Abstract

Abstract Background Necrotizing enterocolitis (NEC) is one of the most dangerous gastrointestinal diseases that affects neonates especially preterm neonates. It is considered one of the oxygen radical diseases of neonatology as it is attributed to accumulation of reactive oxygen species (ROS) and free radicals leading to cellular oxidative damage. Melatonin proved to be an effective antioxidant and free radical scavenger with no documented side effects. Objective We aimed to evaluate the efficacy and safety of melatonin as adjuvant therapy in feeding intolerance and prophylaxis against NEC. Methods This was an interventional trial conducted on 90 preterm neonates with feeding intolerance. They were simply randomized to Group I that received melatonin treatment (n = 45) and Group II that received traditional treatment only (n = 45). Melatonin was administered at a total dose of 20 mg enterally in two divided doses of 10 mg each, 1 h apart. Tumor necrosis factor alpha (TNFα) level was assessed in patients 72 hours after starting treatment and both groups were observed for incidence of NEC, clinical improvement of feeding intolerance and time needed to reach full intake. Results Group I reported significantly less incidence of NEC in Group I treated with melatonin. Improved tolerance to feeds was observed in Group I resulting in earlier achievement of full enteral intake. Significantly higher levels of TNF alpha were found in Group II that received traditional treatment, indicative of higher level of oxidative stress and free radicals. Conclusion Melatonin in an effective and safe antioxidant and free radical scavenger associated with improvement of clinical and laboratory data in preterm infants with feeding intolerance and significantly less incidence of NEC.

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