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Abstract O-03: DIURNAL PATTERN OF MELATONIN SECRETION IS HETEROGENEOUSLY MAINTAINED IN CRITICALLY ILL CHILDREN

Foster, J.1,2,3,4; Tijssen, J.2,3,4; Miller, M.2,3; Seabrook, J.2,3,4,5,6; Fraser, D.2,3,4

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 4–5
doi: 10.1097/01.pcc.0000537345.08195.9b
Oral Abstracts
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1IWK Health Centre, Pediatric Critical Care, Halifax, Canada

2Western University, Pediatrics, London, Canada

3Children’s Health Research Institute, None, London, Canada

4Lawson Health Research Institute, None, London, Canada

5Brescia College of Western University, School of Food and Nutritional Sciences, London, Canada

6Western University, Epidemiology & Biostatistics, London, Canada

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Aims & Objectives:

Melatonin secretion patterns in critically ill children are poorly understood. This study examined whether diurnal variation of melatonin secretion was maintained during the early phase of PICU admission.

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Methods

Prospective, observational study of children (3 months to 18 years) within 24 hours of PICU admission with access for urinary sampling and PRISM III of ≥1. Urine samples collected at 4-hour intervals for 24 hours, stored at -80oC, and 6-sulfatoxymelatonin (aMT6s) was determined in duplicate by direct ELISA.

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Results

Fifty patients, heterogeneous for diagnosis, median age of 97.2 (IQR = 73.2) months, and median PRISM III of 10 (IQR=8). Mean (SD) total daily aMT6s production was higher than literature normal values (p<0.01) in the age <3 year group (13.6[10.2]mcg, n=14) and similar (p=0.86) for the 3–18 years group (37.7[27.5], n=30). Mean aMT6s production fit a periodic function, with amplitude 326ng/hour, peak excretion 1568ng/hour from 04:00 to 08:00, and nadir from 16:00 to 20:00 (F=4.43, p=0.01). Patients with respiratory failure requiring intubation and deep sedation (n=8) demonstrated a non-reliable amplitude of 117ng/hour (p=0.36), and model fit for a periodic function was poor (F=0.44, p=0.67), Figure 1. Similar results were demonstrated for patients with neurologic injury (n=6; amplitude 586ng/hour, p=0.22; F=0.74, p=0.49; Figure 2), and with sepsis (n=14; amplitude 147ng/hour, p=0.41; F=0.33, p=0.72; Figure 3)

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Conclusions

Diurnal variation of aMT6s production and excretion is heterogeneously maintained early in pediatric critical illness, though this may not hold true for specific diagnostic categories.

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies