Objectives-Acute pancreatitis is a necroinflammatory disease that leads to 210,000 hospitalizations in the United States annually. Recent reports suggest that there may be important differences in clinical features between infants/toddlers and older children. Thus, in this study we make a direct comparison between the pediatric age groups in presentation and management trends of acute pancreatitis.
Patients and Methods-We examined all children (ages 0 to 20 years) admitted to Yale-New Haven Children's Hospital with pancreatitis between 1994 and 2007.Results-Two hundred seventy-one cases met inclusion criteria for acute pancreatitis. Infants and toddlers manifested fewer signs and symptoms of abdominal pain, epigastric tenderness, and nausea compared with older children (43% vs 93%; 57% vs 90%; and 29% vs 76%, respectively; P < 0.05 for all comparisons). They were more likely to be diagnosed by serum lipase than by amylase and to undergo radiographic evaluation (P < 0.05). They had a longer hospital stay (19.5 vs 4 days; P < 0.05) and were less likely to be directly transitioned to oral nutrition (14% vs 71%; P < 0.05).Conclusions-Infants and toddlers with acute pancreatitis present with fewer classical symptoms and are managed differently from older children. We believe these data will be helpful in evaluating and understanding treatment practices in this age group. Keywords acute pancreatitis; amylase; infants; lipase; toddlers Acute pancreatitis is a necroinflammatory disease of the pancreas that has many associated etiologies such as common bile duct stones, alcohol, trauma, medications, toxins, and ductal defects. Acute pancreatitis accounts for more than 210,000 annual hospital admissions (1) and, tallied with chronic pancreatitis, leads to 31,000 deaths per year (2). Although practice parameters for acute pancreatitis are currently evolving using primarily adult studies, information about children is lacking. Although in children there are several studies examining pancreatitis incidence and etiology (3-7), few have characterized their clinical presentation and management (8,9). We hypothesized that in our pediatric population of
NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript acute pancreatitis in New Haven, Connecticut, there are also age-related differences in the management of acute pancreatitis. Indeed, we found that infants and toddlers differ from older children in clinical presentation, level of serum biomarker elevation, type of radiographic evaluation, length of hospitalization, and mode of nutrition.
PATIENTS AND METHODS
Study GroupA retrospective chart review was conducted at Yale-New Haven Children's Hospital, New Haven. Children (younger than 21 years) admitted between August 1994 and July 2007 were screened for International Classification of Diseases-9 codes pertaining to pancreatitis. The study was approved by the Yale University School of Medicine institutional review board. Details of the cohort, including referral trends for pancreatitis over time, eti...
