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Author Notes:

Corresponding author information: Veronique D. Morinville, MDCM, FRCPC, Division of Pediatric Gastroenterology and Nutrition, Montreal Children’s Hospital, McGill University Health Centre; B04.2443, 1001 Blvd Decarie, Montreal, QC, Canada, H4A 3J1. Veronique.morinville@mcgill.ca

MAEH: Co first-author; oversight of subgroup writing of subsection of first manuscript draft, voting on recommendations; editing, review and approval of final manuscript version

SK: Co first-author; oversight of subgroup writing of subsection of first manuscript draft, voting on recommendations; editing, review and approval of final manuscript version

JAQ: Co first-author; oversight of subgroup writing of subsection of first manuscript draft, voting on recommendations; editing, review and approval of final manuscript version

BB, SB, JFE, EJF, VF, DF, AJF, TG, ASG, SZH, KB, RK, SL, TL, QYL, AM, ZMS, FS, AU, SW: Writing of initial manuscript subsection; critical editing of manuscript; voting on recommendations; review and approval of final manuscript version

VDM: senior and corresponding author; original concept of manuscript, outline of document, delineation of tasks; review and editing of all segments and drafts; voting on recommendations; review and approval of final manuscript version

The authors wish to thank Ms Melissa Davis, intake coordinator at Cincinnati Children’s Hospital Medical Center for summarizing the second round of voting results.

We also wish to thank the NASPGHAN Council for their review of the manuscript.

Conflicts reported: nil reported by all authors

Subjects:

Research Funding:

This publication was supported by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN); MAEH by the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) under award Number R43 DK105640-01.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Gastroenterology & Hepatology
  • Nutrition & Dietetics
  • Pediatrics
  • endoscopy
  • fluid management
  • nutrition
  • pain control
  • protease inhibitors
  • surgery
  • ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY
  • TOTAL PARENTERAL-NUTRITION
  • ACUTE NECROTIZING PANCREATITIS
  • RANDOMIZED CONTROLLED-TRIAL
  • EARLY ENTERAL NUTRITION
  • REGIONAL ARTERIAL INFUSION
  • ACUTE LUNG INJURY
  • ACUTE ALCOHOLIC PANCREATITIS
  • ULTRASOUND-GUIDED DRAINAGE
  • LACTATED RINGERS SOLUTION

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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Journal Title:

Journal of Pediatric Gastroenterology and Nutrition

Volume:

Volume 66, Number 1

Publisher:

, Pages 159-176

Type of Work:

Article | Post-print: After Peer Review

Abstract:

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-gastroduodenoscopy, 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.

Copyright information:

© 2017 ESPGHAN and NASPGHAN.

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