nighttime, respectively. Descriptive statistics were used to characterize patients who were administered melatonin, dosing information, and quantitative change in annual melatonin orders between areas. The comparison of daytime versus nighttime melatonin administrations and ratio of administrations between ICU and non-ICU areas for each study year were compared via χ2 test. RESULTS Administration of melatonin increased 246.2% between years 1 and 3, with a shift from predominance in ICU to non-ICU areas over the study period (P < .0001). The average dosing varied by age, with the most frequent dose being 5 mg (28.3%), predominantly in patients ≥12 years of age. Ninety-eight percent (n = 9434) of doses were scheduled for nighttime administration, suggesting an indication of sleep regulation. There were significantly more daytime administrations of melatonin in non-ICU areas (P < .0001). CONCLUSIONS Prescribing of melatonin for pediatric inpatients has increased substantially over a 4-year period, despite limited research on dosing, in this single-center. Further research is needed to determine best practices for melatonin prescribing for hospitalized children.
OBJECTIVES: Many children with cancer have repeated and prolonged hospitalizations, and in-hospital sleep disruption may negatively affect outcomes. Our objective for this study was to characterize sleep quality and quantity in hospitalized children with cancer by using parental surveys and actigraphy, to evaluate the association between subjective and objective sleep measures, and to describe hospital-associated risk factors related to poor sleep. METHODS: Cross-sectional study of children aged 0 to 18 years old admitted to a pediatric oncology ward. Parents completed a baseline sleep questionnaire describing their child’s sleep at home before hospitalization, followed by daily questionnaires describing their child’s sleep for up to 3 nights while in the hospital. A subgroup of children aged 5 to 18 years wore actigraphs during the same time period. Demographic and clinical data were extracted from the electronic medical record. The primary outcome was inadequate sleep, defined by the total sleep duration adjusted for age. RESULTS: Among 56 participants over 135 hospital nights, 66% (n = 37) reported inadequate sleep. Actigraphy was completed on 39 nights (29%), with a median total sleep time of 477 (interquartile range 407–557) minutes. There was a strong correlation between subjective questionnaire measures and actigraphic measures (r = 0.76). No patient-specific demographic factors were related to inadequate sleep. A multivariable model indicated the following hospital-related factors were associated with inadequate sleep: noise (adjusted odds ratio [aOR] 3.0; confidence interval [CI] 1.2–7.7), alarms (aOR 3.1; CI 1.2–8.3), child’s worries (aOR 2.8; CI 1.1–7.2), and receipt of benzodiazepines (aOR 2.9; CI 1.2–7.5). CONCLUSIONS: A majority of children experienced inadequate sleep during hospitalization. Subjective report of sleep duration correlated well with objective measures of sleep by actigraphy. Several potentially modifiable factors were independently associated with poor sleep. Further interventional studies are required to test approaches to optimize sleep in hospitalized children with cancer.