Early Enteral Nutrition in Paediatric Acute Pancreatitis—A Review of Published Studies

Abstract

Nowadays, nutrition is said to be an integral aspect of acute pancreatitis (AP) treatment. Early enteral nutrition (EEN) is safe and beneficial for patients. This was confirmed by clinical experience and can be found in guidelines on managing adults with AP. Furthermore, paediatric recommendations encourage EEN use in AP. However, paediatric guidelines are based exclusively on studies in adults. Therefore, we present a review of published studies on the time of nutritional interventions in children with AP. A search was independently conducted in April 2022 by two of the authors. Only full-text papers published in English involving children between 0–21 were considered. Only four papers met our inclusion criteria: one randomised-control trial (RCT), one prospective study with retrospective chart review, and two retrospective chart reviews. All studies supported EEN and there was no recommendation of any delay in its initiation. The results of all four papers suggested EEN with a regular, normal-fat diet. EEN is safe in children with mild or moderately severe AP and may decrease the length of hospitalisation. Unfortunately, all the conclusions are based on a small amount of heterogeneous data that are mostly retrospective. Future prospective RCTs are needed.

Navigating Nutritional Strategies: A Comprehensive Review of Early and Delayed Enteral Feeding in Acute Pancreatitis

“…Additionally, an encompassing meta-analysis highlighted that EEF within the initial 48 hours of admission exhibited enhanced clinical outcomes for acute pancreatitis by mitigating complications [ 5 ]. Moreover, an examination of published studies about pediatric acute pancreatitis concurred, indicating a positive association between EEF and improved clinical outcomes [ 6 ]. Collectively, these findings robustly support the potential benefits of EEF in managing acute pancreatitis.…”

“…The review also underscored the comparable safety profiles of nasogastric and nasojejunal routes [ 3 ]. A randomized controlled trial focusing on pediatric acute pancreatitis patients demonstrated that the implementation of EEN, coupled with aggressive fluid resuscitation, significantly contributed to improved clinical outcomes [ 6 ]. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review and meta-analysis comparing EEN with delayed enteral nutrition (DEN) in acute pancreatitis indicated a lower incidence of complications associated with EEN [ 8 ].…”

“…It underscored the comparable safety profiles of the nasogastric and nasojejunal routes [ 3 ]. Contrarily, a randomized controlled trial focusing on pediatric acute pancreatitis patients revealed improved clinical outcomes with EEN and aggressive fluid resuscitation [ 6 ]. A PRISMA-compliant systematic review and meta-analysis comparing EEN and DEN in acute pancreatitis demonstrated fewer complications associated with EEN [ 6 ].…”

“…Contrarily, a randomized controlled trial focusing on pediatric acute pancreatitis patients revealed improved clinical outcomes with EEN and aggressive fluid resuscitation [ 6 ]. A PRISMA-compliant systematic review and meta-analysis comparing EEN and DEN in acute pancreatitis demonstrated fewer complications associated with EEN [ 6 ]. Despite initial promising results, current evidence does not support using immuno-enhanced nutrients or probiotics in acute pancreatitis [ 3 ].…”

“…A systematic review and meta-analysis of randomized controlled trials underscored that EEN correlated with fewer complications and improved clinical outcomes in acute pancreatitis [ 7 ]. In parallel, findings from a randomized controlled trial at Victoria Hospital, Bengaluru, highlighted that EEF was linked to reduced complications, including necrotizing pancreatitis, organ failure, and lower mortality, than DEF [ 6 ]. The patient's needs and tolerance should guide the selection between elemental and polymeric formulas.…”