Rebecca Brown

136 statements · 4 topics

Abdominal Wall Defects · guest expert Etiologies (Gastroschisis/NEC/Atresia/Volvulus) · guest expert Intestinal Rehab · guest expert Pectus Excavatum · guest expert

Featured statements

The 3 year recurrence rate when you fix umbilical hernia was twice as high in children less than 4 years of age versus if they were greater than 4 years of age.
quote · Abdominal Wall Defects
I think in general, 5 years, regardless of size, if it hasn't closed, fix it. If until then, leave it alone unless they're having symptoms.
quote · Abdominal Wall Defects
If that umbilical hernia was persistent at age 3, spontaneous closure was 20% by 4 years and 35% by 5 years.
quote · Etiologies (Gastroschisis/NEC/Atresia/Volvulus)
Early surgical repair before age 4 was not indicated regardless of the size of the defect.
quote · Etiologies (Gastroschisis/NEC/Atresia/Volvulus)
If it has a huge defect and it's proboscoid, it's probably not gonna close.
quote · Intestinal Rehab
Indications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and consideration for large proboscoid hernias in patients about to start school.
guideline · Intestinal Rehab

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Rebecca's statements about Abdominal Wall Defects 22 statements

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Umbilical Disorders with Dr. Rebeccah Brown

Quotation And it's a bacterial colonization of that umbilical stump. Open
Statement Omphalitis is bacterial colonization of the umbilical stump, most commonly due to staph and strep from skin flora. Open
Statement In advanced omphalitis cases, patients need hospital admission and pediatric surgery consultation. Open
Statement Umbilical hernias are more common in African Americans, low birth weight infants, and premature infants. Open
Quotation Incarceration with umbilical hernias, it's actually pretty rare, less than 0.2%, and it's more common if you have a smaller defect. Open
Statement Incarceration with umbilical hernias is rare, occurring in less than 0.2% of cases, and is more common with smaller defects. Open
Statement In Tiffany Zinz's study of 308 umbilical hernia repairs, there was a higher incidence of complications if patients were less than 4 years of age versus greater than 4 years of age. Open
Statement A literature review of 787 manuscripts (28 meeting quality criteria) showed that early surgical repair of umbilical hernias before age 4 was not indicated regardless of defect size. Open
Quotation Early surgical repair before age 4 was not indicated regardless of the size of the defect. Open
Statement In a 2020 study of 9,809 patients, the 3-year recurrence rate after umbilical hernia repair was twice as high in children less than 4 years of age versus those greater than 4 years of age. Open
Quotation The 3 year recurrence rate when you fix umbilical hernia was twice as high in children less than 4 years of age versus if they were greater than 4 years of age. Open
Quotation If that umbilical hernia was persistent at age 3, spontaneous closure was 20% by 4 years and 35% by 5 years. Open
Statement If an umbilical hernia persisted at age 3, spontaneous closure occurred in 20% by age 4 and 35% by age 5. Open
Quotation If it has a huge defect and it's proboscoid, it's probably not gonna close. Open
Statement Dr. Brown's opinion is that hernias with a huge defect that are proboscoid are probably not going to close spontaneously. Open
Statement Indications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and consideration for large proboscoid hernias in patients about to start school. Open
Quotation I think in general, 5 years, regardless of size, if it hasn't closed, fix it. If until then, leave it alone unless they're having symptoms. Open
Statement Dr. Brown's approach is to repair umbilical hernias at 5 years regardless of size if they haven't closed, or earlier if the patient is having symptoms. Open
Statement Umbilical hernia repair technique involves dissecting around the hernia sac, dividing it, trimming excess sac, closing the fascia with interrupted absorbable sutures (such as Vicryl), and recreating the umbilicus. Open
Statement Umbilical granulomas are the most common umbilical masses in newborns. Open
Statement Dr. Brown recommends neutralizing silver nitrate burns by applying water after silver nitrate application to prevent skin damage and keep it from spreading. Open
Statement Bright red, pedunculated umbilical lesions that bleed easily are more difficult to treat and may represent polyps rather than simple granulomas. Open
Rebecca's statements about Etiologies (Gastroschisis/NEC/Atresia/Volvulus) 22 statements

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Umbilical Disorders with Dr. Rebeccah Brown

Quotation And it's a bacterial colonization of that umbilical stump. Open
Statement Omphalitis is bacterial colonization of the umbilical stump, most commonly due to staph and strep from skin flora. Open
Statement In advanced omphalitis cases, patients need hospital admission and pediatric surgery consultation. Open
Statement Umbilical hernias are more common in African Americans, low birth weight infants, and premature infants. Open
Statement Incarceration with umbilical hernias is rare, occurring in less than 0.2% of cases, and is more common with smaller defects. Open
Quotation Incarceration with umbilical hernias, it's actually pretty rare, less than 0.2%, and it's more common if you have a smaller defect. Open
Statement In Tiffany Zinz's study of 308 umbilical hernia repairs, there was a higher incidence of complications if patients were less than 4 years of age versus greater than 4 years of age. Open
Statement A literature review of 787 manuscripts (28 meeting quality criteria) showed that early surgical repair of umbilical hernias before age 4 was not indicated regardless of defect size. Open
Quotation Early surgical repair before age 4 was not indicated regardless of the size of the defect. Open
Statement In a 2020 study of 9,809 patients, the 3-year recurrence rate after umbilical hernia repair was twice as high in children less than 4 years of age versus those greater than 4 years of age. Open
Quotation The 3 year recurrence rate when you fix umbilical hernia was twice as high in children less than 4 years of age versus if they were greater than 4 years of age. Open
Statement If an umbilical hernia persisted at age 3, spontaneous closure occurred in 20% by age 4 and 35% by age 5. Open
Quotation If that umbilical hernia was persistent at age 3, spontaneous closure was 20% by 4 years and 35% by 5 years. Open
Quotation If it has a huge defect and it's proboscoid, it's probably not gonna close. Open
Statement Dr. Brown's opinion is that hernias with a huge defect that are proboscoid are probably not going to close spontaneously. Open
Statement Indications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and consideration for large proboscoid hernias in patients about to start school. Open
Statement Dr. Brown's approach is to repair umbilical hernias at 5 years regardless of size if they haven't closed, or earlier if the patient is having symptoms. Open
Quotation I think in general, 5 years, regardless of size, if it hasn't closed, fix it. If until then, leave it alone unless they're having symptoms. Open
Statement Umbilical hernia repair technique involves dissecting around the hernia sac, dividing it, trimming excess sac, closing the fascia with interrupted absorbable sutures (such as Vicryl), and recreating the umbilicus. Open
Statement Umbilical granulomas are the most common umbilical masses in newborns. Open
Statement Dr. Brown recommends neutralizing silver nitrate burns by applying water after silver nitrate application to prevent skin damage and keep it from spreading. Open
Statement Bright red, pedunculated umbilical lesions that bleed easily are more difficult to treat and may represent polyps rather than simple granulomas. Open
Rebecca's statements about Intestinal Rehab 22 statements

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Umbilical Disorders with Dr. Rebeccah Brown

Statement Omphalitis is bacterial colonization of the umbilical stump, most commonly due to staph and strep from skin flora. Open
Quotation And it's a bacterial colonization of that umbilical stump. Open
Statement In advanced omphalitis cases, patients need hospital admission and pediatric surgery consultation. Open
Statement Umbilical hernias are more common in African Americans, low birth weight infants, and premature infants. Open
Quotation Incarceration with umbilical hernias, it's actually pretty rare, less than 0.2%, and it's more common if you have a smaller defect. Open
Statement Incarceration with umbilical hernias is rare, occurring in less than 0.2% of cases, and is more common with smaller defects. Open
Statement In Tiffany Zinz's study of 308 umbilical hernia repairs, there was a higher incidence of complications if patients were less than 4 years of age versus greater than 4 years of age. Open
Statement A literature review of 787 manuscripts (28 meeting quality criteria) showed that early surgical repair of umbilical hernias before age 4 was not indicated regardless of defect size. Open
Quotation Early surgical repair before age 4 was not indicated regardless of the size of the defect. Open
Statement In a 2020 study of 9,809 patients, the 3-year recurrence rate after umbilical hernia repair was twice as high in children less than 4 years of age versus those greater than 4 years of age. Open
Quotation The 3 year recurrence rate when you fix umbilical hernia was twice as high in children less than 4 years of age versus if they were greater than 4 years of age. Open
Quotation If that umbilical hernia was persistent at age 3, spontaneous closure was 20% by 4 years and 35% by 5 years. Open
Statement If an umbilical hernia persisted at age 3, spontaneous closure occurred in 20% by age 4 and 35% by age 5. Open
Statement Dr. Brown's opinion is that hernias with a huge defect that are proboscoid are probably not going to close spontaneously. Open
Quotation If it has a huge defect and it's proboscoid, it's probably not gonna close. Open
Statement Indications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and consideration for large proboscoid hernias in patients about to start school. Open
Quotation I think in general, 5 years, regardless of size, if it hasn't closed, fix it. If until then, leave it alone unless they're having symptoms. Open
Statement Dr. Brown's approach is to repair umbilical hernias at 5 years regardless of size if they haven't closed, or earlier if the patient is having symptoms. Open
Statement Umbilical hernia repair technique involves dissecting around the hernia sac, dividing it, trimming excess sac, closing the fascia with interrupted absorbable sutures (such as Vicryl), and recreating the umbilicus. Open
Statement Umbilical granulomas are the most common umbilical masses in newborns. Open
Statement Dr. Brown recommends neutralizing silver nitrate burns by applying water after silver nitrate application to prevent skin damage and keep it from spreading. Open
Statement Bright red, pedunculated umbilical lesions that bleed easily are more difficult to treat and may represent polyps rather than simple granulomas. Open
Rebecca's statements about Pectus Excavatum 70 statements

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Pectus Excavatum Pathway

Quotation I am Rebecca L. Brown, and I'm a pediatric surgeon at Cincinnati Children's and the co-director of the Chestwall Center. Open
Quotation I am Rebecca L. Brown, and I'm a pediatric surgeon at Cincinnati Children's and the co-director of the Chestwall Center. Open
Quotation There are 5 major components to the clinical care pathway pain management, mobility, lung recruitment, daily intake, and daily output. Open
Statement The pectus excavatum clinical care pathway has five major components: pain management, mobility, lung recruitment, daily intake, and daily output. Open
Quotation There are 5 major components to the clinical care pathway pain management, mobility, lung recruitment, daily intake, and daily output. Open
Statement The pectus excavatum clinical care pathway has five major components: pain management, mobility, lung recruitment, daily intake, and daily output. Open
Statement Preoperatively, compression boots are applied for pectus excavatum repair. Open
Statement Preoperatively, compression boots are applied for pectus excavatum repair. Open
Statement A type and screen is performed preoperatively for pectus excavatum repair. Open
Statement A type and screen is performed preoperatively for pectus excavatum repair. Open
Statement Ancef is given prior to incision, or vancomycin if the patient is MRSA positive. Open
Statement Preoperative washes of Dynahex or Hibiclens scrub are applied to prevent infection after pectus excavatum surgery. Open
Statement Ancef is given prior to incision, or vancomycin if the patient is MRSA positive. Open
Statement Preoperative washes of Dynahex or Hibiclens scrub are applied to prevent infection after pectus excavatum surgery. Open
Statement Patients are placed on continuous pulse oximetry postoperatively. Open
Statement Patients are placed on continuous pulse oximetry postoperatively. Open
Statement Patients are given clear liquids and advanced as tolerated to a full regular diet on postoperative day 0. Open
Statement Patients are given clear liquids and advanced as tolerated to a full regular diet on postoperative day 0. Open
Statement Patients are encouraged to be out of bed to the chair and then to ambulate on postoperative day 0, especially if they are the first case of the day. Open
Statement Patients are encouraged to be out of bed to the chair and then to ambulate on postoperative day 0, especially if they are the first case of the day. Open
Statement Incentive spirometry is performed 10 times per hour postoperatively. Open
Statement Incentive spirometry is performed 10 times per hour postoperatively. Open
Statement Patients receive Ancef times 3 doses postoperatively, or clindamycin if they are MRSA positive. Open
Statement Patients receive Ancef times 3 doses postoperatively, or clindamycin if they are MRSA positive. Open
Statement An epidural is routinely used for pain management after pectus excavatum repair, supplemented with Valium, Robaxin, Toradol, IV Tylenol, methadone times 1, and scheduled Zofran for nausea. Open
Statement An epidural is routinely used for pain management after pectus excavatum repair, supplemented with Valium, Robaxin, Toradol, IV Tylenol, methadone times 1, and scheduled Zofran for nausea. Open
Statement Patients are encouraged to chew gum 5 separate times a day for 20 minutes if fully awake postoperatively. Open
Statement Patients are encouraged to chew gum 5 separate times a day for 20 minutes if fully awake postoperatively. Open
Statement For bowel management, patients are given Senna and MiraLax twice a day as well as Movantik. Open
Statement For bowel management, patients are given Senna and MiraLax twice a day as well as Movantik. Open
Statement The Foley catheter inserted during surgery is continued on postoperative day 1. Open
Statement The Foley catheter inserted during surgery is continued on postoperative day 1. Open
Statement On postoperative day 1, patients are encouraged to be out of bed, up to a chair, and ambulating about the room 3 times a day. Open
Statement On postoperative day 1, patients are encouraged to be out of bed, up to a chair, and ambulating about the room 3 times a day. Open
Statement The Foley catheter is removed on postoperative day 1 to encourage ambulation. Open
Statement The Foley catheter is removed on postoperative day 1 to encourage ambulation. Open
Statement On postoperative day 1, the epidural remains in place and medications are supplemented with Valium, Robaxin, Toradol, IV Tylenol, and oxycodone is started orally once patients are tolerating a diet. Open
Statement On postoperative day 1, the epidural remains in place and medications are supplemented with Valium, Robaxin, Toradol, IV Tylenol, and oxycodone is started orally once patients are tolerating a diet. Open
Statement Maintenance IV fluids are continued until the patient is drinking well and urinates after Foley removal. Open
Statement Maintenance IV fluids are continued until the patient is drinking well and urinates after Foley removal. Open
Statement Zofran, initially given routinely every 8 hours, is changed to as needed on postoperative day 1. Open
Statement Zofran, initially given routinely every 8 hours, is changed to as needed on postoperative day 1. Open
Statement On postoperative day 2, IV fluids are discontinued if still running. Open
Statement On postoperative day 2, IV fluids are discontinued if still running. Open
Statement The epidural catheter is stopped at 6 in the morning on postoperative day 2. Open
Statement The epidural catheter is stopped at 6 in the morning on postoperative day 2. Open
Statement The epidural is removed when the pain team rounds later in the morning on postoperative day 2. Open
Statement The epidural is removed when the pain team rounds later in the morning on postoperative day 2. Open
Statement On postoperative day 2, the patient is transitioned to all oral pain medications including oxycodone, Valium, Robaxin, Motrin, and Tylenol. Open
Statement On postoperative day 2, the patient is transitioned to all oral pain medications including oxycodone, Valium, Robaxin, Motrin, and Tylenol. Open
Statement A two-view chest X-ray is obtained on postoperative day 2 to evaluate bar location and to rule out any pleural effusion or pneumothorax. Open
Statement A two-view chest X-ray is obtained on postoperative day 2 to evaluate bar location and to rule out any pleural effusion or pneumothorax. Open
Statement Dressings are removed and the chest is washed daily starting on postoperative day 2. Open
Statement Dressings are removed and the chest is washed daily starting on postoperative day 2. Open
Statement On postoperative day 2, patients are encouraged to ambulate at least 3 times in the halls. Open
Statement On postoperative day 2, patients are encouraged to ambulate at least 3 times in the halls. Open
Statement On postoperative day 3, physical therapy and occupational therapy work with the patient to help them walk up and down the stairs, and PT/OT will sign off once they are able to do this. Open
Statement On postoperative day 3, physical therapy and occupational therapy work with the patient to help them walk up and down the stairs, and PT/OT will sign off once they are able to do this. Open
Statement Prescriptions are filled and the medication schedule is given to the parent and patients on postoperative day 3. Open
Statement Prescriptions are filled and the medication schedule is given to the parent and patients on postoperative day 3. Open
Statement The patient should be on oral pain medication only by postoperative day 3. Open
Statement The patient should be on oral pain medication only by postoperative day 3. Open
Statement The patient is discharged home on postoperative day 3 if pain is well controlled and the patient is tolerating oral intake. Open
Statement The patient is discharged home on postoperative day 3 if pain is well controlled and the patient is tolerating oral intake. Open
Quotation Since institution of our clinical care pathway about 2 to 3 years ago, we have reduced our length of stay from 4.5 days to 3 days and have also increased our patient satisfaction. Open
Statement Since institution of the clinical care pathway about 2 to 3 years ago, length of stay has been reduced from 4.5 days to 3 days. Open
Statement Since institution of the clinical care pathway about 2 to 3 years ago, patient satisfaction has increased. Open
Quotation Since institution of our clinical care pathway about 2 to 3 years ago, we have reduced our length of stay from 4.5 days to 3 days and have also increased our patient satisfaction. Open
Statement Since institution of the clinical care pathway about 2 to 3 years ago, length of stay has been reduced from 4.5 days to 3 days. Open
Statement Since institution of the clinical care pathway about 2 to 3 years ago, patient satisfaction has increased. Open