Tolerance of enteral nutrition in children with acute pancreatitis

AIM evaluation of tolerance and efficacy of enteral nutrition inpatients with acute pancreatitis hospitalised in 2005-2006 in Department of Paediatric Allergology, Gastroenterology and Nutrition, Medical University of Lodz. MATERIAL AND METHODS analysis involved the course of enteral nutrition in 15 children hospitalised in 2005-2006 (aged 11.24+/-3.31 year), in whom 19 episodes of acute pancreatitis were observed caused by: trauma (n=4), SPINK1 mutation (n=1, in analysing period 5 episodes was observed in patient) -mutation of serine protease inhibitor Kazal type 1, pancreas divisum (n=1), cholelithiasis (n=1), parasitic AP (n=2), drug-induced (n=3), idiopathic (n=3). 16 episodes were mild and 3 severe (2 pseudocysts and 1 rapture of pancreas). Half-elementary / low-fat diet (Peptisorb / NUTRICIA) was applied by nasojejunal cathether, using pomp (Flocare). Duration, clinical tolerance of enteral nutrition, amount of calories, change of body weight were estimated. RESULTS the length of enteral nutrition varied from 3 to 46 days (average 16.15+/-10.71). The shortest course involved a patient with hereditary acute pancreatitis (average 7.4+/-2.6) the longest one -posttraumatic pancreatitis (average 28.5+/-12.28). By enteral nutrition we ensured the supply of 40.46+/-13.21 kcal/kg per day on average, reaching increase of body weight 733+/-714.23 g in 6 children; maintenance of initial weight in 3 and decrease in 10 patients (average 600+/-534.52 g). Undesirable effects (nausea, diarrhoea, vomitus), observed in 9 episodes of acute pancreatitis (47.4%) were short term in 6 (31%), needed modification of nutritional therapy in 3 (15.7%) (lowering dose of EN in 2, TPN in 1). CONCLUSIONS 1. Enteral nutrition in children with mild acute pancreatitis is a useful method of therapy and undesirable effects appearing in some patients have transient character. 2. Developing complications in patients with posttraumatic pancreatitis may decrease tolerance to enteral nutrition.