{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:30:45Z","timestamp":1787027445388,"version":"build-2736575974"},"reference-count":20,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T00:00:00Z","timestamp":1786752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Pediatric acute pancreatitis (AP) is increasingly recognized as a clinically significant disease, yet Central and Eastern European cohort data remain limited. Acute recurrent pancreatitis (ARP) affects a substantial proportion of these children and may reflect distinct underlying etiologies. This study aimed to characterize the etiological spectrum, disease severity, and hospitalization outcomes of AP and ARP in a pediatric tertiary referral population, and to identify early clinical predictors of severity. Methods: We retrospectively analyzed 63 children hospitalized between 2018 and 2025 with 77 documented episodes of AP. Diagnosis followed INSPPIRE criteria, and severity was graded using the 2017 NASPGHAN classification. Etiologies, clinical presentation, laboratory parameters, imaging findings, and hospitalization length were compared between AP and ARP groups, across severity and etiological complexity categories using appropriate non-parametric and permutation-based methods. Results: Genetic etiologies predominated in ARP (37.0%), whereas idiopathic and infectious causes were more common in first-episode AP (24.0% and 14.0%, respectively; overall p &lt; 0.001). Severity distribution did not differ between AP and ARP, with mild disease accounting for the majority of episodes in both groups. Serum albumin was significantly lower in moderate\/severe episodes (p = 0.030). Within the single-episode subgroup, etiological complexity emerged as a significant predictor of prolonged hospitalization, with complex multifactorial or systemic etiologies associated with markedly longer stays than idiopathic or single-factor disease (Welch ANOVA p = 0.007). Conclusions: In this Romanian pediatric cohort, genetic causes dominate ARP, while idiopathic and infectious etiologies characterize first-episode AP, supporting a stepwise approach in which comprehensive etiological work-up, including genetic testing, is prioritized after recurrence. The predominance of genetic causes in ARP should be interpreted with caution, as genetic testing was applied selectively, predominantly after recurrence. Recurrence status alone does not predict severity, whereas etiological complexity at first presentation and hypoalbuminemia represent practical, accessible early markers for clinically assessing more severe disease.<\/jats:p>","DOI":"10.3390\/children13081084","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T08:05:41Z","timestamp":1786953941000},"page":"1084","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute and Recurrent Pancreatitis in Children: Insights into Etiology and Clinical Course from a Retrospective Single-Center Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0955-4486","authenticated-orcid":false,"given":"Alexandra","family":"Mititelu","sequence":"first","affiliation":[{"name":"Second Pediatric Discipline, Department of Mother and Child, Iuliu Ha\u0163ieganu University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Grama","sequence":"additional","affiliation":[{"name":"Second Pediatric Discipline, Department of Mother and Child, Iuliu Ha\u0163ieganu University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania"},{"name":"Second Pediatric Clinic, Center of Expertise in Pediatric Rare Liver Diseases, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2099-8379","authenticated-orcid":false,"given":"Gabriel","family":"Ben\u021ba","sequence":"additional","affiliation":[{"name":"Second Pediatric Discipline, Department of Mother and Child, Iuliu Ha\u0163ieganu University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania"},{"name":"Second Pediatric Clinic, Center of Expertise in Pediatric Rare Liver Diseases, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2771-2302","authenticated-orcid":false,"given":"Alexandru-\u0218tefan","family":"Niculae","sequence":"additional","affiliation":[{"name":"Second Pediatric Discipline, Department of Mother and Child, Iuliu Ha\u0163ieganu University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4931-1219","authenticated-orcid":false,"given":"Tudor Lucian","family":"Pop","sequence":"additional","affiliation":[{"name":"Second Pediatric Discipline, Department of Mother and Child, Iuliu Ha\u0163ieganu University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania"},{"name":"Second Pediatric Clinic, Center of Expertise in Pediatric Rare Liver Diseases, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/MPG.0b013e31824f1516","article-title":"Definitions of Pediatric Pancreatitis and Survey of Present Clinical Practices","volume":"55","author":"Morinville","year":"2012","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1053\/j.gastro.2018.12.043","article-title":"Pancreatitis in Children","volume":"156","author":"Uc","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Deng, Y., Qiu, H., Huang, K., Huang, Y., Lian, F., Chen, Y., and Chen, H. (2025). Global, Regional, and National Burdens of Pancreatitis in Children and Adolescents Aged 0\u201324 Years from 1992 to 2021: A Trend Analysis Based on the Global Burden of Disease Study 2021. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1527569"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1038\/s41390-021-01454-1","article-title":"Etiology, Case Fatality, Recurrence, and Severity in Pediatric Acute Pancreatitis: A Meta-Analysis of 48 Studies","volume":"91","author":"Tian","year":"2022","journal-title":"Pediatr. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"117","DOI":"10.3345\/cep.2025.01879","article-title":"Progression from Acute to Chronic Pancreatitis in Children: A Systematic Review and Meta-Analysis","volume":"69","author":"Gagyi","year":"2026","journal-title":"Clin. Exp. Pediatr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"632","DOI":"10.2214\/AJR.14.14223","article-title":"Acute Pancreatitis in Pediatric Patients: Demographics, Etiology, and Diagnostic Imaging","volume":"206","author":"Restrepo","year":"2016","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1097\/MPG.0000000000001583","article-title":"Classification of Acute Pancreatitis in the Pediatric Population: Clinical Report from the NASPGHAN Pancreas Committee","volume":"64","author":"Kumar","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/01.PCC.0000149131.72248.E6","article-title":"International Pediatric Sepsis Consensus Conference: Definitions for Sepsis and Organ Dysfunction in Pediatrics","volume":"6","author":"Goldstein","year":"2005","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Juh\u00e1sz, M.F., Sipos, Z., Ocskay, K., Hegyi, P., Nagy, A., and P\u00e1rniczky, A. (2022). Admission Risk Factors and Predictors of Moderate or Severe Pediatric Acute Pancreatitis: A Systematic Review and Meta-Analysis. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.947545"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1097\/MPA.0000000000001172","article-title":"International Study Group of Pediatric Pancreatitis: In Search for a CuRE Cohort Study: Design and Rationale for INSPPIRE 2 From the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer","volume":"47","author":"Uc","year":"2018","journal-title":"Pancreas"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1097\/MPG.0000000000003590","article-title":"Analysis of INSPPIRE-2 Cohort: Risk Factors and Disease Burden in Children With Acute Recurrent or Chronic Pancreatitis","volume":"75","author":"Uc","year":"2022","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Zhong, R., Tan, S., Peng, Y., Xu, H., Jiang, X., Yan, Y., Lv, M., Liu, L., and Tang, X. (2021). Clinical Characteristics of Acute Pancreatitis in Children: A Single-Center Experience in Western China. BMC Gastroenterol., 21.","DOI":"10.1186\/s12876-021-01706-8"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1111\/apa.70431","article-title":"Phenotype, Management, and Outcomes in Paediatric Acute Pancreatitis: A Real-Life Cross-Sectional Study","volume":"115","author":"Korman","year":"2026","journal-title":"Acta Paediatr."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Mroskowiak, A., Majewska, K., Symela, Z., Rabstein, D., Grzybowska-Chlebowczyk, U., and Wi\u0119cek, S. (2025). The Analysis of the Clinical Course of Acute Pancreatitis in Children\u2014A Single-Center Study. Children, 12.","DOI":"10.3390\/children12121665"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e159318","DOI":"10.5812\/ijped-159318","article-title":"Clinical Characteristics and Early Prognosis of Acute Pancreatitis in Children with Different Etiologies","volume":"35","author":"Hou","year":"2025","journal-title":"Innov. J. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"5505484","DOI":"10.1155\/2022\/5505484","article-title":"Acute Pancreatitis and Recurrent Acute Pancreatitis in Children: A 10-Year Retrospective Study","volume":"2022","author":"Wang","year":"2022","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_17","first-page":"e90167","article-title":"Acute Pancreatitis in Children: Analysis of 15 Cases","volume":"17","author":"Rkain","year":"2025","journal-title":"Cureus"},{"key":"ref_18","first-page":"e14871","article-title":"Acute Pancreatitis in Children: The Clinical Profile at a Tertiary Hospital","volume":"13","author":"Khalaf","year":"2021","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.1097\/MPG.0000000000002033","article-title":"Factors Associated With Length of Stay and 30-Day Revisits in Pediatric Acute Pancreatitis","volume":"67","author":"Gay","year":"2018","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"356","DOI":"10.5223\/pghn.2020.23.4.356","article-title":"Impact of Clinical, Laboratory and Fluid Therapy Variables on Hospital Length of Stay for Children with Acute Pancreatitis","volume":"23","author":"Shahein","year":"2020","journal-title":"Pediatr. Gastroenterol. Hepatol. 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