Melatonin and Neonatal Sepsis: A Promising Antioxidant Adjuvant Agent

Marseglia, Lucia; Reíter, Russel J.; Buonocore, Giuseppe; Gitto, Eloisa; D’Angelo, Gabriella

doi:10.1055/s-0037-1604244

Cited by 16 publications

(9 citation statements)

References 88 publications

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“…Moreover, there was a shorter length of stay in the MT group compared to the CT group, and there was no mortality in the MT group while there were 6 (30%) mortality in CT. This was comparable to [11,13,18,19] who declared that as a therapeutic agent in sepsis, melatonin has been associated with decreased inflammatory markers and improved outcomes.…”

Section: Discussionsupporting

confidence: 73%

Melatonin as an adjuvant therapy in preterm infants with neonatal sepsis, randomized trial

El-Kabbany

El-Farghali

Khafagy

et al. 2020

Egypt Pediatric Association Gaz

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Background: Neonatal sepsis (NS) is a systemic uncontrolled inflammatory response to an infectious agent, resulting in oxidative stress. Melatonin antioxidant and free radical scavenger proved to be safe in neonates. We aimed to evaluate the efficacy and safety of melatonin as adjuvant therapy in NS. This was an interventional trial conducted on 40 preterm neonates with NS diagnosed on the basis of clinical and laboratory criteria. They were simply randomized to melatonin treated (MT) (n = 20) and conventionally treated (CT) (n = 20) groups. Melatonin was administered at a total dose of 20 mg enterally in two divided doses of 10 mg each, 1 h apart. Malondialdehyde (MDA) was assessed in patients at enrollment, 4 and 72 h later in MT, and 72hours later in CT. Fifteen healthy matched neonates were included as a control. Results: There were no significant differences between MT and CT groups regarding baseline sepsis workup. However, total leucocytic count, absolute neutrophil count, and C-reactive protein were significantly higher and platelets were significantly lower in CT compared to MT after 72 h. MDA was doubled in CT while reduced in MT 72 h after intervention (p = 0.000). Mortality was significantly lower in MT. No side effects following melatonin administration were reported. Conclusion:Melatonin is effective and safe adjuvant for treatment of NS that improves clinical and laboratory outcomes.

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Section: Discussionsupporting

confidence: 73%

Melatonin as an adjuvant therapy in preterm infants with neonatal sepsis, randomized trial

El-Kabbany

El-Farghali

Khafagy

et al. 2020

Egypt Pediatric Association Gaz

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“…Interestingly, higher melatonin levels were demonstrated in septic newborns with LOS in comparison to uninfected controls [ 102 ], suggesting that melatonin endogenous production might be upregulated during sepsis, taking part in antioxidant defense. Basing on these favorable preliminary data, randomized control trials are warranted to assess efficacy and safety of melatonin as an adjunct treatment in neonatal sepsis [ 103 ].…”

Section: Antioxidant Strategies In Neonatal Sepsismentioning

confidence: 99%

Sepsis and Oxidative Stress in the Newborn: From Pathogenesis to Novel Therapeutic Targets

Poggi

Dani

2018

Oxidative Medicine and Cellular Longevity

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Sepsis is at present one of the leading causes of morbidity and mortality in the neonatal population. Together with inflammation, oxidative stress is involved in detrimental pathways activated during neonatal sepsis, eventually leading to organ dysfunction and death. The redox cascade during sepsis is mainly initiated by IL-6 and IL-8 stimulation in newborns and includes multiple noxious processes, as direct cell damage induced by reactive oxygen species, activation of gene expression leading to amplification of inflammation and oxidative stress, and impairment of mitochondrial function. Once proinflammatory and prooxidant pathways are established as stimulated by causing pathogens, self-maintaining unfavorable redox cycles ensue, leading to oxidative stress-related cellular damage, independently from the activating pathogens themselves. Despite antioxidant systems are induced during neonatal sepsis, as an adaptive response to an increased oxidative burden, a condition of redox imbalance favoring oxidative pathways occurs, resulting in increased markers of oxidative stress damage. Therefore, antioxidant treatment would exert beneficial effects during neonatal sepsis, potentially interrupting prooxidant pathways and preventing the maintenance of detrimental redox cycles that cannot be directly affected by antibiotic treatment. Among others, antioxidant agents investigated in clinical settings as adjunct treatment for neonatal sepsis include melatonin and pentoxifylline, both showing promising results, while novel antioxidant molecules, as edaravone and endothelin receptor antagonists, are at present under investigation in animal models. Finally, mitochondria-targeted antioxidant treatments could represent an interesting line of research in the treatment of neonatal sepsis.

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“…In conclusion, several studies are needed to discover therapeutic strategies to attenuate uncontrolled inflammatory reaction and provide other medical opportunities to treat NEC, before it evolves into a serious sepsis [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Current status of laboratory and imaging diagnosis of neonatal necrotizing enterocolitis

et al. 2018

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Necrotizing enterocolitis continues to be a devastating disease process for very low birth weight infants in Neonatal Intensive Care Units. The aetiology and pathogenesis of necrotizing enterocolitis are not definitively understood. It is known that necrotizing enterocolitis is secondary to a complex interaction of multiple factors that results in mucosal damage, which leads to intestinal ischemia and necrosis. Advances in neonatal care, including resuscitation and ventilation support technology, have seen increased survival rates among premature neonates and a concomitant detection in the incidence of this intestinal disease.Diagnosis can be difficult, and identifying infants at the onset of disease remains a challenge. Early diagnosis, which relies on imaging findings, and initiation of prompt therapy are essential to limit morbidity and mortality. Moreover, early management is critical and life-saving.This review summarizes what is known on the laboratory and instrumental diagnostic strategies needed to improve neonatal outcomes and, possibily, to prevent the onset of an overt necrotizing enterocolitis.

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Melatonin and Neonatal Sepsis: A Promising Antioxidant Adjuvant Agent

Cited by 16 publications

References 88 publications

Melatonin as an adjuvant therapy in preterm infants with neonatal sepsis, randomized trial

Melatonin as an adjuvant therapy in preterm infants with neonatal sepsis, randomized trial

Sepsis and Oxidative Stress in the Newborn: From Pathogenesis to Novel Therapeutic Targets

Current status of laboratory and imaging diagnosis of neonatal necrotizing enterocolitis

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