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Published on: September 20, 2019
Very early and early nutrition in children with pancreatitis-A randomised trial
Jan S Bukowski1, Tatiana Jamer2, Kinga Kowalska-Duplaga3
1Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.
Insights
Introducing refeeding within 24 hours for children with mild acute pancreatitis (AP) did not alter hospital stay or inflammatory markers. Early nutrition in pediatric AP shows no significant clinical or laboratory benefits compared to delayed refeeding.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Inflammatory Diseases
Background:
- Acute pancreatitis (AP) in children requires careful nutritional management.
- The optimal timing for initiating refeeding in pediatric AP remains debated.
- Early nutritional support aims to prevent malnutrition and modulate inflammatory responses.
Purpose of the Study:
- To assess the impact of very early refeeding (within 24 hours) on the clinical course of pediatric AP.
- To evaluate the effect of early nutrition on inflammatory markers, including cytokines, in children with AP.
Main Methods:
- Prospective randomized study involving 75 children (aged 1-18 years) with mild AP across three Polish university hospitals.
- Patients were randomized into two groups: very early refeeding (within 24h) and early refeeding (at least 24h after admission).
- Serum cytokine concentrations (TNF-α, IL-1β, IL-6, IL-8), C-reactive protein, amylase, lipase, and aminotransferases were measured during the first three days of hospitalization.
Main Results:
- No significant differences were observed between the groups regarding length of hospitalization, AP symptoms, or most laboratory test results.
- Cytokine level analysis in 64 children revealed no significant differences, except for a statistically significant increase in IL-1β on day three in one group (p=0.01).
- The study included 75 patients with mild pancreatitis, with 42 in the very early refeeding group and 33 in the early refeeding group.
Conclusions:
- Initiating oral nutrition within 24 hours versus after 24 hours in children with mild AP does not significantly impact hospitalization duration or symptom occurrence.
- Very early refeeding did not demonstrate a clear advantage in modulating key inflammatory markers like TNF-α, IL-1β, IL-6, and IL-8.
- Current evidence suggests that the timing of refeeding in mild pediatric AP may not be critical for clinical outcomes or inflammatory response.
Objectives:
The aim of our study was to assess the impact of the very early introduction of refeeding on the course of acute pancreatitis (AP) in children. Additionally, we evaluated the effect of nutrition on inflammatory markers, including cytokines.
Methods:
This prospective randomised study was conducted in three university hospitals in Poland. Patients, aged 1-18 years with AP, were randomised into two groups: A-refeeding within 24 h of hospital admission (very early), and B-refeeding at least 24 h after admission (early nutrition). The severity of AP was assessed after 48 h. The serum concentrations of four cytokines (tumour necrosis factor α [TNFα], interleukin-1β [IL-1β], interleukin-6 [IL-6] and interleukin-8 [IL-8]) and C-reactive protein, as well as the activity of amylase, lipase and aminotransferases, were measured during the first 3 days of hospitalisation.
Results:
A total of 94 children were recruited to participate in the study. The statistical analysis included 75 patients with mild pancreatitis: 42-group A and 33-group B. The two groups did not differ in the length of hospitalisation (p = 0.22), AP symptoms or results of laboratory tests. Analysis of cytokine levels was conducted for 64 children: 38-group A and 26-group B. We did not find a difference in concentrations of the measured cytokines, except for IL-1β on the third day of hospitalisation (p = 0.01).
Conclusions:
The time of initiation of oral nutrition within 24 h (very early) or after 24 h (early) from the beginning of hospitalisation had no impact on the length of hospitalisation, concentrations of TNF-α, IL-1β, IL-6 and IL-8, activity of amylase and lipase or occurrence of symptoms in children with mild AP.
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