Sarah M. Nofal, Abdel‑Rahman M. El‑Mashad, Asmaa M. Elmesiry, Amany M. Abouelenain, Mostafa M. Awny
Tanta University.
Egypt
European Journal of Pediatrics
Eur J Pediatr 2026; 185:
DOI: 10.1007/s00431-026-06864-z
Abstract
The aim of this study is to investigate the effects of melatonin on the left ventricular (LV) function in persistent pulmonary hypertension of the newborn (PPHN) and to assess its potential role in enhancing cardiac performance and reducing oxidative stress. This randomized controlled trial was conducted on 80 neonates (≥ 36 weeks’ gestational age) with PPHN confirmed by echocardiography (Echo). Participants were assigned to receive standard therapy alone or in combination with oral melatonin. LV function was evaluated using echocardiographic parameters, and levels of serum biomarkers of oxidative stress and inflammation were also measured. Unlike the placebo group, the melatonin group exhibited significantly better LV function, regarding the conventional and advanced echocardiographic parameters. Additionally, melatonin administration was associated with earlier weaning from mechanical ventilation (MV) and respiratory support, shorter hospital stays, lower levels of serum high-mobility group box-1 (HMGB1) protein, and N-terminal pro-B-type natriuretic peptide (NT-proBNP).
Conclusion: Melatonin can enhance LV function in PPHN, likely through its cardioprotective and antioxidative mechanisms. These findings support melatonin as a promising adjunctive therapy in neonatal pulmonary hypertension, warranting further investigation in larger clinical trials.
Trial registration: registered on ClinicalTrials.gov (ID: NCT07090720), URL: https://clinicaltrials.gov/study/NCT07090720?cond=NCT07090720&rank=1 , Date: (29/7/2025).
What is known: • PPHN induces hypoxic respiratory failure, jeopardizing multiorgan function, including LV performance. • Oxidative stress is crucial in pulmonary arterial hypertension development.
What is new: • Melatonin’s antioxidant and vasodilatory properties may serve as an adjunctive therapy in PPHN and enhance myocardial protection from the hypoxic effect of PPHN.
Category
Class I. Persistent Pulmonary Hypertension of the Newborn
Heart Dysfunction Associated with Pulmonary Vascular Disease (Left)
Diagnostic Testing for Pulmonary Vascular Disease. Non-invasive Testing
Medical Therapy. Efficacy or Lack of Efficacy
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes