(P18-038-23) Exocrine Pancreatic Insufficiency in the Pediatric Intensive Care Unit

Objectives: Malnutrition and impaired exocrine pancreatic function are well-documented comorbidities seen in adult patients in the intensive care setting. Patients can have pancreatic insufficiency due to infection or multi-organ dysfunction, without preexisting pancreatic disease or acute injury. Exocrine pancreatic insufficiency results in a lack of digestive enzymes and malnutrition, which is associated with poor clinical outcomes in adult and pediatric ICU patients. There is no literature regarding pancreatic insufficiency in PICU patients. Children with malnutrition are screened for pancreatic insufficiency; however, routine screening in PICU patients is not standard of care as the prevalence of pancreatic insufficiency is unknown. If patients are found to have pancreatic insufficiency during their acute illness, enzyme supplementation to improve their nutritional status may be warranted. The standard of care to determine if patients have pancreatic insufficiency, is fecal pancreatic elastase (FE) via enzyme-linked immunoassay. We propose to study the prevalence of pancreatic insufficiency in PICU patients.

Methods: Patient admitted to the PICU with respiratory failure, sepsis, shock, or cardiac arrest and have started enteral nutrition within 5 days of admission are recruited. Data collected includes patient demographics, vital signs, GCS, blood gas values, Amylase, Lipase, Lactate, inflammatory markers, CBC, BMP, liver function tests, Coagulation studies, SARS-COV2 status. The degree of severity of illness is calculated using Pediatric Risk of Mortality 3 (PRISM3) scoring. If enteral nutrition is held for 24 hours or more, patients are excluded from the study. If consented, up to two stools are sent for FE testing. If patients are found to have pancreatic insufficiency, appropriate therapy with enzyme supplementation will be initiated.

Results: This study is currently ongoing, and data collection with statistical analysis is pending at this time. Preliminary results indicate an average FE value of >200 µg/g (100%, n=20). Normal FE values per lab criteria is considered greater than or equal to 200 µg/g.

Conclusions: Preliminary results indicate that exocrine pancreatic insufficiency is not prevalent in pediatric patients who are acutely ill in the intensive care setting.

Funding Sources: This is study is funded by Alcresta Therapeutics, Inc.