Elsevier

The Journal of Pediatrics

Volume 191, December 2017, Pages 164-169
The Journal of Pediatrics

Original Articles
The Benefits of Early Oral Nutrition in Mild Acute Pancreatitis

https://doi.org/10.1016/j.jpeds.2017.08.032Get rights and content

Objective

To determine whether early patient-directed oral nutrition in children with mild acute pancreatitis decreases the length of hospitalization without increasing complications.

Study design

Hospitalized patients aged 2-21 years of age who met the criteria for acute pancreatitis based on the Revised Atlanta Classification were enrolled prospectively and allowed to eat by mouth at their discretion (patient-directed nutrition [PDN]). These patients were compared with a retrospective cohort of children who were allowed to eat based on traditional practices (treatment team-directed nutrition [TTDN]). Outcomes included length of hospitalization, time nil per os (NPO), and complications within 30 days of discharge.

Results

The study included 30 patients in the PDN group and 92 patients in the TTDN group. Patients in the PDN group had a median length of stay of 48.5 hours (IQR 37-70 hours) compared with 93 hours (IQR 52-145 hours) in the TTDN group (P < .0001). Patients were NPO for a median of 14 hours (IQR 7-19.5 hours) in the PDN group compared with 34 hours (IQR 19.3-55 hours) in the TTDN group (P < .0001). No patients in the PDN group developed complications within 30 days of discharge.

Conclusion

Early patient-directed oral nutrition in mild acute pancreatitis was well tolerated and resulted in decreased length of NPO status and hospitalization with no obvious complications.

Clinical Trial Registration

ClinicalTrials.gov: NCT01423786.

Section snippets

Methods

We performed a prospective study (ClinicalTrials.gov: NCT01423786) of patient-directed dietary management of mild acute pancreatitis at Nationwide Children's Hospital in Columbus, Ohio. Patients aged 2-21 years hospitalized with an admission diagnosis of primary or secondary acute pancreatitis from August 2011 through October 2013 were included. Written informed consent was obtained from the parents or guardians of the children who served as subjects in the investigation. We used the Revised

Results

A total of 33 children were recruited to participate in the PDN study. Three patients were withdrawn before any study intervention, as they did not meet inclusion criteria; 30 encounters (29 unique patients) were included for statistical analysis. Table I shows the demographics and baseline clinical variables in the PDN group.

For the TTDN comparison cohort, a total of 165 children were found to have a diagnosis of acute pancreatitis. A total of 73 patients were excluded: 19 patients due to a

Discussion

In our prospective intervention study evaluating nutritional therapy of mild acute pancreatitis in children, we found that patient-directed early oral nutrition was safe and decreased the length of hospitalization. Limited evidence in adult studies of mild acute pancreatitis suggests that early oral feedings may be associated with improved outcomes.6, 18, 19 Eckerwall et al performed a randomized, prospective study comparing traditional fasting with immediate oral feeding in adult patients with

References (20)

  • G.E. Eckerwall et al.

    Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery—a randomized clinical study

    Clin Nutr

    (2007)
  • R. Meier et al.

    ESPEN guidelines on enteral nutrition: pancreas

    Clin Nutr

    (2006)
  • S. Kumar et al.

    Nutrition and acute pancreatitis: review of the literature and pediatric perspectives

    Curr Gastroenterol Rep

    (2013)
  • M. Abu-El-Haija et al.

    Variability in pancreatitis care in pediatrics: a single institution's survey report

    Pancreas

    (2016)
  • BaiH.X. et al.

    What have we learned about acute pancreatitis in children?

    J Pediatr Gastroenterol Nutr

    (2011)
  • M. Abu-El-Haija et al.

    Update to the management of pediatric acute pancreatitis: highlighting areas in need of research

    J Pediatr Gastroenterol Nutr

    (2014)
  • V.D. Morinville et al.

    Increasing incidence of acute pancreatitis at an American pediatric tertiary care center: is greater awareness among physicians responsible?

    Pancreas

    (2010)
  • M. Abu-El-Haija et al.

    Early enteral nutrition in children with acute pancreatitis

    J Pediatr Gastroenterol Nutr

    (2016)
  • S. Tenner et al.

    American College of Gastroenterology guideline: management of acute pancreatitis

    Am J Gastroenterol

    (2013)
  • N. Teich et al.

    Optimal timing of oral refeeding in mild acute pancreatitis: results of an open randomized multicenter trial

    Pancreas

    (2010)
There are more references available in the full text version of this article.

Cited by (15)

  • Pancreatitis

    2020, Pediatric Gastrointestinal and Liver Disease, Sixth Edition
  • EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis

    2018, Pancreatology
    Citation Excerpt :

    In another adult study, they administration of solid food was recommended immediately instead of starting with a liquid diet [79]. A pediatric study that examined the role of nutrition in AP, showed that feeds within 24 h of admission are feasible, safe and not associated with increased pain compared to the group of patients that didn't received feeds [80,81]. If adequate oral feeding is not tolerated or the required energy cannot be achieved by oral feeding within 72 h, enteral tube feeding is recommended. (

  • Progress on enteral nutrition therapy for acute pancreatitis

    2023, Chinese Journal of Clinical Nutrition
  • Acute Pancreatitis in Children

    2023, The Pancreas: an Integrated Textbook of Basic Science, Medicine, and Surgery, Fourth Edition
View all citing articles on Scopus

Supported by the intramural funding, grant 277711, through the Research Institute at Nationwide Children's Hospital, Columbus, Ohio. The authors declare no conflicts of interest.

View full text