Abu-El-Haija Maisam, Kumar Soma, Quiros Jose Antonio, Balakrishnan Keshawadhana, Barth Bradley, Bitton Samuel, Eisses John F, Foglio Elsie Jazmin, Fox Victor, Francis Denease, Freeman Alvin Jay, Gonska Tanja, Grover Amit S, Husain Sohail Z, Kumar Rakesh, Lapsia Sameer, Lin Tom, Liu Quin Y, Maqbool Asim, Sellers Zachary M, Szabo Flora, Uc Aliye, Werlin Steven L, Morinville Veronique D
Division of Gastroenterology Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Division of Pediatric Gastroenterology, Medical University of South Carolina Children's Hospital, Charleston, SC.
J Pediatr Gastroenterol Nutr. 2018 Jan;66(1):159-176. doi: 10.1097/MPG.0000000000001715.
Although the incidence of acute pancreatitis (AP) in children is increasing, management recommendations rely on adult published guidelines. Pediatric-specific recommendations are needed.
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.
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.
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.
尽管儿童急性胰腺炎（AP）的发病率在上升，但管理建议仍依赖于成人发布的指南。需要针对儿科的具体建议。
北美儿科胃肠病学、肝病学和营养学会胰腺委员会使用了几个与成人和儿科AP管理考虑相关的预选关键词进行了MEDLINE综述。对文献进行了总结，审查了证据质量，并制定了建议声明。作者们开会讨论了证据、声明，并对建议进行了投票。批准一项建议需要至少75%的共识。
儿科AP的诊断应遵循已发表的国际儿科胰腺炎研究组：寻找病因定义（通过满足以下3项标准中的至少2项：（1）与AP相符的腹痛，（2）血清淀粉酶和/或脂肪酶值≥正常上限的3倍，（3）与AP一致的影像学表现）。特别是在最初24小时内，用晶体液进行充分的液体复苏似乎是关键。当阿片类药物节省措施不足时，镇痛可能包括使用阿片类药物。应密切监测肺部、心血管和肾脏状况，尤其是在最初48小时内。应尽早开始肠内营养，无论通过口服、胃内或空肠途径。几乎没有证据支持使用预防性抗生素、抗氧化剂、益生菌和蛋白酶抑制剂。食管胃十二指肠镜检查、内镜逆行胰胆管造影和内镜超声在诊断和管理中的作用有限。应密切关注儿童AP早期或晚期并发症的发生以及复发情况。
本临床报告代表了首份关于儿科AP管理的英文建议。未来的目标应包括前瞻性多中心儿科研究，以进一步验证这些建议并优化对AP儿童的护理。
