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Early Feeding in Acute Pancreatitis in Children: A Randomized Controlled Trial
Oren Ledder1,2, Giles Duvoisin3, Marina Lekar4
1Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel; orenl@szmc.org.il.
Insights
Early feeding in pediatric acute pancreatitis (AP) showed no significant difference in discharge time or complications compared to traditional fasting. However, early feeding led to better weight gain in children with AP.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Pancreatic Diseases
Background:
- Traditional management of acute pancreatitis (AP) often involves bowel rest, but recent studies suggest early feeding may be beneficial.
- Previous research on early feeding in AP was limited to adults and used specific diets, necessitating pediatric-specific data.
Purpose of the Study:
- To compare early enteral feeding with a standard diet or formula against traditional fasting and intravenous fluids in pediatric patients with mild-moderate AP.
- To generate high-quality prospective data on the efficacy and safety of early feeding in children experiencing acute pancreatitis.
Main Methods:
- A randomized controlled trial involving children aged 2 to 18 years with mild-moderate AP.
- Patients were randomized to either initial fasting with intravenous fluids or immediate, unrestricted diet.
- Outcomes measured included time to discharge, pain scores, biochemical markers, imaging, and complication rates.
Main Results:
- No significant differences were observed in time to discharge (2.6 vs 2.9 days), reduction in serum lipase by day 2 (58% vs 48%), or readmission rates (6% vs 13%) between early feeding and fasting groups.
- Complication rates (immediate or delayed) did not differ between the two groups.
- Patients receiving early feeding experienced statistically significant weight gain (1.3 kg) compared to weight loss (-0.8 kg) in the fasting group (P = .028).
Conclusions:
- This is the first randomized controlled trial to investigate early oral feeding in pediatric acute pancreatitis.
- Early initiation of a standard oral diet in pediatric AP demonstrated no significant difference in major outcomes compared to initial fasting.
- While not impacting primary outcomes, early feeding was associated with improved weight gain in pediatric patients with AP.
Background:
Studies have increasingly challenged the traditional management of acute pancreatitis (AP) with bowel rest. However, these studies used a low-fat diet or transgastric feeding and only included adults. Aiming to generate higher-quality prospective pediatric data, we compared the traditional approach of fasting and intravenous fluids and early enteral feeding with standard diet or formula.
Methods:
Randomized controlled trial of children (2-18 years) with mild-moderate AP. Patients were randomly assigned 1:1 to initial fasting and intravenous fluids or an immediate, unrestricted diet. Pain scores, blood measures, and cross-sectional imaging were recorded throughout admission and follow-up. The primary outcome was time to discharge, and secondary outcomes were clinical and biochemical resolution and local and systemic complication rates.
Results:
Of 33 patients (17 [52%] boys, mean age of 11.5 [±4.8] years), 18 (55%) were randomly assigned to early feeding and 15 (45%) were randomly assigned to initial fasting. We recorded the median (interquartile range [IQR]) time to discharge (2.6 [IQR 2.0 to 4.0] vs 2.9 [IQR 1.8 to 5.6]; P = .95), reduction in serum lipase levels by day 2 (58% [IQR 2% to 85%] vs 48% [IQR 3% to 71%]; P = .65), and readmission rates (1 of 18 [6%] vs 2 of 15 [13%]; P = .22) between the early feeding and fasting cohorts, respectively. Immediate or delayed complication rates did not differ. Patients randomly assigned to early feeding had weight gain of 1.3 kg (IQR 0.29 to 3.6) at follow-up, compared with weight loss of 0.8 kg (IQR -2.1 to 0.7) in fasted patients (P = .028).
Conclusions:
This is the first randomized controlled trial in pediatric AP. There was no difference between early commencement of a standard oral diet and initial fast in any of the major outcome measures.
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