title: Restoration of energy level in the early phase of acute pediatric pancreatitis.
abstract: Acute pancreatitis (AP) is a serious inflammatory disease with rising incidence both in the adult and pediatric populations. It has been shown that mitochondrial injury and energy depletion are the earliest intracellular events in the early phase of AP. Moreover, it has been revealed that restoration of intracellular ATP level restores cellular functions and defends the cells from death. We have recently shown in a systematic review and meta-analysis that early enteral feeding is beneficial in adults; however, no reviews are available concerning the effect of early enteral feeding in pediatric AP. In this minireview, our aim was to systematically analyse the literature on the treatment of acute pediatric pancreatitis. The preferred reporting items for systematic review (PRISMA-P) were followed, and the question was drafted based on participants, intervention, comparison and outcomes: P: patients under the age of twenty-one suffering from acute pancreatitis; I: early enteral nutrition (per os and nasogastric- or nasojejunal tube started within 48 h); C: nil per os therapy; O: length of hospitalization, need for treatment at an intensive care unit, development of severe AP, lung injury (including lung oedema and pleural effusion), white blood cell count and pain score on admission. Altogether, 632 articles (PubMed: 131; EMBASE: 501) were found. After detailed screening of eligible papers, five of them met inclusion criteria. Only retrospective clinical trials were available. Due to insufficient information from the authors, it was only possible to address length of hospitalization as an outcome of the study. Our mini-meta-analysis showed that early enteral nutrition significantly (SD = 0.806,P= 0.034) decreases length of hospitalization compared with nil per os diet in acute pediatric pancreatitis. In this minireview, we clearly show that early enteral nutrition, started within 24-48 h, is beneficial in acute pediatric pancreatitis. Prospective studies and better presentation of research are crucially needed to achieve a higher level of evidence.
authors.affiliation: Dóra Mosztbacher, First Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary.
authors.forename: Dóra
authors.initials: D
authors.lastname: Mosztbacher
authors.affiliation: Dóra Mosztbacher, First Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary.
authors.forename: Nelli
authors.initials: N
authors.lastname: Farkas
authors.affiliation: Dóra Mosztbacher, First Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary.
authors.forename: Margit
authors.initials: M
authors.lastname: Solymár
authors.affiliation: Dóra Mosztbacher, First Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pár
authors.affiliation: Dóra Mosztbacher, First Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary.
authors.forename: Judit
authors.initials: J
authors.lastname: Bajor
authors.affiliation: Dóra Mosztbacher, First Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary.
authors.forename: Ákos
authors.initials: Á
authors.lastname: Szűcs
authors.affiliation: Dóra Mosztbacher, First Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary.
authors.forename: József
authors.initials: J
authors.lastname: Czimmer
authors.affiliation: Dóra Mosztbacher, First Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary.
authors.forename: Katalin
authors.initials: K
authors.lastname: Márta
authors.affiliation: Dóra Mosztbacher, First Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Mikó
authors.affiliation: Dóra Mosztbacher, First Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Rumbus
authors.affiliation: Dóra Mosztbacher, First Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Varjú
authors.affiliation: Dóra Mosztbacher, First Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Hegyi
authors.affiliation: Dóra Mosztbacher, First Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary.
authors.forename: Andrea
authors.initials: A
authors.lastname: Párniczky
mesh_terms: D000208:Acute Disease; D055371:Acute Lung Injury / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D004035:Diet Therapy / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D005440:Fluid Therapy; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D007958:Leukocyte Count; D010147:Pain Measurement; D010195:Pancreatitis / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D012720:Severity of Illness Index; D013997:Time Factors
keywords: ATP restoration; enteral nutrition; length of hospitalization; nil per os diet; pediatric pancreatitis