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"Intestinal rehabilitation"

Olivia Mayer, John A Kerner
Short bowel syndrome is a potentially devastating morbidity for the very low birth weight infant and family with a high risk for mortality. Prevention of injury to the intestine is the ideal, but, if and when the problem arises, it is important to have a systematic approach to manage nutrition, use pharmaceutical strategies and tools to maximize the outcome potential. Safely maximizing parenteral nutrition support by providing adequate macronutrients and micronutrients while minimizing its hepatotoxic effects is the initial postoperative strategy...
August 26, 2016: Seminars in Fetal & Neonatal Medicine
Stephanie So, Catherine Patterson, Anna Gold, Alaine Rogers, Christina Kosar, Nicole de Silva, Karolina Maria Burghardt, Yaron Avitzur, Paul W Wales
BACKGROUND: The survival rate of infants and children with intestinal failure is increasing, necessitating a greater focus on their developmental trajectory. AIMS: To evaluate neurodevelopmental outcomes in children with intestinal failure at 0-15months corrected age. STUDY DESIGN: Analysis of clinical, demographic and developmental assessment results of 33 children followed in an intestinal rehabilitation program between 2011 and 2014. Outcome measures included: Prechtl's Assessment of General Movements, Movement Assessment of Infants, Alberta Infant Motor Scale and Mullen Scales of Early Learning...
October 2016: Early Human Development
P A Lobos, S E M Calello, V B Busoni, M M Urquizo Lino, S G Prodan, R Sanchez Claria
CASE REPORT: Gastroschisis is the most frequent congenital abdominal wall defect. When associated with intestinal atresia (complex gastroschisis), short bowel syndrome may occur. Complicated gastroschisis is the most frequent cause of short bowel syndrome in our series. The serial transverse enteroplasty procedure has been used to lengthen the bowel and achieve intestinal rehabilitation in patients with dilated gut. The use of this technique in the newborn period, for tailoring the bowel while preserving absorptive mucosa, has been recently described...
March 2016: Transplantation Proceedings
Carol Oliveira, Nicole T de Silva, Sanja Stanojevic, Yaron Avitzur, Ahmed M Bayoumi, Wendy J Ungar, Jeffrey S Hoch, Paul W Wales
BACKGROUND: The clinical picture of pediatric intestinal failure has changed over the past 15 years, while effectiveness evolving treatment options remains unclear. This study explored evolution in care and quantified independent effects of new treatment options. STUDY DESIGN: Consecutive patients (n = 196) with neonatal or infantile intestinal failure, born between July 1996 and December 2011, were derived from an intestinal rehabilitation program (IRP) patient registry...
June 2016: Journal of the American College of Surgeons
Shishira Bharadwaj, Parul Tandon, Krishna Meka, John M Rivas, Andrea Jevenn, Ning-Tsu Kuo, Ezra Steiger
Intestinal failure (IF) is a state in which the nutritional demands are not met by the gastrointestinal absorptive surface. A majority of IF cases are associated with short-bowel syndrome, which is a result of malabsorption after significant intestinal resection for numerous reasons, some of which include Crohn's disease, vascular thrombosis, and radiation enteritis. IF can also be caused by obstruction, dysmotility, and congenital defects. Recognition and management of IF can be challenging, given the complex nature of this condition...
May 2016: Journal of Clinical Gastroenterology
Prathima Nandivada, Gillian L Fell, Paul D Mitchell, Alexis K Potemkin, Alison A O'Loughlin, Kathleen M Gura, Mark Puder
BACKGROUND: Fish oil lipid emulsion (FOLE) and multidisciplinary care for infants with intestinal failure (IF) have been associated with reduced morbidity and mortality due to IF-associated liver disease (IFALD). With increased survival, a greater proportion of infants with IF are now able to remain on parenteral nutrition (PN) in the long term. The purpose of this study was to examine outcomes in children with IFALD who have required long-term PN and FOLE therapy due to chronic IF. MATERIALS AND METHODS: A review of prospectively collected data was performed for children with IFALD who required at least 3 years of PN and FOLE therapy due to chronic IF...
March 9, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
Loris Pironi, Jann Arends, Federico Bozzetti, Cristina Cuerda, Lyn Gillanders, Palle Bekker Jeppesen, Francisca Joly, Darlene Kelly, Simon Lal, Michael Staun, Kinga Szczepanek, André Van Gossum, Geert Wanten, Stéphane Michel Schneider
BACKGROUND & AIMS: Chronic Intestinal Failure (CIF) is the long-lasting reduction of gut function, below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth. CIF is the rarest organ failure. Home parenteral nutrition (HPN) is the primary treatment for CIF. No guidelines (GLs) have been developed that address the global management of CIF. These GLs have been devised to generate comprehensive recommendations for safe and effective management of adult patients with CIF...
April 2016: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Christina Kosar, Nicole De Silva, Yaron Avitzur, Karen Steinberg, Glenda Courtney-Martin, Kathryn Chambers, Kevin Fitzgerald, Elizabeth Harvey, Paul W Wales
BACKGROUND: Outcomes of children with intestinal failure have improved over the last decade. However, with improved survival, other co-morbidities have become evident. The goal of our study was to evaluate the presence of renal nephrocalcinosis or increased echogenicity in a cohort of patients with pediatric intestinal failure (PIF). METHODS: A cross-sectional prevalence design was performed in PIF patients followed by our intestinal rehabilitation program between 2013 and 2014...
May 2016: Journal of Pediatric Surgery
Benyamine Abbou, Igor Sukhotnik, Amnon Rofe
Management of children with short bowel syndrome is optimized by interdisciplinary coordination of parenteral and enteral nutrition support, medical management of associated complications, surgical lengthening procedures, and intestinal transplantation. Pediatric Intestinal Failure Centers were established in 14 pediatric hospitals throughout the United States and Canada and the Pediatric Intestinal Failure Consortium has been developed and is implementing prospective, multi-institutional studies to better define the specific aspects of intestinal failure management that optimize long-term outcomes...
December 2015: Harefuah
Jasmeet S Mokha, Zev H Davidovics
BACKGROUND: Human breast milk is used sparingly in infants with intestinal failure due to observations from studies using syringe pumps that show loss of macronutrients with continuous feeding. Because of the potential benefits of using human milk, we sought to assess macronutrient losses using human milk as continuous tube feeds as done in the inpatient and home setting using a feeding bag and pump. METHODS: Using in vitro simulations of human milk to assess macronutrient losses with continuous tube feeds, hourly samples were analyzed using the SpectraStar Near-Infrared Analyzer (Unity Scientific, Columbia, MD)...
February 5, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
Wencheng Kong, Jian Wang, Rongchao Ying, Yousheng Li, Huicheng Jin, Qi Mao, Danhua Yao, Mingxiao Guo
BACKGROUND: Fundamental researches suggest that ileum presents greater adaptive potential than the jejunum. However, few studies estimate the association between ileum and adaptive potential in human. To discover the association, we conducted this matched case-control study. METHODS: A 1:2 pair-matched, case-control study was conducted from January 1, 2001 to January 1, 2015 in Intestinal Rehabilition and Transplant Center. The case group was ileum predominated (IP) group and the control group was jejunum predominated (JP) group...
2016: BMC Gastroenterology
Berkeley N Limketkai, Alyssa M Parian, Neha D Shah, Jean-Frédéric Colombel
Crohn's disease is a chronic and progressive inflammatory disorder of the gastrointestinal tract. Despite the availability of powerful immunosuppressants, many patients with Crohn's disease still require one or more intestinal resections throughout the course of their disease. Multiple resections and a progressive reduction in bowel length can lead to the development of short bowel syndrome, a form of intestinal failure that compromises fluid, electrolyte, and nutrient absorption. The pathophysiology of short bowel syndrome involves a reduction in intestinal surface area, alteration in the enteric hormonal feedback, dysmotility, and related comorbidities...
May 2016: Inflammatory Bowel Diseases
Ethan A Mezoff, Lin Fei, Misty Troutt, Kim Klotz, Samuel A Kocoshis, Conrad R Cole
BACKGROUND: Prophylactic ethanol lock therapy (ELT) reduces central line-associated bloodstream infections (CLA-BSIs) in children with intestinal failure (IF). However, the risk of associated complications is unclear. We aim to describe our experience with prophylactic ethanol locks in a cohort of patients with IF. MATERIALS AND METHODS: Thirty patients on ELT from 2010-2013 were identified by review of our intestinal rehabilitation registry. Patient demographics, CLA-BSI events, and line complications were extracted...
August 2016: JPEN. Journal of Parenteral and Enteral Nutrition
Eric A Sparks, Faraz A Khan, Jeremy G Fisher, Brenna S Fullerton, Amber Hall, Bram P Raphael, Christopher Duggan, Biren P Modi, Tom Jaksic
PURPOSE: Necrotizing enterocolitis (NEC) remains one of the most common underlying diagnoses of short bowel syndrome (SBS) in children. The relationship between the etiology of SBS and ultimate enteral autonomy has not been well studied. This investigation sought to evaluate the rate of achievement of enteral autonomy in SBS patients with and without NEC. METHODS: Following IRB approval, 109 patients (2002-2014) at a multidisciplinary intestinal rehabilitation program were reviewed...
January 2016: Journal of Pediatric Surgery
Mariela Dore, Paloma Triana Junco, Ane M Andres, Alba Sánchez-Galán, Maria Virginia Amesty, Esther Ramos, Gerardo Prieto, Francisco Hernandez, Manuel Lopez Santamaria
Intestinal failure (IF) requires a multidisciplinary management based on nutritional support, surgical and medical rehabilitation, and transplantation. The aim of this study is to review our experience with surgical rehabilitation techniques (SRTs: enteroplasty, Bianchi, Serial Transverse Enteroplasty Procedure [STEP]) in patients with short bowel syndrome (SBS) and poor prognosis due to complex abdominal pathology. We performed a single-center retrospective study of patients with IF evaluated for intestinal transplantation in the Intestinal Rehabilitation Unit who underwent an SRT...
February 2016: European Journal of Pediatric Surgery
Catherine J Goodhue, Natalie E Demeter, Rita V Burke, Khadija T Toor, Jeffrey S Upperman, Russell J Merritt
BACKGROUND: Children with special healthcare needs are a vulnerable population in disasters. Special-needs families tend to be less prepared for a disaster than the general public. The purpose of this pilot project was to examine the disaster preparedness levels of families in an intestinal rehabilitation (IR) clinic. MATERIALS AND METHODS: We administered an anonymous survey to a convenience sample of IR clinic families and conducted 2 focus groups. Descriptive analyses were used for survey data; Atlas...
April 2016: Nutrition in Clinical Practice
Claire McNiven, Noah Switzer, Melisssa Wood, Rabin Persad, Marie Hancock, Sarah Forgie, Bryan J Dicken
PURPOSE: The intestinal failure (IF) population is dependent upon central venous catheters (CVC) to maintain minimal energy requirements for growth. Central venous catheter infections (CVCI) are frequent and an independent predictor of intestinal failure associated liver disease. A common complication in children with long-term CVC is the risk of line breakage. Given the often-limited usable vascular access sites in this population, it has been the standard of practice to perform repair of the broken line...
March 2016: Journal of Pediatric Surgery
W Kong, J Wang, X Ni, Y Li, Q Mao, D Yao, S Fan, Y Chen, Z Cai, J Li
BACKGROUND: Short bowel syndrome (SBS) patients need long-term parenteral nutrition or intestine transplantation. With the development of medicine, society, and economy over the past decade, characteristics of these patients might have undergone some changes. To study the issue, we conducted this retrospective study. METHODS: A retrospective study was conducted from January 1, 2004, to January 1, 2014, in an intestinal rehabilitation and transplant center. A total of 335 SBS patients were hospitalized at our center...
July 2015: Transplantation Proceedings
Zev H Davidovics, Beth A Carter, Ruth Ann Luna, Emily B Hollister, Robert J Shulman, James Versalovic
BACKGROUND: Changes in the intestinal microbiome of patients with short bowel syndrome (SBS) are thought to significantly affect clinical outcome. These changes may not only delay enteral diet advancement but may also predispose patients to bacterial translocation, bacteremia, and liver disease. Patients with SBS are thought to be more susceptible to changes in gut microbial communities due to intestinal dysmotility and/or lack of anatomic safeguards such as the ileocecal valve. MATERIALS AND METHODS: We analyzed the bacterial composition of 21 fecal specimens from 9 children with SBS and 8 healthy children ages 4 months to 8 years by 16S ribosomal RNA gene sequencing...
June 9, 2015: JPEN. Journal of Parenteral and Enteral Nutrition
Bram P Raphael, Paul D Mitchell, Darryl Finkton, Hongyu Jiang, Tom Jaksic, Christopher Duggan
OBJECTIVES: To describe the natural history of growth patterns and nutritional support in a cohort of infants with short bowel syndrome (SBS), and to characterize risk factors for suboptimal growth. STUDY DESIGN: A retrospective chart review of 51 infants with SBS followed by our intestinal rehabilitation program. Weight and length data were converted to age, sex, and gestational age-standardized weight-for-age z-scores (WAZ) and length-for-age z-scores (LAZ). RESULTS: Median (IQR) age at enrollment was 8...
July 2015: Journal of Pediatrics
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