# Short Bowel Syndrome — GCMD Library living collection

Also covered as: intestinal failure · necrotizing enterocolitis · gastroschisis · intestinal atresia · Hirschsprung disease · liver disease · malrotation · volvulus

Experts: Dr. Ellen Encisco, Dr. Rod Gerardo, Dr. Michael Helmrath, Dr. Paul Wales

Updated: n/a · 10 episodes · 182 cited statements

## Episodes
### Fundamentals
- [Necrotizing Enterocolitis with Dr. Gail Besner](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297) — podcast · 46:29 · [machine version](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297.md)
- [Intestinal rehabilitation: What is intestinal rehab? - Episode 1](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741) — video · 14:33 · [machine version](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741.md)
- [Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742) — podcast · 14:33 · [machine version](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742.md)

### Surgical Management
- [Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913) — podcast · 19:07 · [machine version](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913.md)

### Evidence & Research
- [Quick Literature Updates Episode 7](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686) — video · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686.md)
- [Disruption of enterohepatic Circulation of Bile acids ameliorates small bowel resection associated hepatic injury](https://qa.library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050) — video · 0:59 · [machine version](https://qa.library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050.md)
- [Outcomes of Children With Short Bowel Syndrome: Experiences in a Multidisciplinary Intestinal Rehabilitation Unit Over Two Decades](https://qa.library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027) — video · 0:45 · [machine version](https://qa.library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027.md)
- [Impact of social determinants of health on outcomes in pediatric short bowel syndrome...](https://qa.library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896) — video · 0:43 · [machine version](https://qa.library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896.md)

### In-Depth Reviews
- [Intestinal Failure with Dr. Brad Warner](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296) — podcast · 52:46 · [machine version](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296.md)

### Long-Term Care
- [Care transition from a pediatric intestinal rehabilitation program to adult care and the risk of all-cause mortality: A retrospective cohort study](https://qa.library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901) — video · 1:01 · [machine version](https://qa.library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=0) Introduction and Episode Overview (Ep 1)
- [1:39](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=99) Definition and Prognostic Factors in Intestinal Failure (Ep 1)
- [5:29](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=329) Natural History and Outcomes in Short Gut Syndrome (Ep 1)
- [10:22](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=622) Medical Management and TPN Strategy (Ep 1)
- [17:51](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1071) Enteral Feeding Strategy and Intestinal Adaptation (Ep 1)
- [21:48](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1308) Indications for Surgical Intervention (Ep 1)
- [26:01](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1561) Surgical Techniques: Bianchi and STEP Procedures (Ep 1)
- [36:00](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2160) Bowel Tapering and Technical Considerations (Ep 1)
- [41:31](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2491) Management of TPN-Related Cholestasis and Bacterial Overgrowth (Ep 1)
- [43:35](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2615) Growth Factors and Future Therapies (Ep 1)
- [46:31](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2791) Intestinal Transplantation: Indications and Outcomes (Ep 1)
- [51:21](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=3081) Multidisciplinary Care and Closing Remarks (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=0) Introduction and Research Background (Ep 2)
- [2:33](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=153) Initial Evaluation and Medical Management (Ep 2)
- [8:45](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=525) Medical Management Protocol (Ep 2)
- [11:44](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=704) Duration of Medical Management and Stricture Surveillance (Ep 2)
- [15:05](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=905) Surgical Indications and Decision-Making (Ep 2)
- [19:10](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1150) Peritoneal Drainage versus Laparotomy (Ep 2)
- [23:48](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1428) Peritoneal Drain Technique (Ep 2)
- [27:46](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1666) Management After Drain Placement (Ep 2)
- [31:00](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1860) Laparotomy Technique and Principles (Ep 2)
- [34:43](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2083) Stoma Creation Technique (Ep 2)
- [36:52](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2212) Management of Indeterminate and Skip Lesions (Ep 2)
- [39:07](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2347) Stoma Reversal and Refeeding (Ep 2)
- [42:05](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2525) NEC Totalis Management (Ep 2)
- [44:06](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2646) Special Considerations and Closing (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=0) Introduction and Program Context (Ep 3)
- [1:56](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=116) Defining Intestinal Failure and Intestinal Rehabilitation (Ep 3)
- [4:50](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=290) Three Categories of Intestinal Failure (Ep 3)
- [8:20](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=500) Timing of Diagnosis and Referral (Ep 3)
- [10:05](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=605) Team Approach and Future Challenges (Ep 3)
- [13:15](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=795) Series Goals and Closing (Ep 3)
- [0:00](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=0) Introduction to the intestinal rehabilitation series and guest experts (Ep 4)
- [1:46](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=106) Defining intestinal failure and the need for intestinal rehabilitation (Ep 4)
- [3:03](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=183) What is intestinal rehabilitation and the multidisciplinary team approach (Ep 4)
- [4:39](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=279) Three categories of intestinal failure causes (Ep 4)
- [8:30](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=510) Three time points for diagnosis and referral to intestinal rehabilitation (Ep 4)
- [10:04](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=604) Building the Cincinnati Children's intestinal rehabilitation program (Ep 4)
- [12:34](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=754) Long-term survival outcomes and emerging chronic comorbidities (Ep 4)
- [0:00](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=0) Historical Context and Natural History of Intestinal Failure Surgery (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Until recently, there was no standardized definition for intestinal failure." — Paul Wales (clinical) [Ep 3 · 1:56](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=116)
- "Intestinal failure is when gut function is insufficient to absorb enough nutrients, fluids, and calories to support survival and, in children, growth." — Paul Wales (clinical) [Ep 3 · 2:03](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=123)
- "New guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function." — Rod Gerardo (host_summary) [Ep 3 · 2:24](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=144)
- "Earlier recognition and taking advantage of the gut's biology to adapt are time dependent." — Michael Helmrath (clinical) [Ep 3 · 2:40](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=160)
- "An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm that brings coordinated care for children with intestinal failure through comprehensive management of their specialized nutrition and other associated needs, as defined in recent ASPEN guidelines." — Paul Wales (guideline) [Ep 3 · 3:03](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=183)
- "Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth." — Rod Gerardo (host_summary) [Ep 3 · 3:33](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=213)
- "The intestinal rehabilitation approach streamlines care and improves communication with families and between care providers." — Paul Wales (clinical) [Ep 3 · 3:44](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=224)
- "Intestinal rehabilitation depends on nutrition in the gut, nutrition in the body, and healing." — Michael Helmrath (clinical) [Ep 3 · 4:07](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=247)
- "Pattern recognition from multiple experienced clinicians observing patients over time is essential in intestinal rehabilitation." — Michael Helmrath (clinical) [Ep 3 · 4:19](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=259)
- "Causes of intestinal failure divide into three categories: short bowel syndrome, motility disorders, and congenital enteropathies." — Paul Wales (clinical) [Ep 3 · 4:39](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=279)
- "Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients." — Paul Wales (epidemiological) [Ep 3 · 4:50](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=290)
- "Causes of short bowel syndrome include congenital anomalies (intestinal atresia, malrotation, volvulus, gastroschisis, long segment Hirschsprung disease) and acquired neonatal diseases (necrotizing enterocolitis)." — Paul Wales (clinical) [Ep 3 · 5:06](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=306)
- "Motility disorders occur when abnormalities of intestinal muscle or the nerves controlling that muscle prevent coordinated propulsion of food and stool." — Paul Wales (clinical) [Ep 3 · 5:45](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=345)
- "Congenital enteropathies are conditions where patients have all their bowel but the mucosal lining does not digest or absorb properly." — Paul Wales (clinical) [Ep 3 · 6:17](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=377)
- "Mucosal defects in enteropathies lead to hypersecretion and profuse fluid losses, preventing nutrient absorption." — Ellen Encisco (host_summary) [Ep 3 · 6:30](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=390)
- "Some patients have elements of two or all three categories of intestinal failure in their presentation." — Paul Wales (clinical) [Ep 3 · 7:11](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=431)
- "Gastroschisis can involve all three categories: short bowel from nonviable tissue, inflammation affecting absorption, and motility issues." — Ellen Encisco (host_summary) [Ep 3 · 7:22](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=442)
- "Most intestinal failure patients are infants or babies, but some older pediatric patients develop intestinal failure from inflammatory bowel disease, Crohn disease complications, trauma, malignancy, or vascular thrombosis." — Paul Wales (epidemiological) [Ep 3 · 7:45](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=465)
- "Access and availability to intestinal rehabilitation programs is still very rare." — Rod Gerardo (host_summary) [Ep 3 · 8:41](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=521)
- "Three time points exist for diagnosis and referral to intestinal rehab: prenatal diagnosis (atresia with cystic fibrosis, gastroschisis), postnatal acquired problems (volvulus, NEC), and later presentations after discharge when patients fail to progress." — Michael Helmrath (clinical) [Ep 3 · 8:53](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=533)
- "Innovation in intestinal rehabilitation comes from multiple approaches to problems and different visions, with more expertise leading to better outcomes." — Michael Helmrath (opinion) [Ep 3 · 10:15](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=615)
- "Transitioning older children with intestinal failure into their late teen years and beyond is a major obstacle currently not being adequately addressed." — Michael Helmrath (clinical) [Ep 3 · 10:51](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=651)
- "The intestinal rehabilitation team includes dietitians (for nutritional needs), social workers, nurse practitioners, pharmacy, interventional radiology, pathology, endocrinology, and nephrology." — Michael Helmrath (clinical) [Ep 3 · 11:52](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=712)
- "Overall long-term survival in major intestinal rehabilitation programs is usually over 90%." — Rod Gerardo (host_summary) [Ep 3 · 12:34](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=754)
- "Long-term survivors now develop chronic comorbidities not previously seen to the same extent because patients did not live long enough, including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life problems." — Paul Wales (clinical) [Ep 3 · 12:46](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=766)
- "Until recently, there was no standardized definition for intestinal failure." — Paul Wales (guideline) [Ep 4 · 1:56](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=116)
- "Intestinal failure is a functional problem where gut function is insufficient to absorb enough nutrients, fluids, and calories to support survival and, in children, growth." — Paul Wales (clinical) [Ep 4 · 2:03](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=123)
- "New guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days." — Rod Gerardo (host_summary) [Ep 4 · 2:24](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=144)
- "Earlier recognition and taking advantage of the gut's adaptive biology are time dependent." — Michael Helmrath (clinical) [Ep 4 · 2:40](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=160)
- "An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm that brings coordinated care for children with intestinal failure through comprehensive management of their specialized nutrition and other associated needs, as defined in recent ASPEN guidelines." — Paul Wales (guideline) [Ep 4 · 3:03](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=183)
- "Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth." — Rod Gerardo (host_summary) [Ep 4 · 3:33](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=213)
- "Intestinal rehabilitation streamlines care and improves communication between family and care providers through an amalgamation of experts providing holistic, comprehensive, coordinated care." — Paul Wales (clinical) [Ep 4 · 3:44](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=224)
- "Intestinal rehabilitation depends on key factors: nutrition in the gut, nutrition in the body, and healing." — Michael Helmrath (clinical) [Ep 4 · 4:07](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=247)
- "Pattern recognition from multiple expert eyes observing a patient over time is essential in intestinal rehabilitation." — Michael Helmrath (clinical) [Ep 4 · 4:19](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=259)
- "Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients." — Paul Wales (epidemiological) [Ep 4 · 4:50](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=290)
- "Causes of short bowel syndrome are usually related to neonatal disorders including congenital anomalies (intestinal atresia, malrotation, volvulus, gastroschisis, long segment Hirschsprung disease) or acquired diseases (necrotizing enterocolitis)." — Paul Wales (clinical) [Ep 4 · 4:50](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=290)
- "Motility disorders occur when abnormalities of the intestinal muscle itself or the nerves controlling that muscle prevent coordinated propulsion of food and stool, making patients dependent on intravenous support." — Paul Wales (clinical) [Ep 4 · 5:45](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=345)
- "Enteropathies or congenital diarrheas are conditions where the patient has all of their bowel but the mucosal lining that digests and absorbs does not work, leading to hypersecretion and profuse fluid losses." — Paul Wales (clinical) [Ep 4 · 6:17](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=377)
- "Some patients will have elements of two or all three categories of intestinal failure; for example, gastroschisis can involve short bowel, inflammation affecting absorption, and motility issues." — Paul Wales (clinical) [Ep 4 · 7:11](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=431)
- "Although most intestinal failure patients are infants or babies, older pediatric patients can develop intestinal failure from inflammatory bowel disease, Crohn's disease complications, trauma, malignancy, or vascular thrombosis leading to gut loss." — Paul Wales (clinical) [Ep 4 · 7:45](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=465)
- "Families reach intestinal rehabilitation programs at three time points: prenatal diagnosis (typically atresia with cystic fibrosis or gastroschisis), postnatal acquired problems (volvulus or NEC), and later diagnosis after discharge when patients fail to progress." — Michael Helmrath (clinical) [Ep 4 · 8:53](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=533)
- "Innovation comes from multiple approaches to a problem and different visions; bringing in more expertise leads to better outcomes." — Michael Helmrath (opinion) [Ep 4 · 10:15](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=615)
- "Transitioning older children with intestinal failure into their late teen years and beyond is a major obstacle currently not being met." — Michael Helmrath (clinical) [Ep 4 · 10:51](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=651)
- "The intestinal rehabilitation team includes dietitians (understanding nutritional needs), social work, nurse practitioners, pharmacy, interventional radiology, pathology, and subspecialties including endocrinology and nephrology." — Michael Helmrath (clinical) [Ep 4 · 11:52](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=712)
- "Overall survival in big intestinal rehabilitation programs is usually over 90% long-term." — Rod Gerardo (host_summary) [Ep 4 · 12:34](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=754)
- "Improved survival has revealed chronic comorbidities not previously seen to the same extent because patients did not live long enough, including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life concerns." — Paul Wales (clinical) [Ep 4 · 12:46](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=766)
- "Adrian Bianchi first reported the longitudinal intestinal lengthening procedure (Bianchi procedure) that divides bowel along its two leaves and tubularizes it." — Michael Helmrath (clinical) [Ep 5 · 1:23](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=83)
- "In the 1980s and 1990s, babies with intestinal failure had poor outcomes primarily due to liver progression to inflammation and fibrosis associated with parenteral nutrition, lipids, and phytosterols." — Ellen Encisco (host_summary) [Ep 5 · 1:50](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=110)
- "Rising direct bilirubin was recognized as a sign that children with intestinal failure would not do well." — Michael Helmrath (clinical) [Ep 5 · 2:13](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=133)
- "The first 4 months of life is when care for intestinal failure patients is most uncoordinated, and surgical decisions made during this period have the most profound effect on long-term outcome." — Todd Ponsky (host_summary) [Ep 5 · 2:29](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=149)
- "The gut doubles in length during the last trimester and the first year of life, and this maturation process occurs when the baby is fed." — Michael Helmrath (clinical) [Ep 5 · 2:55](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=175)
- "Healthy growth of the intestine requires nutrition; anything that disrupts this affects maturation of both absorptive/digestive capacity and peristalsis." — Michael Helmrath (clinical) [Ep 5 · 3:03](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=183)
- "Absorptive surface area comes from the waves of peristalsis moving over the villi, not from the exposed length of bowel." — Todd Ponsky (host_summary) [Ep 5 · 3:32](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=212)
- "Lengthening bowel that doesn't have peristalsis does not increase absorption; very short bowel children can sometimes come off TPN because their motility is good." — Michael Helmrath (clinical) [Ep 5 · 3:46](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=226)
- "The majority of pediatric short bowel syndrome cases present at birth due to neonatal causes: congenital GI anomalies or acquired conditions like necrotizing enterocolitis." — Paul Wales (epidemiological) [Ep 5 · 4:18](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=258)
- "When reestablishing bowel continuity, size discrepancy between bowel ends must be addressed or a functional obstruction will result even if the anastomosis is patent." — Paul Wales (clinical) [Ep 5 · 5:42](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=342)
- "Size discrepancy can be managed by resection to a more appropriate caliber, tapering enteroplasty, or serial transverse enteroplasty (STEP) depending on available bowel length." — Paul Wales (clinical) [Ep 5 · 6:02](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=362)
- "Gastroschisis patients tend to not do as well with STEP procedures regardless of whether atresia is present; among STEP procedures performed over the years, gastroschisis cases consistently had worse outcomes." — Paul Wales (epidemiological) [Ep 5 · 7:08](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=428)
- "Gastroschisis patients have inherent dysmotility." — Todd Ponsky (host_summary) [Ep 5 · 7:21](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=441)
- "The enteric nervous system in gastroschisis is damaged from exposure to amniotic fluid and requires a healing and recovery phase; this regeneration is attenuated by dysmotility and stasis, not enhanced." — Michael Helmrath (clinical) [Ep 5 · 7:32](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=452)
- "In atresia without gastroschisis, the bowel may have good peristalsis from working against an obstruction, and when done correctly with proper orientation, a longitudinal lengthening procedure may benefit the child." — Michael Helmrath (opinion) [Ep 5 · 7:55](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=475)
- "Children who undergo STEP procedures in their first year of life sometimes never progress and are labeled as poor motility patients unable to tolerate enteral feeds." — Michael Helmrath (clinical) [Ep 5 · 8:19](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=499)
- "Among patients with limited gut, necrotizing enterocolitis patients do best because they have been fed before, have established GI motility, and the maturation phase has already been initiated." — Michael Helmrath (opinion) [Ep 5 · 8:40](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=520)
- "STEP procedure is not usually performed unless bowel is at least 5 centimeters dilated to make it worthwhile." — Paul Wales (clinical) [Ep 5 · 9:09](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=549)
- "At birth, neonatal bowel is usually not dilated enough to apply the STEP procedure." — Ellen Encisco (host_summary) [Ep 5 · 9:36](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=576)
- "In scenarios where bowel is not adequately dilated, options include resecting bulbs with tapering enteroplasty, establishing continuity if possible, or leaving bowel disconnected with distal feeding tube access to grow the distal bowel before reconnection." — Paul Wales (clinical) [Ep 5 · 9:41](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=581)
- "The STEP procedure was originally described by HP Kim and Tom Jackson." — Paul Wales (clinical) [Ep 5 · 10:45](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=645)
- "For STEP, a transverse supraumbilical abdominal incision is used, all adhesions are lysed, and the entire intestinal tract is laid out from top to bottom to understand anatomy and maximize mobility." — Paul Wales (clinical) [Ep 5 · 11:02](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=662)
- "The anti-mesenteric surface of the bowel is marked with surgical pen after drying with a lap sponge; maintaining this alignment prevents longitudinal twisting of the bowel during stapling." — Paul Wales (clinical) [Ep 5 · 11:29](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=689)
- "Bowel length is measured before the procedure using 30 silk dipped in mineral oil; caliber and length of the dilated segment to be stepped are also recorded." — Paul Wales (clinical) [Ep 5 · 11:58](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=718)
- "An endo-GIA stapler is preferred over an open GIA stapler because the smaller cartridge head is more amenable in smaller patients." — Paul Wales (opinion) [Ep 5 · 12:20](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=740)
- "Staple lines are applied perpendicular to the mesentery at 90° and 270° (3 o'clock and 9 o'clock positions if mesenteric vessels are at 0°)." — Paul Wales (clinical) [Ep 5 · 12:34](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=754)
- "A vascular (white) cartridge with 2.5 mm staples that crimp to 1 mm is used; this is more appropriate for younger patients' bowel thickness and prevents leaks that occurred with classic blue loads in early experience." — Paul Wales (clinical) [Ep 5 · 12:58](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=778)
- "Target caliber for STEP is 1.5 cm in babies and 2 to 2.5 cm in older infants or children; making it too narrow risks obstruction, especially in patients with borderline motility." — Paul Wales (clinical) [Ep 5 · 13:23](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=803)
- "Before firing the stapler, measurements are taken to both the end of the bowel and to the side to ensure proper caliber is maintained throughout the length." — Paul Wales (clinical) [Ep 5 · 14:09](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=849)
- "A U-stitch with 4-0 PDS is placed in the crotch of each staple line to prevent potential leaks at that point." — Paul Wales (clinical) [Ep 5 · 14:28](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=868)
- "The procedure is performed with a partner, alternating sides of the bowel, working down the length; 45 mm cartridges are most versatile, but 30 mm and 60 mm cartridges may be needed depending on bowel diameter." — Paul Wales (clinical) [Ep 5 · 14:50](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=890)
- "At the top and bottom of the STEP segment, an additional oblique staple line is fired to taper the transition and avoid a 'dog ear' blind loop that can dilate over time." — Paul Wales (clinical) [Ep 5 · 15:08](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=908)
- "If one part of the stepped bowel becomes dilated, the STEP segments can rotate away from each other separately, causing twisting and functional obstruction." — Ellen Encisco (host_summary) [Ep 5 · 15:57](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=957)
- "After completing the STEP, the length of stepped bowel, new total bowel length, and final caliber (2-2.5 cm) are recorded." — Todd Ponsky (host_summary) [Ep 5 · 16:13](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=973)
- "The STEP procedure is performed with staple lines perpendicular to the mesentery (90° and 270°), not in the anti-mesenteric to mesenteric orientation (180° and 0°)." — Paul Wales (clinical) [Ep 5 · 16:23](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=983)
- "The duodenum is not stepped; the STEP procedure starts where the bowel begins to dilate, usually distal to the duodenum." — Paul Wales (clinical) [Ep 5 · 16:56](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=1016)
- "Avoiding staple lines in the duodenum allows proximal access if emergency reoperation is needed for a leak." — Paul Wales (opinion) [Ep 5 · 17:03](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=1023)
- "If duodenal narrowing is needed, a stapler is used to partially narrow the lateral side away from the bile duct and ampulla; plication sutures are not used because they usually fail." — Paul Wales (clinical) [Ep 5 · 17:15](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=1035)
- "The duodenum has no mesentery, making it impossible to orient 90° and 270° positions; surgeons who STEP the duodenum end up entering the bowel at inconsistent orientations." — Michael Helmrath (clinical) [Ep 5 · 17:32](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=1052)
- "Allen et al. studied 277 children with Hirschsprung's disease, approximately half had Soave procedure, one-third had Duhamel, and the rest had Swenson procedure." — Britney Levy (host_summary) [Ep 6 · 0:47](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=47)
- "217 of the 277 Hirschsprung's disease patients had long-term outcome data available." — Britney Levy (host_summary) [Ep 6 · 0:47](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=47)
- "Duhamel procedure has the lowest risk of incontinence but the highest risk of constipation in school age children with Hirschsprung's disease." — Britney Levy (host_summary) [Ep 6 · 0:47](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=47)
- "Peters et al. retrospectively reviewed 55 pediatric patients with small bowel syndrome to examine whether presence or absence of ileocecal valve and/or colon can predict enteral autonomy." — Rod Gerardo (host_summary) [Ep 6 · 1:35](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=95)
- "Infants with an ileocecal valve had significantly shorter duration on parenteral nutrition." — Rod Gerardo (host_summary) [Ep 6 · 1:35](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=95)
- "Patients with less than 50% of their colon had significantly less time on parenteral nutrition as long as they had their ileocecal valve." — Rod Gerardo (host_summary) [Ep 6 · 1:35](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=95)
- "Olsen et al. systematic review analyzed 10 studies with 6,430 patients examining surgeon volume and pediatric thyroid surgery outcomes." — Cecilia Gigena (host_summary) [Ep 6 · 2:43](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=163)
- "The definition of a high volume surgeon varies widely, ranging from 9 thyroidectomies per year to over 200 thyroidectomies with at least 30 being in pediatric patients." — Cecilia Gigena (host_summary) [Ep 6 · 2:43](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=163)
- "Thyroidectomies performed by high volume surgeons show shorter length of stays." — Cecilia Gigena (host_summary) [Ep 6 · 2:43](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=163)
- "Tendon et al. conducted a prospective randomized control trial between 2017 and 2018 comparing three skin closure methods: sutures with tissue adhesive, sutures with adhesive tape, and sutures alone." — Ellen Encisco (host_summary) [Ep 6 · 3:35](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=215)
- "Wounds were assessed at two weeks, six weeks, and more than six months after operation by surveying clinicians and parents." — Ellen Encisco (host_summary) [Ep 6 · 3:35](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=215)
- "Wounds with tissue adhesive had poorer cosmesis at six weeks compared to other closure methods." — Em Tombash (host_summary) [Ep 6 · 4:17](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=257)
- "The cosmesis difference between tissue adhesive and other closure methods disappears by six months." — Em Tombash (host_summary) [Ep 6 · 4:17](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=257)
- "At six months, there was no difference in wound outcomes between the three closure groups for either clinicians or parents." — Em Tombash (host_summary) [Ep 6 · 4:17](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=257)
- "Disruption of the enterohepatic circulation of bile acids is beneficial for the liver" — Cecilia Gigena (host_summary) [Ep 7 · 0:00](https://qa.library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=0)
- "The study was conducted at Saint Louis Children's Hospital and aimed to elucidate the driving force behind hepatic injury following bowel resection" — Cecilia Gigena (host_summary) [Ep 7 · 0:13](https://qa.library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=13)
- "The study used three groups of mice: sham, 50% with proximal or duodenal resection, and 50% with distal resection or resection of the ileocecal valve" — Cecilia Gigena (host_summary) [Ep 7 · 0:22](https://qa.library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=22)
- "Tissue samples were taken at the second and tenth post-operative weeks" — Cecilia Gigena (host_summary) [Ep 7 · 0:34](https://qa.library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=34)
- "Mice with distal resection showed less hepatic oxidative stress compared to proximal resection" — Cecilia Gigena (host_summary) [Ep 7 · 0:41](https://qa.library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=41)
- "Mice with distal resection showed a more hydrophilic bile acid profile compared to proximal resection" — Cecilia Gigena (host_summary) [Ep 7 · 0:41](https://qa.library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=41)
- "Ileal resection could lead to less hepatic injury" — Cecilia Gigena (host_summary) [Ep 7 · 0:41](https://qa.library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=41)
- "This retrospective study examined 64 pediatric patients with short bowel syndrome managed by a multidisciplinary intestinal rehab program between 2001 and 2022." — Lizzie Lee (host_summary) [Ep 8 · 0:10](https://qa.library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=10)
- "89% of patients with short bowel syndrome in the study survived." — Lizzie Lee (host_summary) [Ep 8 · 0:22](https://qa.library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=22)
- "78% of patients with short bowel syndrome were able to wean off parenteral nutrition." — Lizzie Lee (host_summary) [Ep 8 · 0:22](https://qa.library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=22)
- "Survival rates of children with short bowel syndrome improved over time in the study period." — Lizzie Lee (host_summary) [Ep 8 · 0:22](https://qa.library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=22)
- "Introduction of fish oil-based parenteral nutrition in 2007 improved survival in pediatric short bowel syndrome patients." — Lizzie Lee (host_summary) [Ep 8 · 0:31](https://qa.library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=31)
- "Presence of intestinal failure associated liver disease affected survival in pediatric short bowel syndrome patients." — Lizzie Lee (host_summary) [Ep 8 · 0:31](https://qa.library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=31)
- "Advances in medicine have dramatically improved survival rates for children with intestinal failure" — Julian Goddard (host_summary) [Ep 9 · 0:00](https://qa.library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=0)
- "Cincinnati Children's intestinal rehabilitation team tracked 46 patients who turned 20 to examine outcomes when they transitioned to adult healthcare centers or continued pediatric care" — Julian Goddard (epidemiological) [Ep 9 · 0:13](https://qa.library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=13)
- "59% of patients transitioned to adult focused programs while the rest continued receiving care at Cincinnati Children's" — Julian Goddard (epidemiological) [Ep 9 · 0:23](https://qa.library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=23)
- "Patients who transitioned to adult care had a significantly higher mortality rate of 33% compared to 5% among those who stayed in pediatric care" — Julian Goddard (epidemiological) [Ep 9 · 0:29](https://qa.library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=29)
- "Patients who transitioned to adult care showed no obvious differences in medical complexity or disease burden compared to those who remained in pediatric care" — Julian Goddard (epidemiological) [Ep 9 · 0:29](https://qa.library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=29)
- "The median time from transition to death was approximately 12 months" — Julian Goddard (epidemiological) [Ep 9 · 0:42](https://qa.library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=42)
- "Young adults with a history of intestinal failure aging out of pediatric care remain a critically vulnerable population in need of greater attention and support until structured transition programs are developed and widely implemented" — Julian Goddard (opinion) [Ep 9 · 0:46](https://qa.library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=46)
- "This was a retrospective cohort study of children with short bowel syndrome in an intestinal rehabilitation program, followed from 2006 to 2019." — Lizzie Lee (host_summary) [Ep 10 · 0:07](https://qa.library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=7)
- "The study asked whether social determinants of health predict outcomes like bloodstream infections, liver disease, and achieving enteral autonomy." — Lizzie Lee (host_summary) [Ep 10 · 0:16](https://qa.library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=16)
- "Social determinants of health do predict outcomes in pediatric short bowel syndrome in real ways." — Lizzie Lee (host_summary) [Ep 10 · 0:24](https://qa.library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=24)
- "Distance from the hospital was associated with higher risks of serious complications in children with short bowel syndrome." — Lizzie Lee (host_summary) [Ep 10 · 0:27](https://qa.library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=27)
- "Parental education was linked with fewer central line infections in children with short bowel syndrome." — Lizzie Lee (host_summary) [Ep 10 · 0:33](https://qa.library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=33)
- "Social determinants need to be considered to support families of children with short bowel syndrome better." — Lizzie Lee (host_summary) [Ep 10 · 0:37](https://qa.library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=37)
- "Intestinal failure is an umbrella term for when the small intestine is unable to absorb or digest enough nutrition to support the patient entirely by oral or enteral feeding" — Brad Warner (clinical) [Ep 1 · 1:42](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=102)
- "The intestine of a newborn or fetus doubles in length in the last trimester of gestation" — Brad Warner (clinical) [Ep 1 · 3:03](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=183)
- "A 24-25 week premature infant with 20-25 cm of bowel will likely increase to at least 50 cm just on the basis of growth alone" — Brad Warner (clinical) [Ep 1 · 3:13](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=193)
- "For a neonate with ileocecal valve and entire colon, 10-15 cm of small intestine is a ballpark figure for potential viability" — Brad Warner (clinical) [Ep 1 · 4:03](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=243)
- "Without the colon and ileocecal valve, at least 15-20 cm of small intestine would be needed for potential viability in a neonate" — Brad Warner (clinical) [Ep 1 · 4:37](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=277)
- "In adult studies, patients with less than 50 cm of intestine have about 40% mortality after 5-10 years" — Brad Warner (epidemiological) [Ep 1 · 4:51](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=291)
- "According to Pediatric Intestinal Failure Research Consortium data, of children on TPN for more than several months due to short gut syndrome: 25% die, 25% need transplant, and 50% can wean off TPN" — Brad Warner (epidemiological) [Ep 1 · 6:38](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=398)
- "Common causes of death in intestinal failure include liver failure, septic episodes from central line or bacterial overgrowth, variceal bleeding from liver disease, and loss of IV access" — Brad Warner (clinical) [Ep 1 · 7:11](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=431)
- "Intestinal adaptation in humans probably takes place over about a year or two after small bowel resection" — Brad Warner (clinical) [Ep 1 · 7:49](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=469)
- "The goal of management is to wean TPN and push enteral feeding, accepting stool outputs of up to 40 cc per kilo per day as the limit" — Brad Warner (clinical) [Ep 1 · 8:19](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=499)
- "The most common reasons children develop short gut syndrome are necrotizing enterocolitis, gastroschisis, midgut volvulus, and atresias" — Brad Warner (epidemiological) [Ep 1 · 9:22](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=562)
- "For TPN, target about 100-120 calories per kilo per day for total calories, with about 50% from glucose and remainder from fat and protein" — Brad Warner (clinical) [Ep 1 · 10:22](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=622)
- "Shoot for about 2-3 g of protein per kilo per day and about 2-3 g of fat per kilo per day in TPN" — Brad Warner (clinical) [Ep 1 · 10:45](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=645)
- "Begin enteral feeding as soon as feasible after resection and reanastomosis when they start stooling, generally starting with slow continuous drip" — Brad Warner (clinical) [Ep 1 · 11:06](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=666)
- "With continuous drip feeding, nutrient transporters are upregulated and ability to get more nutrition in may be advantageous" — Brad Warner (opinion) [Ep 1 · 11:23](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=683)
- "Want a baby to gain about 20-30 g a day, which approximates in utero progression for a newborn" — Brad Warner (clinical) [Ep 1 · 12:05](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=725)
- "Lipid reduction strategy takes fat from 2-3 g per kilo per day given daily down to about 1 g per kilo per day delivered twice or 3 times a week, which has been effective in reducing TPN-associated cholestasis" — Brad Warner (clinical) [Ep 1 · 12:53](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=773)
- "Omegaven is a fish oil-based fat containing primarily omega-3 fatty acids that are anti-inflammatory, compared to soybean-based intralipid with omega-6 fatty acids that are pro-inflammatory" — Brad Warner (clinical) [Ep 1 · 14:03](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=843)
- "When fish oil (omegaven) is introduced to children getting jaundiced, there has been demonstrated significant fall in their jaundice levels" — Brad Warner (clinical) [Ep 1 · 14:38](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=878)
- "SMOF lipid contains soybean-based lipid (essential fatty acids), medium chain triglycerides (more easily digested), olive oil, and fish oil, and has recently been FDA approved in the United States" — Brad Warner (clinical) [Ep 1 · 15:08](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=908)
- "Breast milk is the best choice for neonates because it contains proper fat, growth factors like EGF and IGF, and milk oligosaccharides that enhance adaptation" — Brad Warner (opinion) [Ep 1 · 18:11](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1091)
- "Complex formulas fed enterally may stimulate adaptation better than elemental formulas by causing secretion of enterotrophic hormones to a greater extent" — Brad Warner (opinion) [Ep 1 · 19:26](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1166)
- "There is a threshold percentage of enteral calories that prevents onset of liver damage from TPN, with 90% enteral feeding having far less risk of TPN-related cholestasis than 10% enteral" — Brad Warner (clinical) [Ep 1 · 21:19](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1279)
- "Time to consider surgical intervention is when enteral tolerance plateaus and then declines (going backward rather than forward), or with multiple sepsis episodes plus abdominal distention and dilated bowel loops, or when child starts getting jaundiced" — Brad Warner (clinical) [Ep 1 · 22:33](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1353)
- "Dilated bowel loops can cause subclinical portal bacteremia contributing to jaundice, and bacterial overgrowth causes secretory diarrhea that impairs enzyme function" — Brad Warner (clinical) [Ep 1 · 23:28](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1408)
- "More than 4-5 centimeters of bowel dilation with failure to advance enteral feeds or going backward is an indication for surgical intervention" — Brad Warner (clinical) [Ep 1 · 25:43](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1543)
- "If a child has over 100 centimeters of intestine, less than 5-10% should require TPN, suggesting there may be an underlying motility or mucosal problem" — Brad Warner (clinical) [Ep 1 · 27:53](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1673)
- "For bowel lengthening, need less than 100 cm (ideally less than 50 cm) of intestine and bowel that is at least 4-5 cm dilated" — Brad Warner (clinical) [Ep 1 · 28:37](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1717)
- "The STEP (serial transverse enteroplasty) procedure has emerged as the most commonly performed lengthening operation" — Brad Warner (epidemiological) [Ep 1 · 29:31](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1771)
- "The Bianchi procedure takes advantage of the V-shaped blood supply bifurcation before reaching the bowel wall, allowing creation of two tubes each supplied by one arm of the V" — Brad Warner (clinical) [Ep 1 · 30:00](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1800)
- "STEP procedure is easier to perform with less risk of injuring mesenteric blood supply because you only cut partially across the bowel at right angles" — Brad Warner (clinical) [Ep 1 · 32:30](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1950)
- "STEP can redilate requiring redo procedures, and outcomes are not as good if you have to redo a STEP compared to never needing a redo" — Brad Warner (clinical) [Ep 1 · 32:54](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1974)
- "You can do a Bianchi and then later do a STEP on top of it, but you cannot do a Bianchi once a STEP has been done" — Brad Warner (clinical) [Ep 1 · 33:26](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2006)
- "In a case where a STEP was acting as a brake causing dysmotility, removing the distal stepped bowel allowed the patient to completely wean off TPN" — Brad Warner (clinical) [Ep 1 · 35:04](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2104)
- "Would taper a child with dilated bowel who had at least 90-100 centimeters of intestinal length" — Brad Warner (clinical) [Ep 1 · 38:23](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2303)
- "Strategies for TPN cholestasis include bile salts (chenodeoxycholic acid), changing lipid composition, and increasing enteral feeds" — Brad Warner (clinical) [Ep 1 · 39:00](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2340)
- "Dan Teitelbaum's trial of cholecystokinin to promote bile flow and mitigate TPN cholestasis did not work" — Brad Warner (clinical) [Ep 1 · 39:23](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2363)
- "Dilated bowel is a nidus for infection encouraging translocation of bacteria and endotoxin into portal circulation, damaging the liver" — Brad Warner (clinical) [Ep 1 · 39:51](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2391)
- "Medical management of bacterial overgrowth includes oral antibiotics (Cipro, Flagyl), probiotics (lactobacilli), prebiotics, and potentially fecal transplantation" — Brad Warner (clinical) [Ep 1 · 40:26](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2426)
- "The gut bacteria in short gut syndrome become more efficient, creating an obesogenic-like microbiome that helps adapt by encouraging greater absorption and digestion" — Brad Warner (clinical) [Ep 1 · 41:54](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2514)
- "In mouse studies, oral vancomycin to knock out gram-positive organisms completely prevented hepatic steatosis after bowel resection" — Brad Warner (clinical) [Ep 1 · 42:19](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2539)
- "Teduglutide (GLP-2 analog) has been shown in randomized prospective trials in adults to reduce TPN requirements by about 1-2 liters per week" — Brad Warner (clinical) [Ep 1 · 43:57](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2637)
- "Teduglutide is not yet approved for children in the United States, with concerns about malignancy risk due to promoting proliferation" — Brad Warner (clinical) [Ep 1 · 44:34](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2674)
- "Growth factors shown to promote adaptation in animal studies include EGF, HB-EGF (demonstrated by Gail Bessner), interleukins, and growth hormone with glutamine" — Brad Warner (clinical) [Ep 1 · 45:13](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2713)
- "Growth hormone and glutamine combinations in patients have shown primarily mixed results and are expensive" — Brad Warner (clinical) [Ep 1 · 45:46](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2746)
- "Survival for small bowel transplant is about 50-60% at 5 years, with one-year survivals now above 70-80%" — Brad Warner (epidemiological) [Ep 1 · 46:51](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2811)
- "The intestine is highly immunogenic, filled with white cells and macrophages that mount a huge graft-versus-host response, requiring industrial strength immunosuppression" — Brad Warner (clinical) [Ep 1 · 47:11](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2831)
- "Ethanol locks for central lines have significantly reduced the number of sepsis episodes in patients with short gut syndrome who have Broviac catheters" — Brad Warner (clinical) [Ep 1 · 49:22](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2962)
- "Multidisciplinary teams including pharmacists, nutritionists, surgeons, GI doctors, ID specialists, and interventional radiologists improve survival in intestinal failure patients, as demonstrated in series from Boston, Michigan, and Texas" — Brad Warner (clinical) [Ep 1 · 51:20](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=3080)
- "Despite 6 decades of research, the exact cause of necrotizing enterocolitis is unknown and there is no absolute cure for the disease." — Gail Besner (clinical) [Ep 2 · 2:11](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=131)
- "Indomethacin administration predisposes babies to both isolated ileal perforation and necrotizing enterocolitis." — Gail Besner (clinical) [Ep 2 · 3:53](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=233)
- "PPIs, H2 blockers, and other acid suppression medications predispose to or increase chances of NEC development; gastric acid neutralization should be avoided." — Gail Besner (clinical) [Ep 2 · 4:44](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=284)
- "In premature babies with patent processus vaginalis, intestinal contents leaking into the abdomen can cause scrotal swelling and discoloration." — Gail Besner (clinical) [Ep 2 · 5:29](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=329)
- "Neutropenia and low white blood cell count are more concerning than elevated white count in NEC, suggesting overwhelming sepsis that the patient is not compensating for." — Gail Besner (clinical) [Ep 2 · 7:17](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=437)
- "Thrombocytopenia can result from endotoxemia and gram-negative septicemia in NEC; low platelet count is important to know before surgery to optimize patient condition." — Gail Besner (clinical) [Ep 2 · 7:33](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=453)
- "Cross-table lateral or lateral decubitus X-ray films are essential in addition to plain films because free air can be quite subtle and easily missed." — Gail Besner (clinical) [Ep 2 · 8:50](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=530)
- "Pneumoperitoneum (free air) is an absolute indication for surgical intervention, either drain placement or laparotomy." — Gail Besner (clinical) [Ep 2 · 9:38](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=578)
- "Clinical deterioration in the face of maximum medical management is an indication for surgery." — Gail Besner (clinical) [Ep 2 · 9:54](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=594)
- "Fixed loops of intestine on serial X-rays are not an absolute indication for surgery but are a worrisome sign that the patient is not improving." — Gail Besner (clinical) [Ep 2 · 10:02](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=602)
- "Portal venous air is a concerning and worrisome sign, but not an absolute indication for surgery; some patients with portal venous air improve with medical management and don't need operation." — Gail Besner (clinical) [Ep 2 · 10:16](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=616)
- "Medical management of NEC includes withholding feeds, inserting orogastric tube for gastric decompression, starting broad-spectrum antibiotic therapy, and performing serial abdominal exams, labs, and X-rays." — Gail Besner (clinical) [Ep 2 · 10:58](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=658)
- "Small French feeding tubes are not adequate for gastric decompression in NEC; feeding tube should be removed and replaced with orogastric tube." — Gail Besner (clinical) [Ep 2 · 12:05](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=725)
- "There is tremendous diversity in antibiotic regimens for NEC across the United States; broad-spectrum coverage is critical but specific regimen may depend on bacterial colonization of the intensive care unit environment." — Gail Besner (clinical) [Ep 2 · 12:33](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=753)
- "At Nationwide Children's Hospital, abdominal X-rays are obtained at intervals (approximately every 8 hours) rather than waiting 12-24 hours between films." — Gail Besner (clinical) [Ep 2 · 13:37](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=817)
- "Medical management (NPO, decompression, antibiotics) should continue for at least 1 week to 10 days, preferably a week and a half, before starting feeds." — Gail Besner (clinical) [Ep 2 · 14:15](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=855)
- "Some babies have repeated episodes of necrotizing enterocolitis." — Gail Besner (clinical) [Ep 2 · 14:29](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=869)
- "Post-NEC stricture formation typically occurs in the colon, usually near the splenic flexure in the left colon, but can occur anywhere." — Gail Besner (clinical) [Ep 2 · 14:40](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=880)
- "For suspected post-NEC stricture, contrast enema is preferred as initial study over upper GI with small bowel follow-through because strictures are more common in colon and contrast from below avoids long wait time if patient is partially obstructed." — Gail Besner (clinical) [Ep 2 · 15:17](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=917)
- "Serial abdominal exams are important for surgical decision-making; worsening distention, signs of peritoneal irritation, hemodynamic instability with increasing pressor support, and renal shutdown with no urine production build up to indicate need for surgery." — Gail Besner (clinical) [Ep 2 · 16:23](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=983)
- "Two randomized controlled trials (MOSS trial in US and PIERO trial in Europe) of peritoneal drainage versus laparotomy showed no difference in overall mortality." — Gail Besner (clinical) [Ep 2 · 19:44](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1184)
- "MOSS and PIERO trials looked at early endpoints rather than delayed endpoints of neurological recovery." — Gail Besner (clinical) [Ep 2 · 20:04](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1204)
- "Babies who have peritoneal drains instead of laparotomy may do worse from neurological standpoint if neurological outcomes are examined 1-2 years after recovery from NEC." — Gail Besner (clinical) [Ep 2 · 20:14](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1214)
- "The ongoing NEST trial (necrotizing enterocolitis surgery trial) in the United States has randomized 300 babies to peritoneal drainage versus laparotomy and will examine neurological outcomes at 18-22 months after recovery from NEC with detailed neurological assessments." — Gail Besner (clinical) [Ep 2 · 20:34](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1234)
- "Dr. Besner predicts that in the next 1-2 years, practice will move towards laparotomy versus peritoneal drainage for the majority of NEC babies, with neurological outcomes expected to be better in babies who undergo laparotomy with removal of inflammatory necrotic tissue." — Gail Besner (opinion) [Ep 2 · 21:44](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1304)
- "Babies with peritoneal drains can have striking degree of dead bowel remaining in abdomen, as seen when some drain patients subsequently undergo laparotomy." — Gail Besner (clinical) [Ep 2 · 22:09](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1329)
- "Systemic inflammatory response syndrome can make patients just as sick and hemodynamically unstable from isolated intestinal perforation as from necrotizing enterocolitis." — Gail Besner (clinical) [Ep 2 · 24:15](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1455)
- "Peritoneal drain placement is a bedside procedure performed with small amount of local anesthesia using small transverse incision in right lower quadrant; incision must not be too large to prevent subsequent hernia." — Gail Besner (clinical) [Ep 2 · 26:15](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1575)
- "Quarter-inch Penrose drain is used for peritoneal drainage; drain is passed gently multiple times without forcing to avoid bleeding, then sutured in place." — Gail Besner (clinical) [Ep 2 · 26:41](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1601)
- "After peritoneal drain placement, significant proportion of patients continue to decline and require subsequent laparotomy." — Gail Besner (clinical) [Ep 2 · 25:46](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1546)
- "Operating during peak inflammatory process (e.g., 2 weeks after drain with ongoing stool output) can result in severe adhesions, serosal tears, and enterotomies; sometimes smartest decision is to stop operation, create proximal diverting stoma if possible, and avoid making situation worse." — Gail Besner (clinical) [Ep 2 · 28:43](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1723)
- "After successful drain placement with patient recovery, drain should be advanced out over several days starting at 7-10 days post-operation rather than withdrawing all at once." — Gail Besner (clinical) [Ep 2 · 29:48](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1788)
- "Continual leakage of stool at drain site is concerning; upper GI small bowel follow-through should be considered before drain removal if ongoing stool leakage present." — Gail Besner (clinical) [Ep 2 · 30:09](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1809)
- "If feeds are started after drain removal without contrast study and patient doesn't tolerate feeds, contrast study becomes mandatory to ensure everything is intact." — Gail Besner (clinical) [Ep 2 · 30:49](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1849)
- "For laparotomy, if baby is too hemodynamically unstable or on very high oscillator settings to safely transport to OR, operation can be performed at bedside in ICU with surgical team and anesthesiologists." — Gail Besner (clinical) [Ep 2 · 31:24](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1884)
- "Laparotomy uses supraumbilical transverse incision; extreme care needed due to thin skin and underlying dilated bowel to avoid immediate enterotomy." — Gail Besner (clinical) [Ep 2 · 31:43](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1903)
- "Patient should be resuscitated preoperatively with at least partial correction of platelet and coagulation abnormalities; blood products (packed red blood cells, platelets, fresh frozen plasma) must be available for operation." — Gail Besner (clinical) [Ep 2 · 32:05](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1925)
- "It is critically important not to injure liver or spleen in premature babies during laparotomy; even minimal trauma can cause subcapsular hematoma that baby can exsanguinate from." — Gail Besner (clinical) [Ep 2 · 32:27](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1947)
- "Spontaneous intestinal perforation (SIP) presents as one small localized area of perforation, while NEC is more diffuse disease with pneumatosis involving more than one tiny area; differentiation can be difficult preoperatively." — Gail Besner (clinical) [Ep 2 · 33:21](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2001)
- "Some surgeons worldwide perform primary anastomosis after limited NEC resection; in the United States, surgeons are less likely to do primary anastomosis due to concern about anastomotic healing in these patients." — Gail Besner (clinical) [Ep 2 · 34:04](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2044)
- "Dr. Besner typically performs resection with stoma and mucous fistula rather than primary anastomosis, with stoma closure when patient is bigger (at least 2000g) and stable." — Gail Besner (clinical) [Ep 2 · 34:20](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2060)
- "Stomas are brought out through laparotomy incision with functional end and mucous fistula positioned close together to facilitate limited reoperation for closure; stomas are tacked to fascia but not matured." — Gail Besner (clinical) [Ep 2 · 35:07](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2107)
- "Distal end of stoma must protrude slightly because it can slough off; leaving small distal end prevents recession under fascia." — Gail Besner (clinical) [Ep 2 · 35:50](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2150)
- "When bowel appears injured but not clearly necrotic (thin-walled, brownish discoloration, pneumatosis but not dead), acceptable approach is to not resect and perform second-look operation in 24-48 hours." — Gail Besner (clinical) [Ep 2 · 37:12](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2232)
- "Abdomen may be left open if there are many dilated loops of bowel to avoid adding pressure that may compromise blood flow." — Gail Besner (clinical) [Ep 2 · 37:35](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2255)
- "For multiple skip lesions that are very close together, can resect all without creating short bowel syndrome rather than having multiple anastomoses." — Gail Besner (clinical) [Ep 2 · 38:07](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2287)
- "For separated skip lesions, can perform multiple anastomoses with proximal diverted stoma so anastomoses are distal to diversion; if anastomotic healing problem occurs, it won't be major issue because of proximal diversion." — Gail Besner (clinical) [Ep 2 · 38:19](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2299)
- "Clip and drop technique (resecting dead bowel, clipping ends, replacing in abdomen, returning for anastomosis when baby more stable) can be life-saving maneuver in very unstable patients without time for multiple anastomoses." — Gail Besner (clinical) [Ep 2 · 38:46](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2326)
- "Stoma reversal typically performed when baby is stable, well, hopefully feeding, and approximately 2000g in size; anastomosis is easier when baby is bigger." — Gail Besner (clinical) [Ep 2 · 39:32](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2372)
- "Earlier stoma reversal is indicated if baby develops TPN-induced cholestasis or cannot be nourished due to very high stoma output." — Gail Besner (clinical) [Ep 2 · 39:56](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2396)
- "Mucous fistula refeeding is done selectively rather than routinely, particularly for very high output stomas where any nourishment given comes directly out the stoma." — Gail Besner (clinical) [Ep 2 · 40:48](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2448)
- "Recent Journal of Pediatric Surgery article showed substantial decrease in TPN use with mucous fistula refeeding." — Todd Ponsky (host_summary) [Ep 2 · 41:06](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2466)
- "Mucous fistula often strictures post-operatively, losing opportunity for refeeding; if serious about refeeding (e.g., after massive resection with very high stoma), consider leaving small soft catheter in mucous fistula post-op to maintain access." — Gail Besner (clinical) [Ep 2 · 41:22](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2482)
- "NEC totalis is one of most tragic findings on exploratory laparotomy for NEC; chance of baby living to be old enough for small bowel-liver transplant is very close to zero." — Gail Besner (clinical) [Ep 2 · 42:15](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2535)
- "For very small premature baby with NEC totalis, current technology cannot get baby through this devastating problem; no one would be criticized for explaining severity to parents and providing comfort care after closing abdomen." — Gail Besner (opinion) [Ep 2 · 42:56](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2576)
- "In Dr. Besner's experience, chance of baby with NEC totalis surviving months-to-years of required TPN is very low; TPN will irreversibly injure liver, and even if baby lives to transplant size, small bowel transplant results remain suboptimal." — Gail Besner (opinion) [Ep 2 · 43:42](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2622)
- "Small subset of premature patients with severe lung disease can develop pneumothorax that dissects through diaphragm into abdomen, causing pneumoperitoneum; must confirm problem is in abdomen rather than chest." — Gail Besner (clinical) [Ep 2 · 44:28](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2668)
- "For extremely unstable patient (e.g., 800g on jet ventilation and pressors) with pneumoperitoneum and severe distention, angiocatheter can be inserted through abdominal wall to release pneumoperitoneum as temporizing maneuver while mobilizing for definitive operation." — Gail Besner (clinical) [Ep 2 · 45:06](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=2706)
- "At London NEC conference, 100% of European surgeons polled perform laparotomy for NEC and no one places peritoneal drains." — Gail Besner (epidemiological) [Ep 2 · 19:10](https://qa.library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297?t=1150)

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Sep 7: Audit reverted — short clips unhidden
- Aug 31: 14 doctors auto-found from episode dossiers
- Aug 30: 14 doctors auto-found from episode dossiers
- Aug 30: 12 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 15 doctors auto-found from episode dossiers
- Aug 29: 15 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 15 items, 12 dossiers, summaries for 2 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 9 items, 8 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 9 items, 8 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 9 items, 8 dossiers, summaries for 2 audience(s)

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