Efficacy of melatonin for auditory brainstem response testing in children: A systematic review

Objective: To examine the literature on pre-treatment with melatonin for successful completion of Auditory Brainstem Response (ABR) testing in pediatric patients and evaluate melatonin dosing protocols. Data sources: The Cochrane Library, PubMed, Ovid MEDLINE, and Web of Science from inception through May 20th, 2019. In addition, a retrospective case series of pediatric patients (<18yr) who underwent melatonin assisted ABR testing between 2015 and 2018 was performed at our institution. Review methods: Prospective and retrospective studies involving melatonin use in pediatric patients (<18yrs) for auditory brainstem response testing were evaluated. Studies meeting inclusion/exclusion criteria reported success rate of ABR testing using melatonin pre-treatment, dosage of melatonin used, duration of sleep, and whether adverse events occurred. Results: 43 studies were identified, 8 studies were selected, and finally 5 studies were included in the review. A total of 480 pediatric patients underwent ABR testing with pre-treatment of melatonin with success rates ranging from 65% to 86.7%. Age across studies ranged from 1 month to 14 years, 6 months. Dosage of melatonin varied from 0.25 mg for patients <3 months of age to 20 mg for patients >6 years of age, with one study using a weight-based approach. No significant adverse events were reported by any of the included studies. Conclusion: Pre-medication with melatonin may be a useful option for obtaining successful results of non-sedated ABR testing in pediatric patients and may provide a useful alternative to sedation. Dosing patterns are highly variable. No adverse events were reported with any dosing strategy.