Classification and Nutrition Management of Acute Pancreatitis in the Pediatric Intensive Care Unit
Sarah Cole1, Martin Wakeham2, Steven Werlin1
1Pediatric Gastroenterology and Nutrition.
Insights
Pediatric patients with acute pancreatitis (AP) often experience delayed enteral nutrition and overuse of parenteral nutrition, indicating suboptimal nutritional management in the pediatric intensive care unit (PICU). This retrospective study highlights critical areas for improving care for children with AP.
Area of Science:
- Pediatrics
- Gastroenterology
- Critical Care Medicine
Background:
- Acute pancreatitis (AP) is a serious condition in children requiring intensive care.
- Nutritional management is crucial for pediatric patients with AP, with guidelines emphasizing early enteral nutrition.
- Previous studies suggest variability in nutritional support for pediatric AP.
Purpose of the Study:
- To classify the severity of acute pancreatitis in pediatric intensive care unit (PICU) admissions.
- To evaluate the adherence to current guidelines for nutritional management in pediatric AP.
- To identify the outcomes associated with nutritional management in pediatric AP.
Main Methods:
- Retrospective cohort study design.
- Inclusion of 54 children admitted to the PICU with a diagnosis of acute pancreatitis.
- Analysis of diagnosis type (primary vs. secondary AP), severity, timing of nutritional interventions (enteral and parenteral nutrition), and patient outcomes.
Main Results:
- The majority of pediatric AP cases (77.8%) were secondary diagnoses, with a high proportion of severe cases (81%).
- Less than half of the patients (48.1%) received enteral nutrition before the third day of admission, with an average delay of 2.3 days.
- Over half of the patients (51.8%) received parenteral nutrition, suggesting overuse and late initiation of enteral feeds.
Conclusions:
- Nutritional management for pediatric patients with acute pancreatitis in the PICU is often suboptimal.
- There is a significant delay in initiating enteral nutrition and an overuse of parenteral nutrition in this population.
- Adherence to evidence-based guidelines for nutritional support in pediatric AP requires improvement to optimize patient outcomes.
Abstract:
The aims of this retrospective cohort study were to classify the severity of patients admitted to the pediatric intensive care unit (PICU) with acute pancreatitis (AP) and to identify how many patients received appropriate nutritional management in accordance with more recent guidelines and the outcomes of those patients. Of the 54 children with AP, 12 (22.2%) had a primary diagnosis of AP (50% severe, 17% moderate) whereas 42 (77.8%) had a secondary diagnosis of AP (81% severe, 11.9% moderate). Just under half of the patients (48.1%) had enteral nutrition commenced before the third day of admission (50% with primary AP, 47.6% with secondary AP). The average time to initiation of enteral feeds was 2.3 days for those that received enteral nutrition. 51.8% of patients received parenteral nutrition (25% with primary AP, 59.5% with secondary AP). Most patients received enteral nutrition late and parenteral nutrition was overused in patients with AP admitted to the PICU.
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