Use of melatonin sedation for auditory brainstem response testing in children: safety and effectiveness

Abstract Background A wide range of sedative drugs are used for auditory brain stem response testing in pediatric population, but still there is no ideal sedative drug, because no single agent can provide adequate sedation while minimizing serious risks such as cardiorespiratory depression and also allow for rapid recovery. Methods A randomized clinical trial on 113 children aged 3–6 years with normal hearing. Group (A) comprised 83 children with normal neurodevelopment, and Group (B) included 30 children with neurodevelopmental disorders (NDD). Each group was subdivided according to the sedative used, either melatonin or CH. All children underwent otological examination, full audiological assessment to ensure normal hearing thresholds. Then ABR was done with the appropriate preparations; sedation was received, vital signs and adverse effects were monitored. Results Group A, initial sedation success rate was 69.8% with melatonin and 87.5% with chloral hydrate, with no statistically significant difference. Supplemental melatonin dosing increased success to 81.4%. nearly the same pattern was found with the children with NDD. Vital signs remained within normal ranges for both drugs, although chloral hydrate caused slightly more reductions in heart and respiratory rates. Arousal time was significantly shorter with melatonin. Adverse effects were mild and less frequent with melatonin. ABR thresholds and most of the waveform parameters showed no clinically significant differences between both sedatives. Conclusion Melatonin is a safe and effective alternative to chloral hydrate for sedation during paediatric ABR testing. Its flexible dosing, rapid recovery, favorable safety profile, and minimal impact on ABR parameters support its use in routine clinical practice, particularly in difficult-to-test children.