Elsevier

The Journal of Pediatrics

Volume 152, Issue 1, January 2008, Pages 106-110.e1
The Journal of Pediatrics

Original article
Etiology and Outcome of Acute Pancreatitis in Infants and Toddlers

https://doi.org/10.1016/j.jpeds.2007.05.050Get rights and content

Objective

To determine the etiologic factors and outcome of acute pancreatitis in children under age 3 years.

Study design

This was a retrospective study of children under age 3 years with acute pancreatitis between January 1995 and December 2004. Stringent diagnostic criteria were used. Demographic and clinical data were collected, and etiology and outcome were recorded. The study was approved by the University of Pittsburgh’s Institutional Review Board.

Results

Of 109 cases, 87 met the diagnostic criteria. Median age was 20 months (range, 1 week to 35 months). AP was associated with multisystem disease in 29 cases (34%), with hemolytic uremic syndrome (HUS) being common. Pancreatitis was associated with systemic infections in 16 cases (18%) and was idiopathic in 15 cases (17%). Biliary disease played an important etiologic role (9%), as did trauma (8%). Pancreatitis was mild in 76 cases (87.3%) and severe in 3 cases (3.4%).

Conclusions

AP is commonly associated with multisystem disease, particularly with HUS. Idiopathic pancreatitis and pancreatitis associated with biliary disease are seen in children under age 3 years. Trauma is a less frequent cause of pancreatitis, and severe pancreatitis is rare in this age group.

Section snippets

Methods

We reviewed medical records of all children under age 3 years admitted to Children’s Hospital of Pittsburgh with a diagnosis of AP (ICD-9 577.0) between January 1995 and December 2004. Criteria for diagnosis of AP included acute symptoms indicating a change from the usual health of the patient and a 3-fold or greater elevation in serum amylase (normal, <90 IU/L) or lipase (normal, <200 IU/L), abnormal radiologic or surgical findings consistent with AP, or both biochemical and radiologic

Results

We identified 947 cases of AP in children of all ages. Of these children, 109 (11.5%) were under age 3 years; 87 of the 109 met our inclusion criteria. Two children with appendicitis were excluded. AP was the admitting diagnosis in only 21 of the 87 children (24%). Most of the children (66; 76%) were admitted for other illnesses and were diagnosed with pancreatitis while hospitalized.

The study group comprised 45 (51.7%) males and 42 (48.2%) females, with a median age at presentation of 20

Discussion

Our study is complicated because there is no easily applied standard for the diagnosis of AP. Our definition of AP is similar to that used in previous studies and represents reasonable, stringent criteria.2, 4, 5 Requiring clinical, biochemical, and radiologic evidence of AP underestimates disease incidence, because patients can have AP with only biochemical changes.9, 10, 11 Including patients with clinical and biochemical evidence of AP without radiologic changes may overestimate the

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