Liberal Fluid Resuscitation is Associated with Improved Outcomes in Pediatric Acute Pancreatitis

Abstract

Objective

To evaluate outcomes of children from an observational cohort registry of index acute pancreatitis (AP) admissions managed with different types and rates of intravenous fluid therapy.

Study design

Patients with index admission of AP between 2013 and 2023 were included. Those who received >1.5x the maintenance intravenous fluid rate were assigned to the liberal fluid group, and patients who received <1.5x maintenance fluids were assigned to the conservative group. Outcomes including intensive care unit admission rate, organ dysfunction, local pancreatic complications, and AP severity were evaluated. Influence of early enteral feeding and fluid composition on outcomes and clinical course were also analyzed.

Results

Patients who received liberal fluids were less likely to be admitted or transferred to the intensive care unit compared with those receiving conservative management (OR, 0.32; 95% CI, 0.12-0.80; P = .015). The liberal fluid group with early feeding had the lowest rate of moderate/severe manifestations of AP compared with other combinations of diet and fluid orders. Patients within the liberal fluid group who received the highest fluid rates (>2x maintenance) did not have higher rates of organ dysfunction or severe disease.

Conclusions

Children with AP may stand to benefit from liberal fluid therapy and continued diet compared with more conservative fluid resuscitation and nothing by mouth status.