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Home / Journal of Pediatric Gastroenterology and Nutrition, Volume 66, Number 1

Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee

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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.

Keywords: endoscopy; fluid management; nutrition; pain control; protease inhibitors; surgery

Document Type: Research Article

Affiliations: 1: Division of Gastroenterology Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 2: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Rady Children's Hospital, San Diego, CA 3: Division of Pediatric Gastroenterology, Medical University of South Carolina Children's Hospital, Charleston, SC 4: Division of Pediatric Gastroenterology, Maria Fareri Children's Hospital, Valhalla, NY 5: University of Texas Southwestern Medical School, Dallas, TX 6: Pediatric Gastroenterology and Nutrition, Steven & Alexandra Cohen Children's Medical Center of New York, Hofstra Northwell School of Medicine, Hempstead, NY 7: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’ Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 8: Pediatric Gastroenterology, The Children's Hospital of New Jersey at Newark Beth Israel Medical Center, Newark, NJ 9: Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA 10: Pediatric Gastroenterology, Stony Brook University, NY 11: Division of Gastroenterology, Hepatology and Nutrition, Emory University School of Medicine, Atlanta, GA 12: Pediatric Gastroenterology, Toronto Hospital for Sick Children, Toronto, ON, Canada 13: Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Oklahoma Health Sciences Centre, Oklahoma City, OK 14: Gastroenterology, Hepatology and Nutrition, Children's Hospital of the King's Daughters, Norfolk, VA 15: Digestive Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA 16: Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 17: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA 18: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital, Richmond Virginia Commonwealth Medical Center, Richmond, VA 19: University of Iowa Carver College of Medicine, Iowa City, IA 20: Medical College of Wisconsin, Milwaukee, WI 21: Division of Pediatric Gastroenterology and Nutrition, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.

Publication date: 01 January 2018

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