What is the course of secondary pancreatitis in pediatric intensive care unit?

Yıl 2022, , 101 - 106, 01.01.2022

İshak Işık , Hasan Serdar Kıhtır , Ulaş Emre Akbulut , Atike Atalay , Ebru Atike Ongun

https://doi.org/10.31362/patd.1003998

Öz

Purpose: Acute pancreatitis is diagnosed frequently in the pediatric population. Course of acute pancreatitis in children is usually mild. However, severe pancreatitis may develop in some patients with the local or systemic complications. Course of secondary acute pancreatitis in children in the pediatric intensive care unit is unknown.
Aim of this study is to evaluate the clinical characteristics and outcome of children who developed secondary acute pancreatitis in a tertiary pediatric intensive care unit.
Material and methods: Children hospitalized in pediatric intensive care unit for different causes and developed secondary acute pancreatitis were included into this retrospective study. Demographic features of the patients, duration of hospitalization in intensive care unit, primary disease causing hospitalization, other underlying diseases, duration of mechanical ventilation, pediatric mortality risk score III and nutritional status were conducted from hospital records.
Results: Seventy-seven children (58.4%male and mean age: 6.7 years) were included in the study. The most common underlying disease was neurological diseases (19.5%). Majority (46.7%) of the secondary pancreatitis was severe. 68.8% of the children with secondary pancreatitis were on mechanical ventilation. Duration of hospitalization and time on mechanical ventilator was significantly longer in patients with severe pancreatitis. The mean pediatric mortality risk III score was also significantly higher in this group.
Conclusion: Although acute pancreatitis in children has a mild course, secondary acute pancreatitis is often severe and has a high mortality rate in children in the pediatric intensive care unit.

Anahtar Kelimeler

Children, secondary pancreatitis, pediatric intensive care unit

Pediatrik yoğun bakım ünitelerinde gözlenen sekonder pankreatitlerin seyri nasıldır?

Öz

Amaç: Akut pankreatit pediatrik popülasyonda sıklıkla teşhis edilir. Çocuklarda akut pankreatitin seyri genellikle hafiftir. Ancak bazı hastalarda lokal veya sistemik komplikasyonları olan ciddi pankreatit gelişebilir. Pediatrik yoğun bakım ünitesindeki çocuklarda sekonder akut pankreatitin seyri bilinmemektedir. Bu çalışmanın amacı, üçüncü basamak bir pediatrik yoğun bakım ünitesinde sekonder akut pankreatit gelişen çocukların klinik özelliklerini ve sonuçlarını değerlendirmektir.
Gereç ve yöntem: Bu retrospektif çalışmaya çocuk yoğun bakım ünitesine farklı nedenlerle yatırılan ve sekonder akut pankreatit gelişen çocuklar dahil edildi. Hastaların demografik özellikleri, yoğun bakım ünitesinde yatış süreleri, yatışa neden olan birincil hastalıkları, altta yatan diğer hastalıklar, mekanik ventilasyon süresi, pediatrik mortalite risk skoru III ve beslenme durumları hastane kayıtlarından alındı.
Bulgular: Yetmiş yedi çocuk (%58,4 erkek ve ortalama yaş: 6,7 yıl) çalışmaya dahil edildi. En sık altta yatan hastalık nörolojik hastalıklardı (%19,5). Sekonder pankreatitin çoğunluğu (%46,7) şiddetli idi. Sekonder pankreatitli çocukların %68,8'i mekanik ventilatördeydi. Ağır pankreatitli hastalarda hastanede kalış süresi ve mekanik ventilatörde geçirilen süre anlamlı olarak daha uzundu. Ortalama pediatrik mortalite risk skoru III de bu grupta anlamlı olarak daha yüksekti.
Sonuç: Çocuklarda akut pankreatit hafif seyirli olmasına rağmen, sekonder akut pankreatit, çocuk yoğun bakım ünitesindeki çocuklarda sıklıkla şiddetlidir ve mortalite oranı yüksektir.

Anahtar Kelimeler

Çocuk, sekonder pankreatit, pediatrik yoğun bakım ünitesi

Kaynakça

• 1- Pant C, Deshpande A, Olyaee M et al. Epidemiology of Acute Pancreatitis in Hospitalized Children in the United States From 2000-2009. PLoS One. 2014; 9: e95552.
• 2- Suzuki M, Sai JK, Shimizu T. Acute pancreatitis in children and adolescents. World J Gastrointest Pathophysiol 2014; 5: 416-26
• 3- Morinville VD, Barmada MM, Lowe ME. Increasing incidence of acute pancreatitis at an American pediatric tertiary care center: is greater awareness among physicians responsible? Pancreas 2010; 39: 5–8.
• 4- Lopez MJ. The changing incidence of acute pancreatitis in children: a single-institution perspective. J Pediatr 2002; 140: 622–4. 5- Cole S, Wakeham M, Werlin S, Goday SP. Classification and Nutrition Management of Acute Pancreatitis in the Pediatric Intensive Care Unit. J Pediatr Gastroenterol Nutr. 2018; 67: 755-9
• 6- Park A, Latif SU, Shah AU, et al. Changing referral trends of acute pancreatitis in children: a 12-year single-center analysis. J Pediatr Gastroenterol Nutr 2009; 49: 316–22.
• 7- Srinath AI, Lowe ME. Pediatric pancreatitis. Pediatr Rev 2013; 34: 79–90.
• 8- Abu-El-Haija M, Kumar S, Szabo F, et al. Classification of acute pancreatitis in the pediatric population: clinical report from the NASPGHAN pancreas committee. J Pediatr Gastroenterol Nutr 2017;64: 984–90.
• 9- Kandula L, Lowe ME. Etiology and outcome of acute pancreatitis in infants and toddlers. J Pediatr 2008; 152: 106–10. 110.
• 10- Werlin SL, Kugathasan S, Frautschy BC. Pancreatitis in children. J Pediatr Gastroenterol Nutr 2003; 37: 591–595.
• 11- Goday PS, Wakeham M, Kuhn EM, Collins MM, Werlin SL. Acute pancreatitis in the pediatric intensive care unit. J Pediatr Gastroenterol Nutr 2015;61: 108–12.
• 12- Sag E, Kaya G, Bahat-Ozdogan E et al. Acute Pancreatitis in Children: A Single Center Experience Over Ten Years. Turk J Pediatr 2018; 60: 153-8.
• 13- Morinville VD, Husain SZ, Bai H, et al.; INSPPIRE Group. Definitions of pediatric pancreatitis and survey of present clinical practices. J Pediatr Gastroenterol Nutr 2012; 55: 261-265.
• 14- Pollack MM, Patel KM, Ruttimann UE. PRISM III: An updated Pediatric Risk of Mortality score. Crit Care Med 1996; 24: 743-52.
• 15- Steingrub JS, Tidswell M, Higgins TL. Hemodynamic consequences of heart-lung interactions. J Intensive Care Med 2003; 18: 92-99.
• 16- Tanaka S, Sagawa S, Miki K, Claybaugh JR, Shiraki K. Changes in muscle sympathetic nerve activity and renal function during positive-pressure breathing in humans. Am J Physiol 1994; 266: 1220-8.
• 17- Manjuck J, Zein J, Carpati C, Astiz M. Clinical significance of increased lipase levels on admission to the ICU. Chest 2005; 127: 246-250.
• 18- Serrano N. Increased lipase plasma levels in ICU patients: when are they critical? Chest 2005; 127: 7-10.
• 19- Mirtallo JM, Forbes A, McClave SA, et al. International consensus guidelines for nutrition therapy in pancreatitis. JPEN J Parenter Enteral Nutr 2012;36:284–91.
• 20- Lodewijkx PJ, Besselink MG, Witteman BJ, et al. Nutrition in acute pancreatitis: a critical review. Expert Rev Gastroenterol Hepatol 2016;10:571–80.
• 21- Abu-El-Haija M, Kumar S, Quiros JA et al. Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr. 2018 Jan;66(1):159-176.
• 22- Carreazo NY, Ugarte K, Bada C. When should we start oral intake in children with severe acute pancreatitis? Evid Based Med 2008;13:4–5.
• 23- Abu-El-Haija M, Wilhelm R, Heinzman C, et al. Early enteral nutrition in children with acute pancreatitis. J Pediatr Gastroenterol Nutr 2016;62:453–6.