Open AccessManagement of Acute Pancreatitis in the Pediatric Population
Author(s) -
AbuElHaija Maisam,
Kumar Soma,
Quiros Jose Antonio,
Balakrishnan Keshawadhana,
Barth Bradley,
Bitton Samuel,
Eisses John F.,
Foglio Elsie Jazmin,
Fox Victor,
Francis Denease,
Freeman Alvin Jay,
Gonska Tanja,
Grover Amit S.,
Husain Sohail Z.,
Kumar Rakesh,
Lapsia Sameer,
Lin Tom,
Liu Quin Y.,
Maqbool Asim,
Sellers Zachary M.,
Szabo Flora,
Uc Aliye,
Werlin Steven L.,
Morinville Veronique D.
Publication year - 2018
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000001715
Subject(s) - medicine , pediatric gastroenterology , hepatology , pancreatitis , acute pancreatitis , abdominal pain , intensive care medicine , gastroenterology , general surgery
Background: Although the incidence of acute pancreatitis (AP) in children is increasing, management recommendations rely on adult published guidelines. Pediatric‐specific recommendations are needed. Methods: The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas committee performed a MEDLINE review using several preselected key terms relating to management considerations in adult and pediatric AP. The literature was summarized, quality of evidence reviewed, and statements of recommendations developed. The authorship met to discuss the evidence, statements, and voted on recommendations. A consensus of at least 75% was required to approve a recommendation. Results: The diagnosis of pediatric AP should follow the published INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE definitions (by meeting at least 2 out of 3 criteria: (1) abdominal pain compatible with AP, (2) serum amylase and/or lipase values ≥3 times upper limits of normal, (3) imaging findings consistent with AP). Adequate fluid resuscitation with crystalloid appears key especially within the first 24 hours. Analgesia may include opioid medications when opioid‐sparing measures are inadequate. Pulmonary, cardiovascular, and renal status should be closely monitored particularly within the first 48 hours. Enteral nutrition should be started as early as tolerated, whether through oral, gastric, or jejunal route. Little evidence supports the use of prophylactic antibiotics, antioxidants, probiotics, and protease inhibitors. Esophago‐gastro‐duodenoscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography have limited roles in diagnosis and management. Children should be carefully followed for development of early or late complications and recurrent attacks of AP. Conclusions: This clinical report represents the first English‐language recommendations for the management of pediatric AP. Future aims should include prospective multicenter pediatric studies to further validate these recommendations and optimize care for children with AP.