title: Early Enteral Nutrition and Aggressive Fluid Resuscitation are Associated with Improved Clinical Outcomes in Acute Pancreatitis.
abstract: OBJECTIVE
  To determine whether recommendations for treatment of acute pancreatitis (AP) in adults impact the outcomes of pediatric AP.
  
  
  METHODS
  Adult guidelines regarding early management of AP were implemented through an admission order set at Cincinnati Children's Hospital Medical Center at the beginning of the year 2014. Recommendations included administering high rates of intravenous fluid (IVF) within 24 hours of admission and enteral nutrition within 48 hours of admission. A retrospective chart review of AP admissions before and after the implementation of the recommendations was undertaken. Outcomes studied were: hospital length of stay, intensive care unit transfer rates, development of severe AP, pulmonary complications, and readmission rates post discharge from the hospital.
  
  
  RESULTS
  The study included 201 patients. Children who received feeds within the first 48 hours and received greater than maintenance IVF within 24 hours had a shorter length of stay, less intensive care unit admissions and severe AP rates compared with the patients who remained nil per os during the first 48 hours and received lower rates of IVF.
  
  
  CONCLUSIONS
  Our data support that early enteral nutrition and early aggressive IVF improve outcomes of pediatric AP.
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Flora K
authors.initials: FK
authors.lastname: Szabo
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Lin
authors.initials: L
authors.lastname: Fei
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Ligia Alfaro
authors.initials: LA
authors.lastname: Cruz
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: maisam.haija@cchmc.org.
authors.forename: Maisam
authors.initials: M
authors.lastname: Abu-El-Haija
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003422:Critical Care; D004750:Enteral Nutrition; D005260:Female; D005440:Fluid Therapy; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult