Source:

Ledder
O
,
Duvoisin
G
,
Lekar
M
, et al
Early feeding in acute pancreatitis in children: a randomized controlled trial
.
Pediatrics.
2020
;
146
(
3
):
e20201149
; doi:
https://doi.org/10.1542/peds.2020-1149

Investigators from multiple institutions conducted a randomized controlled trial comparing outcomes in children with mild-to-moderate acute pancreatitis (AP) who were treated with initial fasting and IV fluids or with immediate feeding. Study participants were children 2-18 years old admitted with AP of <24 hours duration to 1 of 3 medical centers in Australia and Israel between 2015 and 2018. The diagnosis of AP was made using a standardized definition. Participants randomized to the fasting group were given nothing by mouth and received IV fluids, followed by a low-fat diet when their pain resolved and serum lipase and/or amylase levels decreased. Children assigned to the early feeding group were given an unrestricted diet and encouraged to eat as soon as possible. Data collected on study participants included pain as assessed twice-daily by the Wong-Baker pain rating scale, serial serum lipase and amylase levels, and change in weight. The primary study outcome was time until ready for hospital discharge, defined as “no pain” on 2 consecutive assessments, no analgesic requirement other than acetaminophen, and an oral diet meeting >75% of estimated energy requirements. Secondary outcomes included serum lipase and amylase levels, hospital readmission, and weight change from discharge until a follow-up 30-60 days later. Outcomes among patients in the 2 treatment groups were compared using chi-square or Fisher exact tests for categorical outcomes and t-tests or Wilcoxon rank test for continuous outcomes.

A total of 33 children were enrolled in the study, with 18 assigned to the early feeding group and 15 to the fasting group. The mean age of study participants was 11.5 ±4.8 years. At enrollment, there were no significant differences between groups for age, gender, serum lipase or amylase levels, or pain scores. Median time until ready for discharge was 2.9 days for those in the fasting group vs 2.6 days for patients assigned to early feeding (P = 0.95). Median reduction in serum lipase levels between enrollment and day 2 was 48% and 58%, respectively, in participants randomized to fasting or early feeding (P = 0.65). There were also no significant differences between groups for change in serum amylase levels or time until pain free. Two patients in the fasting group were readmitted for AP, and 1 in the early feeding group was readmitted with gastroenteritis. At a median of 47 days from discharge the median weight change was -0.8 kg in those randomized to the fasting group compared to +1.3 kg in children assigned to early feeding (P = 0.028).

The authors conclude that outcomes were similar in children with AP treated with early feeding or initial fasting.

Dr Rosenthal has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

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