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Observational Study
. 2025 Jan:276:114329.
doi: 10.1016/j.jpeds.2024.114329. Epub 2024 Sep 30.

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

Nicholas Norris  1 , Peter Farrell  2 , Sherif Ibrahim  3 , Lin Fei  4 , Qin Sun  4 , David S Vitale  2 , Maisam Abu-El-Haija  2
Affiliations
Observational Study

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

Nicholas Norris et al. J Pediatr. 2025 Jan.

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.

Keywords: acute pancreatitis; fluid therapy; lactated ringers; maintenance fluids; normal saline.

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Conflict of interest statement

Declaration of Competing Interest NPF/CAPER Visiting Fellow Program (NN), NIDDK Grant K23DK118190 (MAH). The National Pancreas Foundation and Collaborative Alliance for Pancreatic Education and Research provided funding for a visiting fellowship of the primary author at the primary study site and had no role in the design or conduct of this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Acute pancreatitis registry fluid management according to rate and fluid composition.
Figure 2.
Figure 2.
A, Conservative [LO] vs liberal [HI] fluid resuscitation outcomes; B, outcomes of nested fluid and diet groups; and C, fluid composition outcomes analysis. Significant overall differences with *P < .05 and **P < .01.
Figure 3.
Figure 3.
Comparison of adult acute pancreatitis fluid management to pediatric practice.
See this image and copyright information in PMC

References

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