# Etiologies (Gastroschisis/NEC/Atresia/Volvulus) — GCMD Library living collection

Also covered as: gastroschisis · necrotizing enterocolitis · malrotation · intestinal atresia · Hirschsprung disease · midgut volvulus · umbilical hernia · omphalocele

Experts: Dr. Todd Ponsky, Dr. Rod Gerardo, Dr. Alex Halpern, Dr. Ellen Encisco

Updated: n/a · 75 episodes · 1789 cited statements

## Episodes
### Foundations
- [Pyloric Stenosis](https://library.globalcastmd.com/watch/pyloric-stenosis-2532) — video · 12:30 · [machine version](https://library.globalcastmd.com/watch/pyloric-stenosis-2532.md)
- [Intestinal rehabilitation: What is intestinal rehab? - Episode 1](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741) — video · 14:33 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741.md)
- [Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742) — podcast · 14:33 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742.md)
- [Omphalocele & Gastroschisis](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255) — video · 9:32 · [machine version](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255.md)
- [Malrotation with Dr. Meera Kotagal](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621) — podcast · 13:25 · [machine version](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621.md)
- [Umbilical Disorders with Dr. Rebeccah Brown](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616) — podcast · 11:27 · [machine version](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616.md)

### Acute Management
- [Necrotizing Enterocolitis](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636) — video · 35:06 · [machine version](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636.md)
- [Intestinal Rehabilitation, Episode 2: Overwhelming intestinal damage, Part 1](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954) — podcast · 13:27 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954.md)

### Nutritional Management
- [Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824) — video · 21:09 · [machine version](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824.md)

### Surgical Management
- [Sutureless Gastroschisis Repair: Technique](https://library.globalcastmd.com/watch/sutureless-gastroschisis-repair-technique-960) — video · [machine version](https://library.globalcastmd.com/watch/sutureless-gastroschisis-repair-technique-960.md)
- [Gastroschisis: Advanced Practice Providers](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049) — video · 43:21 · [machine version](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049.md)
- [Staged Closure of Gastroschisis with Spring-loaded Silo](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235) — video · 27:29 · [machine version](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235.md)
- [Staged Closure of Gastroschisis with Spring-loaded Silo](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251) — video · 27:11 · [machine version](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251.md)
- [Sutureless Closure of Gastroschisis - APSA Practice Gaps 2019](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302) — video · 21:04 · [machine version](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302.md)
- [Duodeno-duodenostomy for Duodenal Atresia](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139) — video · 7:04 · [machine version](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139.md)
- [Use of a new vertical traction device for early traction-assisted staged closure of congenital abdominal wall defects: a prospective series of 16 patients](https://library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436) — video · 0:56 · [machine version](https://library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436.md)
- [Malrotation Infant](https://library.globalcastmd.com/watch/malrotation-infant-11940) — video · 9:22 · [machine version](https://library.globalcastmd.com/watch/malrotation-infant-11940.md)
- [Update Course Rewind 2025: Updates in NEC Management](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612) — video · 11:03 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612.md)

### Complications
- [Conservative Management of Necrotizing Enterocolitis in Newborns: Incidence and Management of Intestinal Strictures](https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738) — video · 0:50 · [machine version](https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738.md)

### Evidence & Research
- [91% Decrease in Mortality with Gastroschisis Bundle!](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816) — video · 3:12 · [machine version](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816.md)
- [Immediate vs Silo Closure for Gastroschisis](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022) — video · 0:26 · [machine version](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022.md)
- [Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308) — podcast · 44:19 · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308.md)
- [Gastroschisis and sutureless abdominal wall closure](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557) — podcast · 12:17 · [machine version](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557.md)
- [Journal of Pediatric Surgery Article Review: October 2021](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661) — podcast · 19:10 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661.md)
- [Journal of Pediatric Surgery Article Review: January 2022 APSA Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103) — podcast · 13:09 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103.md)
- [Update Course 2021: TOP PUBLICATIONS IN NON - PED SURG JOURNALS](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404) — video · 22:13 · [machine version](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404.md)
- [Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819) — video · 27:50 · [machine version](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819.md)
- [Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820) — video · 64:30 · [machine version](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820.md)
- [Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis: An evaluation of the diagnostic accuracy of the contrast enema](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603) — video · 0:56 · [machine version](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603.md)
- [Quick Literature Updates Episode 6](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636) — video · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636.md)
- [Quick Literature Updates Episode 10](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801) — video · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801.md)
- [Quick Literature Updates Episode 11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954) — video · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954.md)
- [Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus](https://library.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075) — video · 1:14 · [machine version](https://library.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075.md)
- [Association of Exclusive Breast Milk Intake and Outcomes in Infants With Uncomplicated Gastroschisis: A National Cohort Study](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037) — video · 0:56 · [machine version](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037.md)
- [Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154) — podcast · 17:03 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154.md)
- [Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308) — podcast · 19:28 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308.md)
- [Management of Gastroschisis: Timing of Delivery, Antibiotic Usage, and Closure Considerations](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626) — video · 0:55 · [machine version](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626.md)
- [Quick Literature Updates Episode 16](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732) — video · 4:21 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732.md)
- [STAT trial: stoma or intestinal anastomosis for necrotizing enterocolitis: a multicentre randomized controlled trial](https://library.globalcastmd.com/watch/stat-trial-stoma-or-intestinal-anastomosis-for-necrotizing-enterocolitis-a-multicentre-randomized-controlled-trial-10427) — video · 0:57 · [machine version](https://library.globalcastmd.com/watch/stat-trial-stoma-or-intestinal-anastomosis-for-necrotizing-enterocolitis-a-multicentre-randomized-controlled-trial-10427.md)
- [Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484) — podcast · 16:35 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484.md)
- [Quick Literature Updates Ep 22](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118) — video · 4:23 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118.md)
- [Quick Literature Updates Ep 27](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580) — video · 4:20 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580.md)
- [Availability, utilization, and barriers to bowel ultrasound for necrotizing enterocolitis...](https://library.globalcastmd.com/watch/availability-utilization-and-barriers-to-bowel-ultrasound-for-necrotizing-enterocolitis-13575) — video · 0:55 · [machine version](https://library.globalcastmd.com/watch/availability-utilization-and-barriers-to-bowel-ultrasound-for-necrotizing-enterocolitis-13575.md)

### Case-Based Learning
- [Abdominal Wall Defects](https://library.globalcastmd.com/watch/abdominal-wall-defects-639) — video · 37:50 · [machine version](https://library.globalcastmd.com/watch/abdominal-wall-defects-639.md)
- [Malrotation](https://library.globalcastmd.com/watch/malrotation-629) — video · 42:31 · [machine version](https://library.globalcastmd.com/watch/malrotation-629.md)
- [Tricks - Total Colonic Aganglionosis Associated with Malrotation & Multiple...](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645) — video · 15:41 · [machine version](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645.md)
- [Bilateral Wilm's Tumor - Complex Gastroschisis - Complex Ileal Atresia:...](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669) — video · 29:44 · [machine version](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669.md)
- [Malrotation Rapid Fire Session: Update Course 2015](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879) — video · 8:59 · [machine version](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879.md)
- [Compiled Sandler Rapid Fire Sessions: Update Course 2015](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992) — video · 29:44 · [machine version](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992.md)
- [Total Colonic Hirschsprung Disease with Malrotation: Difficult Cases](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052) — video · 13:15 · [machine version](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052.md)
- [Abdominal Wall Defects: Update Course 2013](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059) — video · 37:40 · [machine version](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059.md)
- [NEC: Update Course 2013](https://library.globalcastmd.com/watch/nec-update-course-2013-1060) — video · 34:22 · [machine version](https://library.globalcastmd.com/watch/nec-update-course-2013-1060.md)
- [Gastroschisis - Clinical Practice Updates](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996) — video · [machine version](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996.md)
- [Malrotation and Volvulus with Trinity](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941) — video · 8:02 · [machine version](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941.md)
- [Gastroschisis](https://library.globalcastmd.com/watch/gastroschisis-13502) — video · [machine version](https://library.globalcastmd.com/watch/gastroschisis-13502.md)

### In-Depth Reviews
- [Malrotation - Volvulus - Meconium Ileus - Solid Organ Injury: Update Course 2015](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673) — video · 27:04 · [machine version](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673.md)
- [Necrotizing Enterocolitis with Dr. Gail Besner](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930) — podcast · 46:29 · [machine version](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930.md)
- [Abdominal Wall Defects with Dr. Jacob Langer](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959) — podcast · 52:45 · [machine version](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959.md)
- [7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797) — video · 285:42 · [machine version](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797.md)
- [Gastroesophageal Reflux Disease](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289) — podcast · 81:04 · [machine version](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289.md)
- [Intestinal Failure with Dr. Brad Warner](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296) — podcast · 52:46 · [machine version](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296.md)
- [Necrotizing Enterocolitis with Dr. Gail Besner](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297) — podcast · 46:29 · [machine version](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297.md)
- [Hirschsprung Disease Part I with Marc Levitt](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311) — podcast · 59:20 · [machine version](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311.md)
- [Abdominal Wall Defects with Dr. Jacob Langer](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821) — podcast · 52:45 · [machine version](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821.md)
- [Umbilical Cord Defects with Dr. Kenneth Azarow](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298) — podcast · 30:16 · [machine version](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298.md)
- [Omphalocele and Gastroschisis With Dr. Foong-Yen Lim](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006) — podcast · 9:31 · [machine version](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006.md)
- [Stay Current Throwbacks Necrotizing Enterocolitis with Dr. Gail Besner](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402) — podcast · 47:54 · [machine version](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402.md)
- [Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405) — video · 23:20 · [machine version](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405.md)
- [Neonatal Gastric Volvulus with Dr. Jason Frischer](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494) — podcast · 11:17 · [machine version](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494.md)
- [Update Course Rewind: 2022 Top Ten Key Takeaways](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766) — video · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766.md)
- [Update Course Rewind: Omphalocele & Gastroschisis 2020](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507) — podcast · 15:18 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507.md)

### Emerging & Future Directions
- [Dr. Colleen Nofi - Best of the Best in Pediatric Surgery 2025](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047) — video · 8:06 · [machine version](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047.md)
- [Remote Ischemic Conditioning (RIC) Decreases the Incidence and Severity of Necrotizing Enterocolitis (NEC) - Validation in a Large Animal Model](https://library.globalcastmd.com/watch/remote-ischemic-conditioning-decreases-the-incidence-and-severity-of-necrotizing-enterocolitis-validation-in-a-large-animal-model-10417) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/remote-ischemic-conditioning-decreases-the-incidence-and-severity-of-necrotizing-enterocolitis-validation-in-a-large-animal-model-10417.md)

### Patient & Family Education
- [What is Gastroschisis? An ERNICA animation for parents and families](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812) — video · 2:59 · [machine version](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812.md)

### Long-Term Care
- [Educational Outcomes in School-Aged Children With a History of Simple and Complex Gastroschisis are Poor Compared to Controls](https://library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437) — video · 0:53 · [machine version](https://library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437.md)

## Chapters
- [0:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=4) Introduction and Program Context (Ep 35)
- [1:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=106) Defining Intestinal Failure (Ep 35)
- [4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=290) Three Categories of Intestinal Failure (Ep 35)
- [8:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=499) Timing of Diagnosis and Referral (Ep 35)
- [10:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=604) Multidisciplinary Team Approach (Ep 35)
- [12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=754) Outcomes and Future Challenges (Ep 35)
- [0:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=0) Introduction and Clinical Scenario (Ep 36)
- [3:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=180) Clinical Observation Over Prediction (Ep 36)
- [5:20](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=320) Liver Protection Strategy (Ep 36)
- [7:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=454) Bowel Regeneration and the 50% Rule (Ep 36)
- [10:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=629) Outcomes and Diagnosis-Specific Considerations (Ep 36)
- [0:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=0) Introduction and Program Expansion (Ep 34)
- [1:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=106) Defining Intestinal Failure (Ep 34)
- [4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=290) Three Categories of Intestinal Failure (Ep 34)
- [8:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=499) Timing of Diagnosis and Referral (Ep 34)
- [10:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=604) Team Approach and Long-term Outcomes (Ep 34)
- [13:14](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=794) Series Goals and Closing (Ep 34)
- [0:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=0) Introduction and Initial Workup of Infant Reflux (Ep 24)
- [5:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=300) Diagnostic Approach and Eosinophilic Esophagitis (Ep 24)
- [11:40](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=700) Medical Management and Role of Testing (Ep 24)
- [20:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1200) NICU Patients and Feeding Tube Management (Ep 24)
- [30:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1800) Indications for Fundoplication and Gastric Emptying (Ep 24)
- [40:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2400) pH Impedance Testing and Rome IV Criteria (Ep 24)
- [50:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3000) Surgical Technique: The Perfect Nissen (Ep 24)
- [60:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3600) Post-Fundoplication Complications and Management (Ep 24)
- [70:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4200) Advanced Options and Rumination Syndrome (Ep 24)
- [0:00](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=0) Introduction and Definition of Intestinal Failure (Ep 25)
- [1:42](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=102) Prognostic Factors and Bowel Length Criteria (Ep 25)
- [7:07](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=427) Medical Management and TPN Strategy (Ep 25)
- [12:55](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=775) Lipid Formulations and Cholestasis Management (Ep 25)
- [17:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1071) Enteral Feeding Strategy and Adaptation (Ep 25)
- [26:01](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1561) Surgical Interventions: Lengthening Procedures (Ep 25)
- [38:10](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2290) Bacterial Overgrowth and Microbiome (Ep 25)
- [43:35](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2615) Growth Factors and Future Therapies (Ep 25)
- [46:32](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2792) Intestinal Transplantation and Multidisciplinary Care (Ep 25)
- [0:00](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=0) Introduction (Ep 30)
- [2:03](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=123) Timing of Umbilical Hernia Repair (Ep 30)
- [7:01](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=421) Incarcerated Umbilical Hernias and Technical Considerations (Ep 30)
- [9:57](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=597) Gastroschisis and Omphalocele-Associated Hernias (Ep 30)
- [16:31](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=991) Umbilical Drainage in Infants (Ep 30)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Intestinal failure is defined as insufficient gut function to absorb enough nutrients, fluids, and calories to support survival and, in children, growth" — Paul Wales (clinical) [Ep 35 · 2:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=125)
- "For a patient to be defined as having intestinal failure, they must have inadequate intestinal function necessitating parenteral support for at least 60 days" — Rod Gerardo (guideline) [Ep 35 · 2:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=144)
- "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 associated needs" — Paul Wales (clinical) [Ep 35 · 3:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=183)
- "Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients" — Paul Wales (epidemiological) [Ep 35 · 4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=290)
- "Causes of short bowel syndrome include congenital anomalies such as intestinal atresia, malrotation, volvulus, gastroschisis, and long segment Hirschsprung's disease" — Paul Wales (clinical) [Ep 35 · 5:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=306)
- "Acquired diseases of the newborn such as necrotizing enterocolitis can cause short bowel syndrome" — Paul Wales (clinical) [Ep 35 · 5:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=318)
- "Motility disorders occur when the bowel is unable to push contents through in a coordinated way due to abnormalities of the muscle itself or the nerves that control that muscle" — Paul Wales (clinical) [Ep 35 · 5:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=345)
- "Congenital enteropathies are conditions where the patient has all of their bowel but the mucosa does not work, leading to hypersecretion and profuse fluid losses" — Paul Wales (clinical) [Ep 35 · 6:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=377)
- "Some patients will have elements of two or three categories of intestinal failure in the way they present" — Paul Wales (clinical) [Ep 35 · 7:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=431)
- "A child with gastroschisis could have short bowel because it was not all viable, inflammation affecting absorption, and motility issues" — Ellen Encisco (clinical) [Ep 35 · 7:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=442)
- "Older pediatric patients can develop intestinal failure from inflammatory bowel disease or Crohn's disease where they have lost gut as a result of complications" — Paul Wales (clinical) [Ep 35 · 7:56](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=476)
- "Trauma, malignancy, and vascular thrombosis leading to gut loss are diagnoses seen more in older patients or adult series and less in pediatrics" — Paul Wales (epidemiological) [Ep 35 · 8:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=484)
- "There are three time points where families reach intestinal rehabilitation programs: prenatal diagnosis, postnatal acquired problems, and later presentations after discharge" — Michael Helmrath (clinical) [Ep 35 · 8:53](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=533)
- "Prenatal diagnoses that lead to intestinal rehabilitation typically include atresia with cystic fibrosis and gastroschisis" — Michael Helmrath (clinical) [Ep 35 · 9:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=555)
- "Postnatal acquired problems leading to intestinal rehabilitation include volvulus and necrotizing enterocolitis" — Ellen Encisco (clinical) [Ep 35 · 9:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=569)
- "Dietitians play a key role in understanding the nutritional needs of children in intestinal rehabilitation" — Michael Helmrath (opinion) [Ep 35 · 11:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=712)
- "Social work is a key component of the intestinal rehabilitation team" — Michael Helmrath (opinion) [Ep 35 · 12:01](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=721)
- "The survival overall in big intestinal rehabilitation programs is usually over 90% long-term survival" — Rod Gerardo (epidemiological) [Ep 35 · 12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=754)
- "Children with intestinal failure who survive long-term now develop chronic comorbidities including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life issues" — Paul Wales (clinical) [Ep 35 · 12:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=766)
- "Earlier recognition and taking advantage of the biology of the gut to adapt are time dependent" — Michael Helmrath (clinical) [Ep 35 · 2:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=160)
- "Intestinal rehabilitation streamlines care and improves communication with families and between care providers and team members" — Paul Wales (opinion) [Ep 35 · 3:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=235)
- "Intestinal rehabilitation comes down to key factors that drive the process: nutrition in the gut, nutrition in the body, and healing" — Michael Helmrath (clinical) [Ep 35 · 4:07](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=247)
- "Pattern recognition from multiple eyes on a baby who have seen them over time is important in intestinal rehabilitation" — Michael Helmrath (opinion) [Ep 35 · 4:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=259)
- "The inflection point of bowel loss requiring prolonged TPN is about 50%" — Michael Helmrath (clinical) [Ep 36 · 9:27](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=567)
- "Intestinal transplant is not experimental therapy but part of the continuum of therapy for a child with short bowel syndrome" — Paul Wales (guideline) [Ep 36 · 2:38](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=158)
- "Babies born with duodenal atresia or very proximal jejunal atresia are born with elevated direct or conjugated bilirubins" — Paul Wales (clinical) [Ep 36 · 6:14](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=374)
- "A 30-week-old baby's gut is in a highly developmental phase and its ability to regenerate is much more profound than a full term baby and certainly a one year old baby" — Michael Helmrath (clinical) [Ep 36 · 7:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=454)
- "The distal bowel, the ileum, can be salvaged by ileocecal blood flow" — Michael Helmrath (clinical) [Ep 36 · 8:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=484)
- "Bowel regeneration with proximal control occurs over 6, 8, 12 weeks based on the liver getting better" — Michael Helmrath (clinical) [Ep 36 · 8:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=497)
- "When the liver is inflamed and has high bilirubin, it's in a catabolic state" — Michael Helmrath (clinical) [Ep 36 · 5:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=357)
- "Decompressing the duodenum is needed to protect the liver" — Michael Helmrath (clinical) [Ep 36 · 5:49](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=349)
- "Giving fish oils and just trying to improve the bilirubin is not enough to protect the liver" — Ellen (clinical) [Ep 36 · 5:32](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=332)
- "In the very acute time after bowel infarction, the risk is dying of sepsis and multi-organ failure" — Paul Wales (clinical) [Ep 36 · 4:31](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=271)
- "Intermediate and longer term complications include intestinal failure associated liver disease, recurrent sepsis, or line problems" — Paul Wales (clinical) [Ep 36 · 4:44](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=284)
- "Success in the last two decades is because we're way better at preventing sepsis and liver disease" — Paul Wales (epidemiological) [Ep 36 · 5:02](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=302)
- "Factors affecting liver function include prematurity, sepsis, choice of TPN, and presence or absence of enteral nutrition" — Paul Wales (clinical) [Ep 36 · 6:42](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=402)
- "If bowel necrosis is focal and less than 50%, the best option is to remove that bowel" — Michael Helmrath (clinical) [Ep 36 · 9:35](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=575)
- "The adaptive potential for a child with less than 50% bowel loss is really great, especially if they have preserved ileum" — Michael Helmrath (clinical) [Ep 36 · 9:44](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=584)
- "When bowel appears dead in a mosaic pattern with parts terrible, parts bad, and maybe a little good, proximal control with a drain and time to heal gives opportunity to come back later" — Michael Helmrath (clinical) [Ep 36 · 10:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=600)
- "Not all bowel will survive and it will become islands of mucosa that need to be tubularized and put back together again" — Michael Helmrath (clinical) [Ep 36 · 10:14](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=614)
- "Stomas lose abdominal domain and lose bowel down the road" — Michael Helmrath (clinical) [Ep 36 · 10:59](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=659)
- "The percentage of kids that do well with proximal drain therapy when looking at dead gut is more than 70 to 80%" — Michael Helmrath (clinical) [Ep 36 · 11:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=671)
- "Kids with necrotizing enterocolitis have the best outcomes because it's a microvascular disease" — Michael Helmrath (clinical) [Ep 36 · 11:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=705)
- "There is an algorithm of children that have overwhelming sepsis where surgery cannot salvage these patients and there is no life saving option" — Michael Helmrath (clinical) [Ep 36 · 3:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=214)
- "Many babies will rally without having their bowel removed, which allows them an opportunity" — Michael Helmrath (clinical) [Ep 36 · 3:41](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=221)
- "Mistakes are commonly made because surgeons think they can predict the future with their eyes" — Michael Helmrath (opinion) [Ep 36 · 3:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=191)
- "The first line of treating a baby with overwhelming catastrophe is to allow the clinical scenario to drive the direction of care and not predetermining care based on what surgeons believe will happen" — Michael Helmrath (opinion) [Ep 36 · 3:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=191)
- "The outlook has changed and what's gone hand in hand with that is a bit more of an aggressive approach to surgical resection" — Paul Wales (opinion) [Ep 36 · 1:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=77)
- "Comorbidities such as neurologic status, pulmonary function, cardiac function, or significant genetic or chromosomal anomaly factor into decision making about how to proceed" — Paul Wales (clinical) [Ep 36 · 1:39](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=99)
- "The conversation with the family and understanding of the family's wishes is important to figure out if the baby is salvageable or not salvageable" — Rod Gerardo (clinical) [Ep 36 · 2:20](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=140)
- "Intestinal failure is defined as insufficient gut function to absorb enough nutrients, fluids, and calories to support survival and, in children, growth" — Paul Wales (clinical) [Ep 34 · 2:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=125)
- "New guidelines define intestinal failure as requiring parental support for at least 60 days" — Rod Gerardo (guideline) [Ep 34 · 2:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=144)
- "An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm providing coordinated care for children with intestinal failure through comprehensive management of specialized nutrition and associated needs" — Paul Wales (clinical) [Ep 34 · 3:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=183)
- "Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients" — Paul Wales (epidemiological) [Ep 34 · 4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=290)
- "Causes of short bowel syndrome include congenital anomalies such as intestinal atresia, malrotation, volvulus, gastroschisis, and long segment Hirschsprung's disease" — Paul Wales (clinical) [Ep 34 · 5:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=306)
- "Acquired diseases of the newborn such as necrotizing enterocolitis cause short bowel syndrome" — Paul Wales (clinical) [Ep 34 · 5:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=318)
- "Motility disorders occur when abnormalities of the intestinal muscle itself or the nerves that control that muscle prevent coordinated movement of food and stool" — Paul Wales (clinical) [Ep 34 · 5:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=345)
- "Children with motility disorders are dependent on intravenous support" — Paul Wales (clinical) [Ep 34 · 6:10](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=370)
- "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" — Paul Wales (clinical) [Ep 34 · 6:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=377)
- "Mucosal defects lead to hypersecretion and profuse fluid losses such that the bowel is unable to tolerate or absorb nutrients" — Ellen (clinical) [Ep 34 · 6:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=390)
- "Some patients will have elements of one, two, or all three categories of intestinal failure" — Paul Wales (clinical) [Ep 34 · 7:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=431)
- "A child with gastroschisis could have short bowel because it was not all viable, inflammation affecting absorption, and motility issues" — Ellen (clinical) [Ep 34 · 7:22](https://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 kids develop intestinal failure" — Paul Wales (epidemiological) [Ep 34 · 7:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=465)
- "Inflammatory bowel disease or Crohn's disease can lead to gut loss and intestinal failure in older patients" — Paul Wales (clinical) [Ep 34 · 7:56](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=476)
- "Trauma, malignancy, and vascular thrombosis leading to gut loss are diagnoses seen more in older patients or adult series and less in pediatrics" — Paul Wales (epidemiological) [Ep 34 · 8:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=484)
- "There are three time points when families reach intestinal rehab programs: prenatal diagnosis, postnatal acquired problems, and later diagnosis after discharge" — Rod Gerardo (clinical) [Ep 34 · 8:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=531)
- "Prenatal diagnoses that lead to intestinal rehab referral include atresia with cystic fibrosis and gastroschisis" — Michael Helmrath (clinical) [Ep 34 · 9:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=555)
- "Postnatal acquired problems leading to intestinal rehab referral include volvulus and necrotizing enterocolitis" — Ellen (clinical) [Ep 34 · 9:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=569)
- "The intestinal rehab team includes surgeons, GI doctors, neonatologists, dietitians, social work, nurse practitioners, pharmacy, interventional radiology, pathology, endocrinology, and nephrology" — Michael Helmrath (clinical) [Ep 34 · 11:43](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=703)
- "Survival overall in big intestinal rehab programs is usually over 90% long-term survival" — Rod Gerardo (epidemiological) [Ep 34 · 12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=754)
- "Long-term survivors now develop chronic comorbidities including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life issues" — Paul Wales (clinical) [Ep 34 · 12:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=766)
- "Earlier recognition and taking advantage of the gut's biology to adapt are time dependent" — Michael Helmrath (opinion) [Ep 34 · 2:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=160)
- "Intestinal rehabilitation comes down to key factors: nutrition in the gut, nutrition in the body, and healing" — Michael Helmrath (clinical) [Ep 34 · 4:07](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=247)
- "Pattern recognition from multiple experienced providers seeing patients over time is essential in intestinal rehabilitation" — Michael Helmrath (opinion) [Ep 34 · 4:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=259)
- "Families living within the region can benefit from understanding that delivery at an intestinal rehab center from the beginning is probably beneficial" — Michael Helmrath (opinion) [Ep 34 · 8:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=510)
- "Access and availability to an intestinal rehab program is still very rare" — Rod Gerardo (epidemiological) [Ep 34 · 8:41](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=521)
- "Innovation comes from multiple approaches to the problem and different visions, with more expertise bringing better outcomes" — Michael Helmrath (opinion) [Ep 34 · 10:25](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=625)
- "Transitioning older children with intestinal failure into their late teen years and later is a major obstacle that needs to be addressed" — Michael Helmrath (clinical) [Ep 34 · 10:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=651)
- "The vast majority of kids who have vomiting, respiratory symptoms, and wheezing are more likely to have oropharyngeal dysphagia and aspiration during swallowing than gastroesophageal reflux" — Rachel Rosen (clinical) [Ep 24 · 3:23](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=203)
- "The peak age of reflux is between 4 and 6 months of age" — Rachel Rosen (epidemiological) [Ep 24 · 4:32](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=272)
- "Proton pump inhibitors are not beneficial in children under the age of 1 because these kids reflux non-acidic gastric content (milk)" — Rachel Rosen (clinical) [Ep 24 · 5:26](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=326)
- "Normal gastric emptying of infants means they still have milk in their stomach for up to 2 to 3 hours; acid production only starts after the 3 hour mark" — Rachel Rosen (clinical) [Ep 24 · 5:45](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=345)
- "Studies have shown both with H2 blockers and PPIs you can get sepsis, UTIs, necrotizing enterocolitis, pneumonias, pharyngitis, upper respiratory infections, and C. diff in young infants" — Rachel Rosen (clinical) [Ep 24 · 7:21](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=441)
- "In kids under the age of 5 presenting with respiratory symptoms, eosinophilic esophagitis is found in about 10% when endoscopy is performed" — Rachel Rosen (epidemiological) [Ep 24 · 9:53](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=593)
- "The number one presentation of eosinophilic esophagitis in kids under age 5 is chronic cough, followed by vomiting or failure to thrive" — Rachel Rosen (clinical) [Ep 24 · 9:41](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=581)
- "You really need to scope every kid before they would get a Nissen because you don't want to wrap a kid who has eosinophilic esophagitis" — Rachel Rosen (guideline) [Ep 24 · 10:54](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=654)
- "The most likely allergen in eosinophilic esophagitis is dairy in about 60 to 70% of kids" — Rachel Rosen (epidemiological) [Ep 24 · 11:57](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=717)
- "Macrolides like erythromycin are motilin agonists that make the antrum contract and help with vomiting, plus have anti-inflammatory benefits for the airway and lungs" — Rachel Rosen (clinical) [Ep 24 · 16:28](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=988)
- "There are no great normal values for the number of reflux episodes in pediatric patients, making pH impedance interpretation difficult" — Rachel Rosen (clinical) [Ep 24 · 17:48](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1068)
- "Reflux is rarely a cause of failure to thrive and respiratory symptoms in infants, especially at 6 months of age when reflux should be improving as solid food is introduced" — Rachel Rosen (opinion) [Ep 24 · 19:18](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1158)
- "An upper GI is not a good study for reflux diagnosis; it only helps identify anatomical problems in about 4% of patients" — Whit Holcomb (clinical) [Ep 24 · 22:38](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1358)
- "The majority of kids with oropharyngeal dysphagia will outgrow it by 3 to 4 months of age" — Rachel Rosen (clinical) [Ep 24 · 28:21](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1701)
- "About 75% of NICU patients with dysphagia managed with NG tubes will not need to go on to gastrostomy" — Rachel Rosen (epidemiological) [Ep 24 · 28:42](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1722)
- "When gastrostomy goes in for children who aspirate from oropharyngeal dysphagia, their rates of hospitalization are about 15 times higher than if you just fed them by mouth" — Rachel Rosen (epidemiological) [Ep 24 · 29:37](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1777)
- "Nasogastric tubes in neonates under 3 months of age don't come out that frequently" — Rachel Rosen (clinical) [Ep 24 · 31:13](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1873)
- "If symptoms go away with nasojejunal feeds, reflux likely is playing a role and Nissen may be an option" — Rachel Rosen (clinical) [Ep 24 · 34:09](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2049)
- "Kids who wretch preoperatively are the most miserable post-Nissen because they wretch a lot postoperatively too" — Rachel Rosen (clinical) [Ep 24 · 35:20](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2120)
- "Rome IV criteria define three categories: non-erosive reflux disease (NERD) with abnormal acid burden, reflux hypersensitivity with normal acid but symptom correlation, and functional heartburn with no correlation" — Rachel Rosen (guideline) [Ep 24 · 40:54](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2454)
- "New GERD guidelines recommend treating with PPI for 2 months then attempting to wean, with goal of weaning ideally 2 times per year" — Rachel Rosen (guideline) [Ep 24 · 44:04](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2644)
- "If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term" — Rachel Rosen (clinical) [Ep 24 · 45:31](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2731)
- "In a prospective randomized trial of 107 patients using minimal mobilization technique, neither group required a redo fundoplication for transmigration" — Whit Holcomb (clinical) [Ep 24 · 46:40](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2800)
- "The primary reason for redo fundoplication historically was transmigration of the wrap into the chest" — Whit Holcomb (epidemiological) [Ep 24 · 47:08](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2828)
- "By doing minimal mobilization and placing sutures between esophagus and crura, transmigration rate was reduced from 12% to 5%" — Whit Holcomb (clinical) [Ep 24 · 57:32](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3452)
- "With minimal mobilization alone (no sutures), there was zero transmigration in prospective trial, with only one wrap loosening" — Whit Holcomb (clinical) [Ep 24 · 58:23](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3503)
- "Kids who aspirate during swallowing and then get a Nissen have saliva pool in their esophagus over the Nissen, leading to gagging, wretching, and coughing" — Rachel Rosen (clinical) [Ep 24 · 49:02](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2942)
- "Blenderized feeds using table food migrate to the antrum away from the LES and cardia, reducing reflux symptoms in neurologically impaired children" — Rachel Rosen (clinical) [Ep 24 · 52:39](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3159)
- "Pyloric Botox works not only for delayed emptying but also with the sensory component that triggers wretching" — Rachel Rosen (clinical) [Ep 24 · 54:19](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3259)
- "Botox doesn't reliably improve gastric emptying but helps significantly with wretching, possibly by affecting sensory mechanisms" — Rachel Rosen (clinical) [Ep 24 · 68:18](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4098)
- "Post-fundoplication patients should be imaged both by putting barium through the G-tube and giving barium from above via nasoesophageal tube to assess esophageal emptying" — Rachel Rosen (clinical) [Ep 24 · 62:02](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3722)
- "A Cincinnati study showed blenderized feeds are effective therapy for treatment of post-fundoplication wretching" — Rachel Rosen (clinical) [Ep 24 · 63:11](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3791)
- "Using esophageal bougie at time of fundoplication has resulted in very little need for postoperative dilation" — Whit Holcomb (clinical) [Ep 24 · 63:46](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3826)
- "Gastric pacing may work through sensory effects rather than motility improvement, as some patients improve without motility changes" — Rachel Rosen (clinical) [Ep 24 · 67:38](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4058)
- "Rates of reflux post-Nissen are between 10 and 20 reflux episodes per 24 hour period, which is considered acceptable" — Rachel Rosen (clinical) [Ep 24 · 71:39](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4299)
- "Patients who ruminate describe vomiting 50-100 times a day, typically within minutes of starting a meal or the hour after, and esophageal motility shows simultaneous gastric contraction with bolus movement into esophagus" — Rachel Rosen (clinical) [Ep 24 · 78:40](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4720)
- "Patients who ruminate continue to do this even with a wrap in place, making fundoplication ineffective" — Rachel Rosen (clinical) [Ep 24 · 79:31](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4771)
- "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 25 · 1:42](https://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 25 · 3:03](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=183)
- "For a neonate with ileocecal valve and entire colon, 10 to 15 centimeters of small intestine is a ballpark figure for salvageability" — Brad Warner (clinical) [Ep 25 · 4:03](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=243)
- "Without the colon and ileocecal valve, at least 15 to 20 centimeters would be a ballpark figure for salvageability" — Brad Warner (clinical) [Ep 25 · 4:37](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=277)
- "In adults with less than 50 centimeters of intestine, about 40% will not be alive after 5 to 10 years" — Brad Warner (epidemiological) [Ep 25 · 4:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=291)
- "For a patient with 15 centimeters of bowel and ileocecal valve, long term 50% should be able to wean from TPN, 25% would require transplant, and 25% would die" — Brad Warner (epidemiological) [Ep 25 · 5:56](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=356)
- "Intestinal adaptation in humans probably takes place over about a year or two after small bowel resection" — Brad Warner (clinical) [Ep 25 · 7:49](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=469)
- "Stool outputs of up to 40 ccs per kilo per day are acceptable when advancing enteral feeding" — Brad Warner (guideline) [Ep 25 · 8:30](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=510)
- "For TPN, shoot for about 100 to 120 calories per kilo per day for total calories, with about 50% from glucose and remainder from fat and protein" — Brad Warner (guideline) [Ep 25 · 10:22](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=622)
- "Generally shoot for about 2 to 3 g of protein per kilo per day and about 2 to 3 g of fat per kilo per day in TPN" — Brad Warner (guideline) [Ep 25 · 10:45](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=645)
- "A baby should gain about 20 to 30 g a day, which approximates in utero progression for a newborn" — Brad Warner (clinical) [Ep 25 · 12:05](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=725)
- "Lipid reduction strategy takes patients from 2 to 3 g per kilo per day of fat delivered daily down to about 1 g per kilo per day delivered twice or 3 times a week to reduce cholestasis" — Brad Warner (guideline) [Ep 25 · 12:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=773)
- "Omegaven is a fish oil-based fat primarily containing 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 25 · 14:03](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=843)
- "SMOF lipid contains soybean (essential fatty acids), medium chain triglycerides (easily digested), olive oil, and fish oil, and has become the most commonly used lipid in Canada" — Brad Warner (clinical) [Ep 25 · 15:08](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=908)
- "Breast milk is the best choice for neonates because it contains growth factors like EGF and IGF, milk oligosaccharides that enhance adaptation, and other beneficial components" — Brad Warner (opinion) [Ep 25 · 18:11](https://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 (clinical) [Ep 25 · 19:26](https://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, though the exact number is unknown" — Brad Warner (clinical) [Ep 25 · 21:19](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1279)
- "Time to consider surgical intervention is when patient hits a plateau enterally and starts backing away, or if going backward rather than forward in enteral tolerance" — Brad Warner (guideline) [Ep 25 · 22:33](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1353)
- "Multiple episodes of sepsis along with abdominal distention and dilated bowel loops is an indication for surgical intervention" — Brad Warner (guideline) [Ep 25 · 23:01](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1381)
- "If child is starting to get jaundiced, there is a role to evaluate the gut for subclinical portal bacteremia arising from dilated bowel loops" — Brad Warner (clinical) [Ep 25 · 23:18](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1398)
- "Dilated bowel loops cause bacterial overgrowth leading to secretory diarrhea that is not related to digestion-absorption capacity but to enzyme dysfunction" — Brad Warner (clinical) [Ep 25 · 23:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1433)
- "More than 4 to 5 centimeters of bowel dilation with failure to advance enteral feeds or going backward is an indication for surgical intervention" — Brad Warner (guideline) [Ep 25 · 25:43](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1543)
- "In a child who is completely stable after 3 years but not progressing, would interrogate bowel and if dilated would proceed with lengthening" — Brad Warner (opinion) [Ep 25 · 26:07](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1567)
- "If a child has over 100 centimeters of intestine, less than 5 or 10% should require TPN, suggesting possible underlying motility or mucosal problem" — Brad Warner (clinical) [Ep 25 · 27:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1673)
- "With less than 50 centimeters of intestine and bowel at least 4 to 5 centimeters dilated, there is an option for either Bianchi or STEP procedure" — Brad Warner (guideline) [Ep 25 · 28:37](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1717)
- "The STEP procedure has emerged to be the most commonly performed lengthening operation because it is easier to do with less risk of injuring mesenteric blood supply" — Brad Warner (clinical) [Ep 25 · 29:31](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1771)
- "STEP procedures can redilate requiring redo procedures, and outcomes are not as good if a redo STEP is needed compared to never needing a redo" — Brad Warner (clinical) [Ep 25 · 32:54](https://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 25 · 33:26](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2006)
- "STEP procedures can cause dysmotility acting as a brake on intestinal transit" — Brad Warner (clinical) [Ep 25 · 35:04](https://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 to 100 centimeters of intestinal length rather than performing a lengthening procedure" — Brad Warner (opinion) [Ep 25 · 38:21](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2301)
- "Chenodeoxycholic acid bile salts can be used to improve bile flow in TPN cholestasis" — Brad Warner (clinical) [Ep 25 · 39:00](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2340)
- "Cholecystokinin administration to promote bile flow and mitigate TPN cholestasis did not work in clinical trials" — Brad Warner (clinical) [Ep 25 · 39:23](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2363)
- "Gut bacteria in short gut syndrome become more efficient and help adapt by encouraging greater absorption and digestion, similar to an obesogenic microbiome" — Brad Warner (clinical) [Ep 25 · 41:54](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2514)
- "In mouse models, oral vancomycin to knock out gram positive organisms completely prevented hepatic steatosis after bowel resection" — Brad Warner (clinical) [Ep 25 · 42:19](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2539)
- "Teduglutide, a GLP-2 analog, has been demonstrated in randomized trials to reduce TPN requirements by about 1-2 liters per week in adults with short gut syndrome" — Brad Warner (clinical) [Ep 25 · 43:45](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2625)
- "Teduglutide is not yet approved for children in the United States due to concerns about malignancy risk from promoting proliferation" — Brad Warner (clinical) [Ep 25 · 44:34](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2674)
- "Growth hormone and glutamine combinations have shown primarily mixed results and have not been a huge advance in TPN weaning" — Brad Warner (clinical) [Ep 25 · 45:40](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2740)
- "Survival for small bowel transplant is about 50 to 60% at 5 years, with one year survivals now above 70 to 80%" — Brad Warner (epidemiological) [Ep 25 · 46:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2811)
- "The intestine is an immunogenic organ filled with white cells and macrophages that mount a huge graft versus host response requiring industrial strength immunosuppression" — Brad Warner (clinical) [Ep 25 · 47:11](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2831)
- "Ethanol locks for central lines have reduced significantly the number of sepsis episodes in patients with short gut syndrome" — Brad Warner (clinical) [Ep 25 · 49:22](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2962)
- "Multidisciplinary teams including pharmacists, nutritionists, surgeons, GI doctors, ID, radiology, and interventional radiology improve survival of intestinal failure patients" — Brad Warner (clinical) [Ep 25 · 51:16](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=3076)
- "Most umbilical hernias will close on their own in the first year and then some in the second year" — Kenneth Azarow (clinical) [Ep 30 · 2:58](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=178)
- "Age 2 is the earliest to consider umbilical hernia repair, with a 2 centimeter proboscis and at least 1 centimeter opening to the abdominal wall" — Kenneth Azarow (clinical) [Ep 30 · 3:05](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=185)
- "Typically before school entry is the optimal time for umbilical hernia repair" — Kenneth Azarow (opinion) [Ep 30 · 3:19](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=199)
- "Large proboscis length does not affect the decision to operate early on umbilical hernias" — Kenneth Azarow (clinical) [Ep 30 · 3:47](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=227)
- "Larger umbilical hernia defects (greater than 1 cm) are less likely to close spontaneously, but this should not affect timing of repair" — Kenneth Azarow (clinical) [Ep 30 · 4:12](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=252)
- "Race or ethnicity of the child does not affect the decision on timing of umbilical hernia repair" — Kenneth Azarow (clinical) [Ep 30 · 4:40](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=280)
- "Anesthesia data regarding operating before 2-3 years of age supports waiting for umbilical hernia repair" — Todd Ponsky (guideline) [Ep 30 · 4:54](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=294)
- "True incarcerated umbilical hernias present with bowel obstruction symptoms; if the child is eating well, it is not an emergent incarcerated hernia" — Kenneth Azarow (clinical) [Ep 30 · 5:38](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=338)
- "Red, tender umbilical lumps in children are usually incarcerated omentum, preperitoneal fat, or infected urachal cysts, not incarcerated bowel" — Kenneth Azarow (clinical) [Ep 30 · 5:42](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=342)
- "Incarcerated fat at the umbilicus can be treated with NSAIDs and urachal infections with antibiotics" — Kenneth Azarow (clinical) [Ep 30 · 6:09](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=369)
- "LMA can be used for umbilical hernia repair if adequate abdominal wall relaxation is achieved" — Kenneth Azarow (clinical) [Ep 30 · 7:47](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=467)
- "PDS or Maxon suture is preferred for umbilical hernia repair because it lasts twice as long as Vicryl and is non-braided" — Kenneth Azarow (clinical) [Ep 30 · 8:26](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=506)
- "Umbilicoplasty should be performed to excise excess skin at the time of umbilical hernia repair to achieve a flat, cosmetic result" — Kenneth Azarow (opinion) [Ep 30 · 10:24](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=624)
- "The undersurface of umbilical skin should be tacked down to the fascia using braided suture (Vicryl) to create an inflammatory response" — Kenneth Azarow (clinical) [Ep 30 · 11:42](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=702)
- "A pressure dressing should be applied for 3 days after umbilical hernia repair" — Kenneth Azarow (clinical) [Ep 30 · 12:24](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=744)
- "Gastroschisis is actually an umbilical ring defect because the natural history is for the hole to close on its own" — Kenneth Azarow (clinical) [Ep 30 · 13:00](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=780)
- "Over half of gastroschisis patients closed with sutureless technique will have large umbilical hernias, but most will close spontaneously over 2-3 years" — Kenneth Azarow (clinical) [Ep 30 · 13:28](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=808)
- "Suturing gastroschisis defects makes the umbilical ring edge ischemic and destroys ring integrity, leading to more hernias that won't close" — Kenneth Azarow (clinical) [Ep 30 · 14:13](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=853)
- "Omphalocele repair should be delayed as long as possible; children will grow and thrive with the defect covered" — Kenneth Azarow (clinical) [Ep 30 · 15:00](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=900)
- "For omphalocele, when the child lies flat and the flanks start bulging out, this indicates the abdominal girth is increasing and primary closure may be possible" — Kenneth Azarow (clinical) [Ep 30 · 15:34](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=934)
- "Operating too early on omphalocele is a mistake" — Kenneth Azarow (opinion) [Ep 30 · 16:15](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=975)
- "For umbilical drainage in infants, no ultrasound or VCUG is needed, only physical examination" — Kenneth Azarow (clinical) [Ep 30 · 18:56](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1136)
- "Operating on umbilical drainage in the first 3 months increases complication rates; many resolve spontaneously after 6 months" — Kenneth Azarow (clinical) [Ep 30 · 19:23](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1163)
- "Silver nitrate can be used to treat umbilical granulomas in the first few weeks" — Kenneth Azarow (clinical) [Ep 30 · 20:59](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1259)
- "Triamcinolone (Kenalog) cream is more effective than silver nitrate for treating umbilical granulomas" — Todd Ponsky (clinical) [Ep 30 · 21:33](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1293)
- "Steroid cream works better than silver nitrate for granulation tissue at gastrostomy sites" — Kenneth Azarow (clinical) [Ep 30 · 21:53](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1313)
- "Urachal remnant exploration is done through an umbilical incision, similar to umbilical hernia repair, with the track found inferiorly" — Kenneth Azarow (clinical) [Ep 30 · 22:12](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1332)
- "The urachal track bluntly dissects away from the preperitoneal space and the dome of the bladder can be pulled up to the umbilicus" — Kenneth Azarow (clinical) [Ep 30 · 23:27](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1407)
- "No preoperative VCUG or ultrasound findings changed management of urachal remnants in a 10-15 year study" — Kenneth Azarow (clinical) [Ep 30 · 24:05](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1445)
- "Infected urachal cysts can usually be treated with antibiotics alone; true abscesses require drainage and antibiotics" — Kenneth Azarow (clinical) [Ep 30 · 24:52](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1492)
- "Elective urachal remnant excision after infection prevents recurrent abscess" — Kenneth Azarow (clinical) [Ep 30 · 25:06](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1506)
- "Infected urachal cysts can be drained percutaneously by interventional radiology" — Kenneth Azarow (clinical) [Ep 30 · 25:20](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1520)
- "Elective urachal remnant excision can be done laparoscopically with stapling at the dome of the bladder and extraction through the umbilicus" — Kenneth Azarow (clinical) [Ep 30 · 25:37](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1537)
- "Patent omphalomesenteric duct (omphalocutaneous fistula with stool from umbilicus) will not close spontaneously and requires operation before hospital discharge" — Kenneth Azarow (clinical) [Ep 30 · 26:23](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1583)
- "Patent omphalomesenteric duct has risk of volvulus from small bowel wrapping around the fistula" — Kenneth Azarow (clinical) [Ep 30 · 26:36](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1596)
- "Patent omphalomesenteric duct can be approached through umbilical exploration with laparoscopic assistance if needed to reduce wrapped bowel" — Kenneth Azarow (clinical) [Ep 30 · 26:56](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1616)
- "Epigastric hernias (epiploceles) are purely elective repairs, will not cause intestinal obstruction, and are always preperitoneal fat through a pinhole defect" — Kenneth Azarow (clinical) [Ep 30 · 28:20](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1700)
- "PHIS hospital data shows the mean age of umbilical hernia repair nationally is 4 years" — Todd Ponsky (epidemiological) [Ep 30 · 29:22](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1762)
- "The Van Haal et al. study included 79 patients who had rigid tracheobronchoscopy done before and after esophageal atresia surgery" — Lizzie Lee (clinical) [Ep 69 · 1:04](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=64)
- "Pre-operative tracheobronchoscopy for the presence of post-operative tracheomalacia had a sensitivity of 50% and a specificity of 67%" — Lizzie Lee (clinical) [Ep 69 · 1:24](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=84)
- "Pre-operative tracheobronchoscopy has limited predictive value for post-operative tracheomalacia despite being routine" — Lizzie Lee (clinical) [Ep 69 · 1:34](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=94)
- "The Mina et al. study was a retrospective review of patients who underwent conservative management of modified Bell stage 2A or greater NEC from 2011 to 2022" — Alex Halpern (clinical) [Ep 69 · 2:05](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=125)
- "126 patients underwent conservative management of NEC in the study period" — Alex Halpern (epidemiological) [Ep 69 · 2:20](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=140)
- "24 of 126 conservatively managed NEC patients eventually underwent surgery for a post-NEC stricture" — Alex Halpern (clinical) [Ep 69 · 2:20](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=140)
- "Primary resection and anastomosis was performed in all post-NEC stricture cases" — Alex Halpern (clinical) [Ep 69 · 2:29](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=149)
- "Post-NEC strictures are a common occurrence after conservative management of NEC" — Alex Halpern (clinical) [Ep 69 · 2:33](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=153)
- "The Huncheid et al. study was a multi-center non-inferiority trial comparing preterm infants treated with expectant management versus early ibuprofen for PDA" — Cecilia Gigena (clinical) [Ep 69 · 3:04](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=184)
- "The PDA trial included 273 infants total, with 136 in expectant management and 137 in early ibuprofen groups" — Cecilia Gigena (epidemiological) [Ep 69 · 3:14](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=194)
- "In the expectant management group for PDA, 17.6% developed necrotizing enterocolitis" — Cecilia Gigena (clinical) [Ep 69 · 3:24](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=204)
- "In the expectant management group for PDA, 33% developed bronchopulmonary dysplasia" — Cecilia Gigena (clinical) [Ep 69 · 3:24](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=204)
- "In the expectant management group for PDA, 14% died" — Cecilia Gigena (clinical) [Ep 69 · 3:24](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=204)
- "In the ibuprofen group for PDA, 15.4% developed necrotizing enterocolitis" — Cecilia Gigena (clinical) [Ep 69 · 3:36](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=216)
- "In the ibuprofen group for PDA, 50% developed bronchopulmonary dysplasia" — Cecilia Gigena (clinical) [Ep 69 · 3:36](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=216)
- "In the ibuprofen group for PDA, 80% died" — Cecilia Gigena (clinical) [Ep 69 · 3:36](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=216)
- "Expectant management is non-inferior to early ibuprofen in preterm patients with PDA" — Cecilia Gigena (clinical) [Ep 69 · 3:53](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=233)
- "The study was carried out by Hospital Infantil de Mexico Federico Gomez with Christian Zayas Vidal as first author and Jamie Nietos Armenio as senior author" — Alex (clinical) [Ep 7 · 0:14](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=14)
- "In Latin American countries, mortality from gastroschisis can exceed 15%" — Alex (epidemiological) [Ep 7 · 0:23](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=23)
- "The study compared outcomes in the first 42 patients treated after protocol implementation to the last 42 patients treated before the protocol" — Alex (clinical) [Ep 7 · 0:41](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=41)
- "Prior to the protocol, pre-transfer communication was incredibly limited" — Alex (clinical) [Ep 7 · 0:50](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=50)
- "After protocol implementation, the accepting hospital was in much closer communication" — Alex (clinical) [Ep 7 · 0:55](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=55)
- "Prior to the protocol, every patient got a central line" — Alex (clinical) [Ep 7 · 0:59](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=59)
- "After the protocol, every patient had a PICC line" — Alex (clinical) [Ep 7 · 1:03](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=63)
- "Prior to the protocol, all patients were taken to the operating room for primary reduction after extension of the defect" — Alex (clinical) [Ep 7 · 1:06](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=66)
- "Pre-protocol OR approach was limited by OR availability and required general anesthesia" — Alex (clinical) [Ep 7 · 1:06](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=66)
- "After the protocol, bedside reduction was attempted in most patients" — Alex (clinical) [Ep 7 · 1:19](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=79)
- "Prior to the protocol, all patients were mechanically ventilated and paralyzed" — Alex (clinical) [Ep 7 · 1:22](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=82)
- "Prior to the protocol, feeding advancement was totally at the discretion of the surgeon" — Alex (clinical) [Ep 7 · 1:22](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=82)
- "After the protocol, only patients with respiratory distress were intubated" — Alex (clinical) [Ep 7 · 1:31](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=91)
- "After the protocol, no patients were paralyzed" — Alex (clinical) [Ep 7 · 1:35](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=95)
- "After the protocol, the authors followed a regimented feeding advancement schedule" — Alex (clinical) [Ep 7 · 1:35](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=95)
- "The protocol resulted in shorter time to arrival at the accepting hospital" — Alex (clinical) [Ep 7 · 1:42](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=102)
- "The protocol resulted in less general anesthesia use" — Alex (clinical) [Ep 7 · 1:45](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "The protocol resulted in fewer central lines placed" — Alex (clinical) [Ep 7 · 1:45](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "The protocol resulted in fewer patients who needed to be intubated" — Alex (clinical) [Ep 7 · 1:45](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "The protocol resulted in less time on the ventilator for those who were intubated" — Alex (clinical) [Ep 7 · 1:45](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "Mortality rate was reduced from 22% to 2% after protocol implementation" — Alex (clinical) [Ep 7 · 1:53](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=113)
- "The institution had a 22% mortality with gastroschisis before the protocol, which was higher than most" (epidemiological) [Ep 7 · 2:11](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=131)
- "Moving from surgical central lines to PICC lines reduced mortality" (clinical) [Ep 7 · 2:27](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=147)
- "Bedside reduction with silo was performed instead of mandated operating room repair" (clinical) [Ep 7 · 2:34](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=154)
- "Bedside reduction was performed without intubation when possible" (clinical) [Ep 7 · 2:59](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=179)
- "In malrotation with volvulus, you either operate or you get a new job" (opinion) [Ep 8 · 0:16](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879?t=16)
- "Right atrial isomerism has a higher incidence of malrotation compared to left atrial isomerism" (epidemiological) [Ep 8 · 2:44](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879?t=164)
- "In right atrial isomerism, children with malrotation are at higher risk for volvulus" (clinical) [Ep 8 · 3:26](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879?t=206)
- "Only one patient with left atrial isomerism had any real issues and it was not a true volvulus" (clinical) [Ep 8 · 3:43](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879?t=223)
- "Failure to thrive should be considered a GI symptom that may warrant intervention in malrotation" (opinion) [Ep 8 · 4:17](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879?t=257)
- "Texas Children's study of 95 consecutive heterotaxy patients with malrotation: three quarters underwent Ladd procedure, none volvulized post-op, but 11% had small bowel obstruction requiring admission and often surgery" (clinical) [Ep 8 · 4:47](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879?t=287)
- "In the Texas Children's study, 25% of heterotaxy patients were observed with no small bowel obstruction and no volvulus at 10-15 year follow-up" (clinical) [Ep 8 · 5:10](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879?t=310)
- "Appendectomy carries a slight complication risk from adhesions causing long-term obstruction" (clinical) [Ep 8 · 5:46](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879?t=346)
- "In situs inversus with malrotation, the appendix is in the correct location (double negative)" (clinical) [Ep 8 · 5:58](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879?t=358)
- "Symptomatic malrotation requiring operation includes significant pain, vomiting (possibly bilious), and bloody stools" (clinical) [Ep 8 · 6:43](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879?t=403)
- "The most common presentation of heterotaxy with malrotation is minimal symptoms: reflux, spitting up, and failure to thrive" (clinical) [Ep 8 · 6:55](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879?t=415)
- "Low-lying ligament of Treitz defines malrotation, not something crossing the midline, because crossing midline can occur with a floppy duodenum and does not exclude malrotation" (clinical) [Ep 8 · 7:46](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879?t=466)
- "A patient with low-lying ligament of Treitz who was observed subsequently presented with volvulus" (clinical) [Ep 8 · 8:36](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879?t=516)
- "The study was a multi-center non-inferiority trial comparing preterm infants treated with expectant management versus early ibuprofen for PDA" — Cecilia Gigena (clinical) [Ep 53 · 0:09](https://library.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=9)
- "The trial enrolled 273 infants total" — Cecilia Gigena (epidemiological) [Ep 53 · 0:22](https://library.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=22)
- "136 infants were treated with expectant management and 137 with early ibuprofen" — Cecilia Gigena (epidemiological) [Ep 53 · 0:25](https://library.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=25)
- "In the expectant management group, 17.6% developed necrotizing enterocolitis" — Cecilia Gigena (clinical) [Ep 53 · 0:31](https://library.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=31)
- "In the expectant management group, 33% developed bronchopulmonary dysplasia" — Cecilia Gigena (clinical) [Ep 53 · 0:31](https://library.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=31)
- "In the expectant management group, the death rate was 14%" — Cecilia Gigena (clinical) [Ep 53 · 0:31](https://library.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=31)
- "In the ibuprofen group, 15.4% developed necrotizing enterocolitis" — Cecilia Gigena (clinical) [Ep 53 · 0:43](https://library.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=43)
- "In the ibuprofen group, 50% developed bronchopulmonary dysplasia" — Cecilia Gigena (clinical) [Ep 53 · 0:43](https://library.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=43)
- "In the ibuprofen group, the death rate was 80%" — Cecilia Gigena (clinical) [Ep 53 · 0:43](https://library.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=43)
- "Expectant management is not inferior to early ibuprofen in preterm patients with PDA" — Cecilia Gigena (clinical) [Ep 53 · 1:01](https://library.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=61)
- "Bowel ultrasound is becoming an important tool for diagnosing necrotizing enterocolitis" — Lizzie Lee (clinical) [Ep 74 · 0:08](https://library.globalcastmd.com/watch/availability-utilization-and-barriers-to-bowel-ultrasound-for-necrotizing-enterocolitis-13575?t=8)
- "A national survey included more than 100 neonatologists, surgeons, and radiologists from 42 children's hospitals" — Lizzie Lee (epidemiological) [Ep 74 · 0:19](https://library.globalcastmd.com/watch/availability-utilization-and-barriers-to-bowel-ultrasound-for-necrotizing-enterocolitis-13575?t=19)
- "Bowel ultrasound was available in 83% of level 4 NICUs" — Lizzie Lee (epidemiological) [Ep 74 · 0:26](https://library.globalcastmd.com/watch/availability-utilization-and-barriers-to-bowel-ultrasound-for-necrotizing-enterocolitis-13575?t=26)
- "Clinicians reported using bowel ultrasound inconsistently, most often only when X-rays were inconclusive" — Lizzie Lee (clinical) [Ep 74 · 0:26](https://library.globalcastmd.com/watch/availability-utilization-and-barriers-to-bowel-ultrasound-for-necrotizing-enterocolitis-13575?t=26)
- "The biggest barriers to bowel ultrasound adoption were lack of standardized protocols, limited provider training, and uncertainty about how bowel ultrasound should guide treatment decisions" — Lizzie Lee (clinical) [Ep 74 · 0:36](https://library.globalcastmd.com/watch/availability-utilization-and-barriers-to-bowel-ultrasound-for-necrotizing-enterocolitis-13575?t=36)
- "Wider adoption of bowel ultrasound for NEC will depend on better evidence, standardized guidelines, and improved clinician training" — Lizzie Lee (opinion) [Ep 74 · 0:46](https://library.globalcastmd.com/watch/availability-utilization-and-barriers-to-bowel-ultrasound-for-necrotizing-enterocolitis-13575?t=46)
- "Abdominal X-rays in NEC have high specificity but very low sensitivity, with studies showing sensitivity between 13 and 25%" — Augusto Zani (clinical) [Ep 75 · 1:56](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=116)
- "For every 10 babies with surgical NEC, an X-ray might only catch one or two in the early stages" — Lizzie Lee (clinical) [Ep 75 · 2:06](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=126)
- "A 2023 study in Pediatric Radiology suggests ultrasound can detect bowel wall thinning, perfusion abnormalities, and fluid collections that X-ray misses" — Lizzie Lee (clinical) [Ep 75 · 2:15](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=135)
- "Ultrasound can assess bowel wall thickening, thinning, perfusion, peristalsis, peritoneal findings, and liver involvement" — Augusto Zani (clinical) [Ep 75 · 2:30](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=150)
- "High-risk ultrasound findings include pneumoperitoneum, fluid collections, and complex fluid, which are more concerning for bowel perforation" — Augusto Zani (clinical) [Ep 75 · 2:59](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=179)
- "Intermediate-risk ultrasound findings include increased bowel wall ecogenicity, absent perfusion, portal venous gas, and bowel thinning and thickening" — Augusto Zani (clinical) [Ep 75 · 3:07](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=187)
- "The majority of surgeons would perform laparotomy rather than drain placement for NEC with free air" — Augusto Zani (opinion) [Ep 75 · 3:56](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=236)
- "Babies are sick post-operatively whether you do anastomosis or not" — Todd Ponsky (clinical) [Ep 75 · 4:19](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=259)
- "Bowel necrosis is a symptom or result of the illness, not the cause of the illness" — Todd Ponsky (clinical) [Ep 75 · 4:28](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=268)
- "The disease still progresses even after resection, which is the problem of going too early" — Todd Ponsky (clinical) [Ep 75 · 4:34](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=274)
- "In stable babies where you remove a segment (e.g., 10 centimeters) for source control, they do not necessarily do poorly" — Augusto Zani (clinical) [Ep 75 · 4:48](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=288)
- "In the long run there is a benefit to primary anastomosis, though you might not see the benefit with immediate survival" — Lizzie Lee (clinical) [Ep 75 · 5:00](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=300)
- "The data shows primary anastomosis is better if the baby is well" — Todd Ponsky (clinical) [Ep 75 · 5:06](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=306)
- "Doing a stoma or clip-and-drop may result in babies not doing as well as primary anastomosis" — Todd Ponsky (opinion) [Ep 75 · 5:08](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=308)
- "The clip-and-drop method involves removing necrotic segment, stapling ends, and returning in 24-48 hours to check gut hemodynamics before committing to stoma or anastomosis" — Lizzie Lee (clinical) [Ep 75 · 5:18](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=318)
- "Current practice favors clip-and-drop with return at 24-48 hours rather than immediate stoma creation" — Todd Ponsky (opinion) [Ep 75 · 5:31](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=331)
- "Decision to proceed with anastomosis depends on hemodynamics including lactate correction, thrombocytopenia correction, and weaning off inotropes" — Todd Ponsky (clinical) [Ep 75 · 5:45](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=345)
- "The SAT trial was a randomized controlled trial with final eligibility decision dependent on surgeon's judgment during laparotomy" — Simon Eaton (clinical) [Ep 75 · 6:19](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=379)
- "In the SAT trial, randomization occurred intraoperatively after determining hemodynamic stability, requiring the surgeon to scrub out and use a computer" — Augusto Zani (clinical) [Ep 75 · 6:34](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=394)
- "Fellows initially had concerns about performing anastomosis in 500-gram infants but became strong believers after seeing post-operative progression" — Augusto Zani (opinion) [Ep 75 · 6:42](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=402)
- "In the SAT trial, mortality was similar in both groups (anastomosis vs stoma)" — Lizzie Lee (clinical) [Ep 75 · 6:55](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=415)
- "Babies who received primary anastomosis got off parenteral nutrition significantly sooner than those with stoma" — Lizzie Lee (clinical) [Ep 75 · 6:56](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=416)
- "Babies with primary anastomosis were able to return to enteral feeds more quickly and had fewer intestinal complications than those with stoma" — Lizzie Lee (clinical) [Ep 75 · 7:06](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=426)
- "Mucous fistula refeeding involves recycling upper stoma output into the lower bowel to keep it healthy" — Lizzie Lee (clinical) [Ep 75 · 7:52](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=472)
- "Mucous fistula refeeding is a practice many clinicians support, although formal evidence is still catching up" — Lizzie Lee (opinion) [Ep 75 · 7:59](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=479)
- "A systematic review and meta-analysis on mucous fistula refeeding by Bonnie Jasani from Toronto Sick Kids shows the evidence isn't strong so far" — Simon Eaton (clinical) [Ep 75 · 8:10](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=490)
- "There is an ongoing randomized controlled trial of mucous fistula refeeding studying time to full enteral feeds" — Simon Eaton (clinical) [Ep 75 · 8:21](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=501)
- "Historically, surgeons waited months for stoma closure, but the tide is turning toward earlier intervention, sometimes when the patient is less than 8 weeks old" — Lizzie Lee (clinical) [Ep 75 · 8:33](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=513)
- "A recent paper in Journal of Surgical Research shows it seems to be safe to close stoma early" — Simon Eaton (clinical) [Ep 75 · 8:41](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=521)
- "The early stoma closure study is very underpowered" — Simon Eaton (clinical) [Ep 75 · 8:54](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=534)
- "In the early closure group (less than 8 weeks), there were 2 infants that had a repeat episode of NEC" — Simon Eaton (clinical) [Ep 75 · 8:56](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=536)
- "There is ongoing preparation for a randomized trial on stoma closure timing in the UK called the SKIN mixed methods study" — Simon Eaton (clinical) [Ep 75 · 9:06](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=546)
- "Surgeons need to be prepared to have some negative laparotomies when operating based on clinical suspicion and ultrasound findings" — Augusto Zani (opinion) [Ep 75 · 9:45](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=585)
- "If there is turbid free fluid on ultrasound, there is something going on even if not visible on X-ray" — Augusto Zani (clinical) [Ep 75 · 9:48](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=588)
- "McMaster University performed a retrospective review of infants born between 2014 and 2022 with uncomplicated gastroschisis" — Alex Halpern (epidemiological) [Ep 55 · 0:13](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=13)
- "Infants with exclusive breast milk intake and those with supplemental or exclusive formula intake had similar outcomes" — Alex Halpern (clinical) [Ep 55 · 0:24](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "No significant differences were found between feeding groups in time to reach full enteral feeds" — Alex Halpern (clinical) [Ep 55 · 0:24](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "No significant differences were found between feeding groups in duration of parenteral nutrition" — Alex Halpern (clinical) [Ep 55 · 0:24](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "No significant differences were found between feeding groups in rates of necrotizing enterocolitis" — Alex Halpern (clinical) [Ep 55 · 0:24](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "No significant differences were found between feeding groups in length of hospital stay" — Alex Halpern (clinical) [Ep 55 · 0:24](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "Formula intake versus exclusive breast milk intake does not affect outcomes in uncomplicated gastroschisis" — Alex Halpern (opinion) [Ep 55 · 0:44](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=44)
- "85% of Hirschsprung disease patients in the study were diagnosed at less than 1 year of age" — Em Gootee (epidemiological) [Ep 57 · 3:20](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=200)
- "Kids with shorter segment Hirschsprung disease (rectosigmoid or small portion of aganglionic bowel) were more likely to be diagnosed at a later age" — Em Gootee (clinical) [Ep 57 · 3:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=225)
- "Children with long segment Hirschsprung disease typically presented at birth with classic symptoms such as failure to pass meconium" — Em Gootee (clinical) [Ep 57 · 3:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=237)
- "Delayed diagnosis of Hirschsprung disease does not impact postoperative outcomes nor the need for revision surgery of the pull-through" — Colin Martin (clinical) [Ep 57 · 4:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=252)
- "Delayed diagnosis is associated with increased need for fecal diversion after pull-through" — Colin Martin (clinical) [Ep 57 · 4:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=252)
- "Approximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through" — Em Gootee (epidemiological) [Ep 57 · 4:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=266)
- "There was no difference in overall rates of redo pull-throughs across age groups" — Em Gootee (clinical) [Ep 57 · 5:01](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=301)
- "Older children were more likely to need a redo pull-through due to an anastomotic leak" — Em Gootee (clinical) [Ep 57 · 5:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=307)
- "Higher rates of diverting ostomy post pull-through were likely a treatment for a post pull-through leak or anastomotic leak" — Em Gootee (clinical) [Ep 57 · 5:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=313)
- "The only functional outcome that was different was nighttime soiling or incontinence in the older patient population" — Em Gootee (clinical) [Ep 57 · 5:24](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=324)
- "Neonates with gastroschisis consume a disproportionate amount of resources compared to other children in the NICU" — Mark Slidell (epidemiological) [Ep 57 · 7:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=463)
- "The gastroschisis systematic review included 28 high quality manuscripts" — Em Gootee (clinical) [Ep 57 · 8:09](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=489)
- "Two randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered" — Em Gootee (clinical) [Ep 57 · 8:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=495)
- "There is no evidence to suggest that earlier delivery prior to 37 weeks for gastroschisis is justified" — Casey Culkins (clinical) [Ep 57 · 9:39](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=579)
- "Planned delivery before 37 weeks gestational age for gastroschisis is probably not beneficial and may in fact be harmful" — Mark Slidell (clinical) [Ep 57 · 9:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=596)
- "Early delivery may promote some of the complications of prematurity" — Mark Slidell (clinical) [Ep 57 · 10:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=604)
- "Delivery of infants with gastroschisis after 37 weeks post-conception seems to be preferable" — Mark Slidell (clinical) [Ep 57 · 10:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=604)
- "Skin organisms are most commonly identified in infections among infants with gastroschisis" — Em Gootee (clinical) [Ep 57 · 10:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=637)
- "Gastroschisis infants have a fairly high rate of wound infection" — Em Gootee (epidemiological) [Ep 57 · 10:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=644)
- "Silo closures have a higher rate of infection than other closure methods" — Em Gootee (clinical) [Ep 57 · 10:50](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=650)
- "Sutureless closure has the lowest rate of infection in gastroschisis" — Em Gootee (clinical) [Ep 57 · 10:50](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=650)
- "Recommendation is to provide antibiotic coverage for skin flora until the gastroschisis defect is closed and potentially for an additional 24 hours thereafter" — Em Gootee (guideline) [Ep 57 · 10:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=657)
- "Once the gastroschisis defect is closed, antibiotics can be safely stopped unless there is some other reason to continue" — Casey Culkins (guideline) [Ep 57 · 11:11](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=671)
- "Stable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes" — Em Gootee (clinical) [Ep 57 · 12:22](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=742)
- "Minimizing fluids and paralytics in gastroschisis infants improves their results" — Em Gootee (clinical) [Ep 57 · 12:29](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=749)
- "Sutureless repair for gastroschisis is associated with a clear decrease in the need for mechanical ventilation" — Casey Culkins (clinical) [Ep 57 · 13:05](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=785)
- "The literature on gastroschisis suffers from a lack of level 1 randomized controlled trials or high level comparative studies" — Mark Slidell (opinion) [Ep 57 · 13:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=797)
- "The Clavien-Madadi classification showed improved agreement rates of respondents at 85% versus 76% for the Clavien-Dindo classification" — Whit Holcomb (clinical) [Ep 57 · 16:39](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=999)
- "The Clavien-Madadi classification was less frequently considered inaccurate for rating in the pediatric population compared to the Clavien-Dindo classification" — Whit Holcomb (clinical) [Ep 57 · 16:53](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=1013)
- "43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification" — Em Gootee (epidemiological) [Ep 57 · 17:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=1024)
- "Advantages of the Clavien-Madadi classification were affirmed by nearly 82% of the surgeons" — Em Gootee (epidemiological) [Ep 57 · 17:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=1036)
- "The ABSA Outcomes and Evidence-based Practice Committee performed a systematic review on optimal initial management of infants with gastroschisis." — Alex Halpern (guideline) [Ep 60 · 0:10](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=10)
- "Delivery after 37 weeks is optimal for infants with gastroschisis." — Alex Halpern (guideline) [Ep 60 · 0:17](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=17)
- "Prophylactic antibiotics covering skin flora are adequate to reduce infection risk until closure in gastroschisis." — Alex Halpern (guideline) [Ep 60 · 0:21](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=21)
- "Studies support primary fascial repair for gastroschisis as long as hemodynamics and abdominal domain permit." — Alex Halpern (guideline) [Ep 60 · 0:27](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=27)
- "Sutureless repair for gastroschisis is safe and effective." — Alex Halpern (clinical) [Ep 60 · 0:27](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=27)
- "Sutureless repair does not delay feeding or increase length of stay in gastroschisis patients." — Alex Halpern (clinical) [Ep 60 · 0:37](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=37)
- "There is a need for high quality randomized controlled trials to provide evidence-based care for infants with gastroschisis." — Alex Halpern (opinion) [Ep 60 · 0:41](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=41)
- "The umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly" — Em Gootee (clinical) [Ep 59 · 0:34](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=34)
- "Umbilical cords usually fall off at 2 to 3 weeks" — Em Gootee (clinical) [Ep 59 · 0:50](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=50)
- "Delayed umbilical cord separation can be a manifestation of immune deficiency" — Em Gootee (clinical) [Ep 59 · 0:50](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=50)
- "Omphalitis is bacterial colonization of the umbilical stump" — Rebecca Brown (clinical) [Ep 59 · 1:12](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=72)
- "Omphalitis is most commonly due to staph and strep from skin flora" — Em Gootee (clinical) [Ep 59 · 1:16](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=76)
- "Mild omphalitis cases may be treated with alcohol, drying, ampicillin, or amoxicillin with follow-up every 24 hours" — Em Gootee (clinical) [Ep 59 · 1:20](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=80)
- "Advanced omphalitis cases require hospital admission and pediatric surgery consultation" — Rebecca Brown (clinical) [Ep 59 · 1:30](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=90)
- "16% of patients admitted with omphalitis develop necrotizing fasciitis" — Em Gootee (epidemiological) [Ep 59 · 1:40](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=100)
- "Umbilical hernias are more common in African Americans, low birth weight infants, and premature infants" — Rebecca Brown (epidemiological) [Ep 59 · 2:17](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=137)
- "Umbilical hernias can be associated with trisomy 13, 18, and 21" — Em Gootee (clinical) [Ep 59 · 2:27](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=147)
- "Most umbilical hernias heal by the time the child is 3 to 5 years old" — Em Gootee (clinical) [Ep 59 · 2:38](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=158)
- "If the fascial opening is larger than 1.5 centimeters, the hernia may not close by itself" — Em Gootee (clinical) [Ep 59 · 2:47](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=167)
- "In Walker's study, 96% of umbilical hernias less than 0.5 centimeters closed by six years, but no hernia greater than 1.5 centimeters closed by six years" — Em Gootee (epidemiological) [Ep 59 · 2:55](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=175)
- "Incarceration with umbilical hernias is rare, less than 0.2%, and more common with smaller defects" — Rebecca Brown (epidemiological) [Ep 59 · 3:21](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=201)
- "In a study of 308 umbilical hernia repairs by Tiffany Zinz, there was higher incidence of complications if patients were less than 4 years of age versus greater than 4 years" — Rebecca Brown (epidemiological) [Ep 59 · 3:42](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=222)
- "For asymptomatic umbilical hernias in children around 4 years old, that is when surgery should be considered" — Em Gootee (guideline) [Ep 59 · 4:20](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=260)
- "Early surgical repair before age 4 was not indicated regardless of the size of the defect" — Rebecca Brown (guideline) [Ep 59 · 4:26](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=266)
- "In a 2020 study of 9,809 patients, the 3-year recurrence rate for umbilical hernia repair was twice as high in children less than 4 years versus greater than 4 years" — Rebecca Brown (epidemiological) [Ep 59 · 4:40](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=280)
- "Unplanned emergency department returns within 30 days occurred at 2.5% and were twice as high for patients younger than 4 years old" — Em Gootee (epidemiological) [Ep 59 · 4:54](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=294)
- "Asymptomatic umbilical hernia repair should be delayed until greater than 4 years of age" — Em Gootee (guideline) [Ep 59 · 5:10](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=310)
- "In Rangel's study of 167,000 patients, 4,486 had umbilical hernia diagnosis at median age of 1.6 months" — Em Gootee (epidemiological) [Ep 59 · 5:18](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=318)
- "Spontaneous closure of umbilical hernias occurred in 89% by age 5" — Em Gootee (epidemiological) [Ep 59 · 5:53](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=353)
- "Closure rates for smaller hernias (less than 1 cm) were nearly 90%, while for larger hernias they were around 80%" — Em Gootee (epidemiological) [Ep 59 · 5:53](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=353)
- "If umbilical hernia was persistent at age 3, spontaneous closure was 20% by 4 years and 35% by 5 years" — Rebecca Brown (epidemiological) [Ep 59 · 6:03](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=363)
- "Umbilical hernia repair should be delayed until age 5 years based on high spontaneous closure rates" — Em Gootee (guideline) [Ep 59 · 6:12](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=372)
- "A large hernia may have a very small defect, and those seen early are more likely to close" — Rebecca Brown (opinion) [Ep 59 · 6:22](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=382)
- "If a hernia has a huge defect and is proboscoid, it is probably not going to close" — Rebecca Brown (opinion) [Ep 59 · 6:34](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=394)
- "Indications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and large proboscoid hernias in children about to start school" — Rebecca Brown (guideline) [Ep 59 · 6:43](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=403)
- "Proboscoid hernia should be corrected before school age to avoid psychological issues" — Em Gootee (guideline) [Ep 59 · 7:00](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=420)
- "General guideline is 5 years regardless of size; if it hasn't closed, fix it; until then leave it alone unless symptomatic" — Rebecca Brown (guideline) [Ep 59 · 7:11](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=431)
- "Umbilical hernia repair involves interrupted closure using vicryl or absorbable suture" — Em Gootee (clinical) [Ep 59 · 7:22](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=442)
- "Umbilical granulomas are the most common umbilical masses of a newborn" — Rebecca Brown (epidemiological) [Ep 59 · 8:52](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=532)
- "Umbilical granulomas are usually moist but commonly dry up and fall off spontaneously over time" — Em Gootee (clinical) [Ep 59 · 8:55](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=535)
- "Umbilical granulomas often respond to silver nitrate treatment" — Em Gootee (clinical) [Ep 59 · 9:00](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=540)
- "Silver nitrate application can cause burnt skin around the belly button if not properly applied" — Em Gootee (clinical) [Ep 59 · 9:07](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=547)
- "Applying water after silver nitrate application helps neutralize the burn and prevent it from spreading" — Rebecca Brown (clinical) [Ep 59 · 9:17](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=557)
- "Bright red, pedunculated umbilical granulomas that bleed easily are more difficult to manage" — Em Gootee (clinical) [Ep 59 · 9:37](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=577)
- "A large multi-center study compared silo versus immediate closure for gastroschisis" (clinical) [Ep 17 · 0:06](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=6)
- "Hawkins et al. published the study in the August issue of GPS" (clinical) [Ep 17 · 0:13](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=13)
- "The study showed no difference between silo and immediate closure for gastroschisis" (clinical) [Ep 17 · 0:13](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=13)
- "The study examined mortality, sepsis, readmission rate, and time to full feeds as outcomes" (clinical) [Ep 17 · 0:18](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "No difference was found in mortality between silo and immediate closure" (clinical) [Ep 17 · 0:18](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "No difference was found in sepsis rates between silo and immediate closure" (clinical) [Ep 17 · 0:18](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "No difference was found in readmission rates between silo and immediate closure" (clinical) [Ep 17 · 0:18](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "No difference was found in time to full feeds between silo and immediate closure" (clinical) [Ep 17 · 0:18](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "Either silo or immediate closure is an acceptable choice for gastroschisis management" (opinion) [Ep 17 · 0:24](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=24)
- "Pyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy" — Bargave Muliudi (clinical) [Ep 21 · 0:31](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=31)
- "Pyloric stenosis leads to gastric outlet obstruction in infants between 2 to 10 weeks of age" — Bargave Muliudi (clinical) [Ep 21 · 0:37](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=37)
- "Pyloric stenosis is more common in males" — Bargave Muliudi (epidemiological) [Ep 21 · 0:46](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=46)
- "There is increased risk for first born infants with a positive family history" — Bargave Muliudi (epidemiological) [Ep 21 · 0:49](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=49)
- "Infants with pyloric stenosis are otherwise well appearing and hungry after vomiting" — Bargave Muliudi (clinical) [Ep 21 · 1:12](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=72)
- "Emesis will progress until it is projectile" — Bargave Muliudi (clinical) [Ep 21 · 1:16](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=76)
- "Hyperbilirubinemia can occur in up to 14% of patients due to downregulation of hepatic enzymes associated with starvation" — Bargave Muliudi (clinical) [Ep 21 · 1:24](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=84)
- "Bilious emesis should always be worked up to rule out intestinal malrotation with midgut volvulus" — Bargave Muliudi (guideline) [Ep 21 · 2:00](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=120)
- "Ultrasound is the gold standard for diagnosing pyloric stenosis" — Bargave Muliudi (guideline) [Ep 21 · 2:50](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=170)
- "Pyloric thickness of 3 millimeters and length of 14 millimeters or above is diagnostic on ultrasound" — Bargave Muliudi (clinical) [Ep 21 · 2:55](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=175)
- "The classic electrolyte abnormality is a hypochloremic, hypokalemic, metabolic alkalosis" — Bargave Muliudi (clinical) [Ep 21 · 3:19](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=199)
- "Prolonged gastric outlet obstruction leads to persistent vomiting and loss of hydrochloric acid, which leads to hypochloremia and metabolic alkalosis" — Bargave Muliudi (clinical) [Ep 21 · 3:29](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=209)
- "The kidneys increase sodium potassium pump activity to retain fluid, leading to urinary excretion of potassium and hypokalemia" — Bargave Muliudi (clinical) [Ep 21 · 3:41](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=221)
- "Excretion of protons leads to paradoxical aciduria, which further worsens metabolic alkalosis" — Bargave Muliudi (clinical) [Ep 21 · 3:56](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=236)
- "In the US, pyloromyotomy is the standard of care" — Bargave Muliudi (guideline) [Ep 21 · 4:17](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=257)
- "In some countries, atropine is used as a non-surgical option, with a success rate of about 60 to 90%" — Bargave Muliudi (clinical) [Ep 21 · 4:22](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=262)
- "Prior to going to the operating room, serum chloride must be corrected to greater than 100 and bicarbonate to less than 30" — Bargave Muliudi (guideline) [Ep 21 · 5:48](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=348)
- "The distal extent of myotomy is generally to the crossing vein of Mayo or the white line, which marks the pyloroduodenal junction" — Bargave Muliudi (clinical) [Ep 21 · 7:07](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=427)
- "After pyloromyotomy is completed, the submucosa should bulge into the myotomy site and each side of the pylorus should move independently" — Bargave Muliudi (clinical) [Ep 21 · 8:18](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=498)
- "Complications include incomplete myotomy, mucosal perforation, aspiration, wound infection, and incisional hernias" — Bargave Muliudi (clinical) [Ep 21 · 8:42](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=522)
- "There is a slight increased risk of incomplete myotomy and perforation with a laparoscopic approach, but the overall low incidence decreases the clinical significance" — Bargave Muliudi (clinical) [Ep 21 · 8:52](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=532)
- "Most infants can be fed immediately after the operation" — Bargave Muliudi (clinical) [Ep 21 · 10:05](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=605)
- "Evidence supports ad-lib feeds; infants achieve full feeds sooner with no increase in readmission rates" — Bargave Muliudi (clinical) [Ep 21 · 10:13](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=613)
- "Small episodes of emesis are almost to be expected as the stomach recovers from days to weeks of progressive dilation" — Bargave Muliudi (clinical) [Ep 21 · 10:32](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=632)
- "Odds of emesis is slightly higher in early and ad-lib feedings compared to gradual or delayed feedings, but the length of stay for ad-lib feedings is much shorter" — Bargave Muliudi (clinical) [Ep 21 · 10:44](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=644)
- "Gastroschisis is a full thickness abdominal wall defect that typically occurs to the right of the umbilicus" (clinical) [Ep 19 · 0:32](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=32)
- "Gastroschisis has a reported incidence of 1 in 6000 to 1 in 10,000" (epidemiological) [Ep 19 · 0:39](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=39)
- "At UC Irvine's two neonatal intensive care units, they care for 30 to 40 patients per year with gastroschisis" (epidemiological) [Ep 19 · 0:49](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=49)
- "Gastroschisis is second only to inguinal hernias as a congenital anomaly requiring surgical correction at their institution" (epidemiological) [Ep 19 · 0:57](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=57)
- "Traditional staged closure with sutured elastic silo carries risks of silo disruption, fascial dehiscence, and infectious complications" (clinical) [Ep 19 · 1:11](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=71)
- "The spring-loaded silo allows for fast, pain-free, sutureless silo placement without need for a formal operation" (clinical) [Ep 19 · 1:27](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=87)
- "Dr. James Fisher and colleagues from Loma Linda University were the first to publish a series of patients undergoing routine bedside silo placement" (clinical) [Ep 19 · 2:08](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=128)
- "A prospective randomized study comparing primary to staged closure of gastroschisis is in progress but results are not yet available" (clinical) [Ep 19 · 2:33](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=153)
- "Several retrospective studies from large US centers reported favorable results with spring-loaded silo staged closure compared to primary closure controls" (clinical) [Ep 19 · 2:43](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=163)
- "Advantages of routine silo placement with delayed closure include decreased airway pressures, earlier extubation, decreased incidence of necrotizing enterocolitis, decreased infectious complications, more rapid return of bowel function, decreased length of stay, and decreased hospital charges" (clinical) [Ep 19 · 2:57](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=177)
- "Most babies with gastroschisis are delivered vaginally after spontaneous onset of labor; routine cesarean section is not performed nor is early labor induced" (clinical) [Ep 19 · 4:30](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=270)
- "The Bentek silo is available in 7 sizes from 3 centimeters to 15 centimeters diameter" (clinical) [Ep 19 · 5:20](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=320)
- "A ring that is 2 centimeters larger than the diameter of the defect is typically chosen" (clinical) [Ep 19 · 5:37](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=337)
- "Most gastroschisis defects are 2 to 3 centimeters in diameter, making 4 and 5 centimeter silos the most commonly used" (clinical) [Ep 19 · 5:42](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=342)
- "Gastroschisis cases involving atresia typically contain severely distended bowel and often require a 7.5 centimeter silo" (clinical) [Ep 19 · 5:59](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=359)
- "A distal colon severely distended with meconium is a good indication of the probable absence of a proximal atresia or stenosis" (clinical) [Ep 19 · 6:56](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=416)
- "If an obstruction exists without perforation, their policy is to proceed with silo placement and closure, followed by exploration 4 to 6 weeks later" (clinical) [Ep 19 · 8:09](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=489)
- "Too much traction on the ring will cause abdominal wall congestion and edema, complicating closure later" (clinical) [Ep 19 · 13:02](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=782)
- "Too little traction will allow the ring to exert constant pressure on abdominal contents, most notably the duodenum, with risk of pressure necrosis" (clinical) [Ep 19 · 13:09](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=789)
- "Final closure is performed when the silo contents are within 2 centimeters of the abdominal wall" (clinical) [Ep 19 · 13:20](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=800)
- "Unnecessary prolongation of silo duration has no advantages, may make closure more involved by slowly enlarging the defect, and may increase infectious and other potential complications" (clinical) [Ep 19 · 13:34](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=814)
- "The silo essentially creates a closed system by completely containing the bowel and peritoneal fluid" (clinical) [Ep 19 · 13:52](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=832)
- "Skin edge bites exactly at the edge are likely to cause skin necrosis and possible wound infection; bites should be approximately 3 millimeters from the skin edge" (clinical) [Ep 19 · 21:07](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1267)
- "The Bentek silo can be used for staged reduction of omphalocele after excision of the sac, with gradual reduction of liver along with bowel" (clinical) [Ep 19 · 25:31](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1531)
- "When a large silo is required for a prolonged period, a few corner stitches between the silo ring and abdominal wall prevent premature dislodgement" (clinical) [Ep 19 · 26:10](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1570)
- "The silo can be used in cases of neonatal abdominal compartment syndrome such as severe diffuse necrotizing enterocolitis" (clinical) [Ep 19 · 26:34](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1594)
- "MMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes" — Em Gootee (clinical) [Ep 56 · 1:25](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=85)
- "MMP-7 plays an important role in tissue repair, arthritis, metastasis, and cirrhosis" — Em Gootee (clinical) [Ep 56 · 1:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=97)
- "Higher levels of MMP-7 are associated with the diagnosis of biliary atresia" — Em Gootee (clinical) [Ep 56 · 1:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=103)
- "Out of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7" — Em Gootee (epidemiological) [Ep 56 · 1:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=116)
- "Low levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT and direct bilirubin" — Em Gootee (clinical) [Ep 56 · 2:36](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=156)
- "GGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain" — Em Gootee (clinical) [Ep 56 · 3:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=182)
- "GGT blood test levels are used to detect diseases of the liver and bile ducts" — Em Gootee (clinical) [Ep 56 · 3:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=192)
- "Biliary atresia patients can have dramatically different outcomes even when they anatomically look like they should behave in a similar fashion" — Em Gootee (clinical) [Ep 56 · 3:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=207)
- "Lower MMP-7 levels within the cohort of biliary atresia patients are associated with worse outcomes" — Em Gootee (clinical) [Ep 56 · 4:09](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=249)
- "The reason why low MMP-7 levels equal the worst prognosis in biliary atresia is unknown" — Em Gootee (clinical) [Ep 56 · 4:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=281)
- "The gastroschisis study included 411 infants treated at CAPSNET centers from 2014 to 2022, with 144 excluded, leaving 267 participants" — Em Gootee (epidemiological) [Ep 56 · 7:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=422)
- "78% of gastroschisis patients received exclusive breast milk in the first 28 days of life, and 22% received supplemental or exclusive formula" — Em Gootee (epidemiological) [Ep 56 · 7:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=463)
- "Patients with gastroschisis who had some exposure to formula in the first 28 days of life did not have increased risk of necrotizing enterocolitis or major differences in reaching full enteral feeds" — Mike Livingston (clinical) [Ep 56 · 8:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=492)
- "There were no significant differences between breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay" — Em Gootee (clinical) [Ep 56 · 8:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=507)
- "Gastroschisis patients exposed to formula seemed to have a slightly faster time getting to full feeds, likely related to timing of closure rather than feeding" — Mike Livingston (clinical) [Ep 56 · 8:34](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=514)
- "Gastroschisis patients who received exclusive breast milk in first 28 days were far more likely to transition to exclusive breastfeeding: 73% compared to 11% in those with formula exposure" — Mike Livingston (clinical) [Ep 56 · 8:53](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=533)
- "The transition systematic review found 8 studies that included patient and parent responses and clinician perspectives" — Whit Holcomb (epidemiological) [Ep 56 · 12:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=766)
- "The transition research included patients between ages 10 to 30 years with anorectal malformation or Hirschsprung disease" — Em Gootee (epidemiological) [Ep 56 · 12:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=775)
- "There is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer (around 25 years)" — Em Gootee (clinical) [Ep 56 · 13:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=796)
- "The life course progression of anorectal malformation and Hirschsprung disease is not well understood" — Em Gootee (clinical) [Ep 56 · 13:30](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=810)
- "Barriers and enablers of successful transition for surgical patients showed agreement with those for medical patients that guidelines were based on" — Sebastian King (clinical) [Ep 56 · 13:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=822)
- "Patients felt clinicians did not always understand the need for transitioning their child's care from pediatric to adult settings, including the reasons, processes, and how to make processes smooth" — Sebastian King (opinion) [Ep 56 · 13:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=822)
- "There was little evidence that transfer of colorectal patients happened in a timely or coordinated manner" — Whit Holcomb (clinical) [Ep 56 · 14:22](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=862)
- "Patients felt clinicians did not always understand the significance of transfer to an adult service" — Whit Holcomb (opinion) [Ep 56 · 14:31](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=871)
- "No models of transfer of care for colorectal conditions were identified" — Whit Holcomb (clinical) [Ep 56 · 14:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=878)
- "Ziegler et al. performed a prospective study in 10 patients with giant omphalocele and 6 with complicated gastroschisis" — Alex Halpern (clinical) [Ep 58 · 0:14](https://library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436?t=14)
- "The study utilized Fascia Tenses Pediatric, a traction-assisted abdominal wall closure device" — Alex Halpern (clinical) [Ep 58 · 0:24](https://library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436?t=24)
- "Complete fascial closure was achieved after a median time of 7 days in children with giant omphalocele" — Alex Halpern (clinical) [Ep 58 · 0:29](https://library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436?t=29)
- "Complete fascial closure was achieved after a median time of 5 days in children with complicated gastroschisis" — Alex Halpern (clinical) [Ep 58 · 0:36](https://library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436?t=36)
- "No patients developed abdominal compartment syndrome" — Alex Halpern (clinical) [Ep 58 · 0:39](https://library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436?t=39)
- "No ventral hernias occurred after a median follow-up of 12 months" — Alex Halpern (clinical) [Ep 58 · 0:39](https://library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436?t=39)
- "Fascia Tenses Pediatric helps facilitate early fascial closure in patients with congenital abdominal wall defects" — Alex Halpern (opinion) [Ep 58 · 0:46](https://library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436?t=46)
- "Connecticut Children's Medical Center implemented an algorithm for managing esophageal button batteries in 2019 that includes activating the critical airway response team" — Eleanor Cisco (clinical) [Ep 61 · 1:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=60)
- "The study compared patients presenting with esophageal button batteries before algorithm implementation (2015-2019) with those after implementation (2019-2022)" — Eleanor Cisco (clinical) [Ep 61 · 1:12](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=72)
- "There was a significant reduction in time from chest X-ray to OR for button battery removal after algorithm implementation" — Eleanor Cisco (clinical) [Ep 61 · 1:25](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=85)
- "The algorithm implementation helped children receive needed care faster for esophageal button batteries" — Eleanor Cisco (opinion) [Ep 61 · 1:34](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=94)
- "McMaster University performed a retrospective review of infants born between 2014 and 2022 with uncomplicated gastroschisis" — Alex Halpern (clinical) [Ep 61 · 2:08](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=128)
- "Infants with exclusive breast milk intake and those with supplemental or exclusive formula intake had similar outcomes in uncomplicated gastroschisis" — Alex Halpern (clinical) [Ep 61 · 2:17](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=137)
- "No significant differences were found between breast milk and formula groups in time to reach full enteral feeds in uncomplicated gastroschisis" — Alex Halpern (clinical) [Ep 61 · 2:17](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=137)
- "No significant differences were found between breast milk and formula groups in duration of parenteral nutrition in uncomplicated gastroschisis" — Alex Halpern (clinical) [Ep 61 · 2:17](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=137)
- "No significant differences were found between breast milk and formula groups in rates of necrotizing enterocolitis in uncomplicated gastroschisis" — Alex Halpern (clinical) [Ep 61 · 2:17](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=137)
- "No significant differences were found between breast milk and formula groups in length of hospital stay in uncomplicated gastroschisis" — Alex Halpern (clinical) [Ep 61 · 2:17](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=137)
- "Formula intake versus exclusive breast milk intake does not affect outcomes in uncomplicated gastroschisis" — Alex Halpern (clinical) [Ep 61 · 2:38](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=158)
- "A retrospective single institution study in Phoenix from 2017 to 2021 examined cryoablation in Nuss procedures" — Cecilia Jenna (clinical) [Ep 61 · 3:08](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=188)
- "The study compared patients undergoing Nuss procedure with cryoanalgesia in the first quarter of experience with the fourth quarter" — Cecilia Jenna (clinical) [Ep 61 · 3:08](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=188)
- "350 patients underwent Nuss procedure with cryoanalgesia in the study period" — Cecilia Jenna (epidemiological) [Ep 61 · 3:27](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=207)
- "Patients in the last quarter were discharged 1.3 days earlier than patients in the first quarter for Nuss procedures with cryoanalgesia" — Cecilia Jenna (clinical) [Ep 61 · 3:32](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=212)
- "Patients in the last quarter required 74% less opioids compared to the first quarter for Nuss procedures with cryoanalgesia" — Cecilia Jenna (clinical) [Ep 61 · 3:32](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=212)
- "Experience plays a role in outcomes for cryoanalgesia in Nuss procedures" — Cecilia Jenna (opinion) [Ep 61 · 3:44](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=224)
- "The study was a retrospective review of all patients who underwent conservative management of modified Bell stage 2A or greater NEC at a single institution from 2011 to 2022." — Alex Halpern (clinical) [Ep 62 · 0:13](https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738?t=13)
- "126 patients underwent conservative management of NEC in the study period." — Alex Halpern (epidemiological) [Ep 62 · 0:27](https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738?t=27)
- "24 of the 126 patients eventually underwent surgery for a post-NEC stricture." — Alex Halpern (clinical) [Ep 62 · 0:27](https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738?t=27)
- "Primary resection and anastomosis was performed in all cases of post-NEC stricture requiring surgery." — Alex Halpern (clinical) [Ep 62 · 0:36](https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738?t=36)
- "Post-NEC strictures are a common occurrence after conservative management of NEC." — Alex Halpern (opinion) [Ep 62 · 0:40](https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738?t=40)
- "Necrotizing enterocolitis is a devastating gastrointestinal disease impacting premature infants whose pathophysiology is driven by complex pathways that are not completely understood" — Colleen Nofi (clinical) [Ep 63 · 0:39](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=39)
- "NEC has limited treatment options and unacceptably high morbidity and mortality risk" — Colleen Nofi (clinical) [Ep 63 · 0:52](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=52)
- "Under biologic conditions, CIRP is found inside the cell where it acts as an RNA chaperone protein" — Colleen Nofi (clinical) [Ep 63 · 1:06](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=66)
- "In states of cellular stress such as sepsis, CIRP escapes outside the cell" — Colleen Nofi (clinical) [Ep 63 · 1:12](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=72)
- "Extracellular CIRP acts as a DAMP by enhancing the release of cytokines and chemokines and amplifying the inflammatory cascade" — Colleen Nofi (clinical) [Ep 63 · 1:19](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=79)
- "MOP3 (MFG-E8 derived oligopeptide 3) is an eCIRP scavenging peptide that removes eCIRP from circulation to reduce inflammation" — Colleen Nofi (clinical) [Ep 63 · 1:33](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=93)
- "CIRP knockout protected pups from NEC severity with preservation of intestinal villi architecture" — Colleen Nofi (clinical) [Ep 63 · 2:30](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=150)
- "CIRP knockout mice subjected to NEC showed reduced intestinal inflammation as measured by mRNA levels of IL-6 and TNF-alpha in the small bowel" — Colleen Nofi (clinical) [Ep 63 · 2:59](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=179)
- "CIRP knockout pups had reduced fluorescence intensity of enterically administered fluorescent dextran in serum, indicating preserved intestinal barrier function" — Colleen Nofi (clinical) [Ep 63 · 3:36](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=216)
- "CIRP knockout pups subjected to NEC had 100% survival compared to 65% survival in wild-type pups under the same model conditions" — Colleen Nofi (clinical) [Ep 63 · 3:57](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=237)
- "MOP3 treatment reduced circulating eCIRP levels in NEC pups compared to vehicle" — Colleen Nofi (clinical) [Ep 63 · 4:18](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=258)
- "Reduction in eCIRP with MOP3 treatment correlated with reduction in systemic inflammatory markers including IL-6 and TNF-alpha" — Colleen Nofi (clinical) [Ep 63 · 4:27](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=267)
- "MOP3 treatment protected against NEC severity with preservation of intestinal villi" — Colleen Nofi (clinical) [Ep 63 · 4:37](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=277)
- "MOP3 treatment reduced intestinal inflammation in NEC as measured by mRNA levels of IL-6 and TNF-alpha" — Colleen Nofi (clinical) [Ep 63 · 4:55](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=295)
- "MOP3 treated pups had significantly reduced fluorescence intensity of enterically administered dextran, indicating protection of intestinal barrier" — Colleen Nofi (clinical) [Ep 63 · 5:05](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=305)
- "Pups treated with MOP3 had 80% survival compared to 50% survival in vehicle-treated pups in the NEC model" — Colleen Nofi (clinical) [Ep 63 · 5:22](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=322)
- "eCIRP exacerbates NEC pathogenesis by increasing inflammation and intestinal injury" — Colleen Nofi (clinical) [Ep 63 · 5:42](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=342)
- "MOP3 protects against NEC pathogenesis by scavenging eCIRP and preventing deleterious downstream impacts" — Colleen Nofi (clinical) [Ep 63 · 5:42](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=342)
- "MOP3 is effective in other models of ischemia reperfusion injury in the gut" — Colleen Nofi (clinical) [Ep 63 · 6:53](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=413)
- "The beneficial impact of CIRP knockdown is greater than the benefit achieved with MOP3 treatment" — Colleen Nofi (clinical) [Ep 63 · 7:00](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=420)
- "The murine NEC model involves 4 days of continuous stressors including LPS, formula gavage, and hypoxia" — Colleen Nofi (clinical) [Ep 63 · 7:34](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=454)
- "MOP3 treatment is administered once per day at the beginning of the NEC model, ongoing with the insult" — Colleen Nofi (clinical) [Ep 63 · 7:49](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=469)
- "No single model of NEC fully recapitulates everything exhibited in neonates" — Colleen Nofi (opinion) [Ep 63 · 6:38](https://library.globalcastmd.com/watch/dr-colleen-nofi-best-of-the-best-in-pediatric-surgery-2025-10047?t=398)
- "The Hirschsprung study was prospective and took place 2021 to 2023, including 33 patients under six months old who underwent endorectal pull-through surgeries" — Lizzie Lee (clinical) [Ep 68 · 1:03](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=63)
- "Primary outcomes examined were anastomotic complications, enterocolitis, and constipation" — Lizzie Lee (clinical) [Ep 68 · 1:20](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=80)
- "There was no significant difference in anastomotic complications between dilation and non-dilation groups" — Lizzie Lee (clinical) [Ep 68 · 1:27](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=87)
- "The non-dilation group had less enterocolitis and less constipation compared to traditional dilation group" — Lizzie Lee (clinical) [Ep 68 · 1:27](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=87)
- "Choosing not to do postoperative anal dilations may be a good alternative with benefits like lower constipation and enterocolitis" — Lizzie Lee (opinion) [Ep 68 · 1:36](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=96)
- "For gastroschisis, delivery after 37 weeks is optimal" — Alex Halpern (guideline) [Ep 68 · 2:18](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=138)
- "Prophylactic antibiotics covering skin flora are adequate to reduce infection risk until closure in gastroschisis" — Alex Halpern (guideline) [Ep 68 · 2:21](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=141)
- "Studies support primary fascial repair for gastroschisis as long as hemodynamics and abdominal domain permit" — Alex Halpern (guideline) [Ep 68 · 2:28](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=148)
- "Sutureless repair for gastroschisis is safe, effective, and does not delay feeding or increase length of stay" — Alex Halpern (clinical) [Ep 68 · 2:28](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=148)
- "There is a need for high quality randomized controlled trials to help provide evidence-based care for gastroschisis infants" — Alex Halpern (opinion) [Ep 68 · 2:42](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=162)
- "The CDH study was retrospective, done in Texas using a state hospital database" — Cecilia Gigena (clinical) [Ep 68 · 3:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=196)
- "The CDH study identified 1,314 patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers" — Cecilia Gigena (epidemiological) [Ep 68 · 3:32](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=212)
- "High volume centers had significantly lower mortality rates for CDH despite having significantly sicker patients" — Cecilia Gigena (clinical) [Ep 68 · 3:46](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=226)
- "High volume centers had significantly shorter length of stay for CDH patients" — Cecilia Gigena (clinical) [Ep 68 · 3:46](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=226)
- "High volume centers had better outcomes for patients with CDH" — Cecilia Gigena (opinion) [Ep 68 · 4:00](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=240)
- "Irrigations are probably the best treatment for Hirschsprung disease and it is very rare that Hirschsprung disease is a surgical emergency, but without irrigation it will become an emergency" — Marc Levitt (clinical) [Ep 28 · 8:50](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=530)
- "Proper irrigation technique requires a large bore tube (20 French Foley), instilling 10-20 cc aliquots of warm saline at a time, moving the tube to and fro, and allowing fluid mixed with stool to drip back" — Marc Levitt (clinical) [Ep 28 · 9:13](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=553)
- "The biggest mistake with irrigations is using too small of a tube and just putting fluid in and letting it sit (an enema), when babies with Hirschsprung disease have no ability to expel enema fluid" — Marc Levitt (clinical) [Ep 28 · 10:51](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=651)
- "Rectal biopsies must be taken at least 1 centimeter in from the dentate line because everyone has an aganglionic segment at the dentate line and biopsying too close can give a false positive diagnosis" — Marc Levitt (clinical) [Ep 28 · 12:38](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=758)
- "The pathologist must confirm both the absence of ganglion cells AND the presence of hypertrophic nerves; absence of ganglion cells alone is not Hirschsprung disease as that could be a biopsy taken too low" — Marc Levitt (clinical) [Ep 28 · 13:23](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=803)
- "Stasis in a Hirschsprung patient leads to bacterial translocation and a very sick baby from bacteremia due to an immune component that makes the bowel mucosa more susceptible to translocation" — Marc Levitt (clinical) [Ep 28 · 14:35](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=875)
- "When irrigations fail and the baby is ill, diversion should be done at the ileum rather than a leveling colostomy, especially without reliable frozen section pathology" — Marc Levitt (clinical) [Ep 28 · 15:42](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=942)
- "Frozen section results can be inaccurate, particularly for transition zones higher in the colon, making permanent section more reliable for determining resection level" — Marc Levitt (clinical) [Ep 28 · 16:40](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=1000)
- "The Swenson operation was done incorrectly historically with perirectal dissection done too wide, leading to fecal incontinence, urinary incontinence, sexual problems, and impotence" — Marc Levitt (clinical) [Ep 28 · 18:17](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=1097)
- "The Soave procedure involves a mucosal dissection inside the outer rectal wall to avoid injuring pelvic nerves, which was quite brilliant" — Marc Levitt (clinical) [Ep 28 · 19:19](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=1159)
- "Of the four classic procedures (Swenson, Soave, Duhamel, Rebein), only the Swenson actually leaves behind virtually no Hirschsprung tissue" — Marc Levitt (clinical) [Ep 28 · 21:18](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=1278)
- "Many patients with residual aganglionic bowel (from Soave, Duhamel, or Rebein) did perfectly well because ganglionic bowel, if it's good, can overcome a lot" — Marc Levitt (clinical) [Ep 28 · 21:43](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=1303)
- "The transanal Swenson is the preferred approach because it is the purest operation, leaving behind no Hirschsprung except at the very bottom just above the dentate line" — Marc Levitt (opinion) [Ep 28 · 25:34](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=1534)
- "If you find the right plane for transanal Swenson it's elegant and bloodless, but if you find the wrong plane you can really injure the patient by dissecting too wide" — Marc Levitt (clinical) [Ep 28 · 26:10](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=1570)
- "Overly aggressive transanal-only approach trying to reach the transition zone without laparoscopy has resulted in significant morbidity" — Marc Levitt (clinical) [Ep 28 · 28:50](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=1730)
- "Transanal-only approach is appropriate when there is a very reachable transition zone comfortably at mid-sigmoid and the transition zone is obvious" — Marc Levitt (clinical) [Ep 28 · 29:18](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=1758)
- "Prone positioning for transanal approach is preferred because the tough anterior dissection becomes easier when looking down on it rather than up at it" — Marc Levitt (opinion) [Ep 28 · 29:52](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=1792)
- "Total colonic Hirschsprung patients present differently: diagnosis isn't made right away, contrast study is not typical, and irrigations don't go well" — Marc Levitt (clinical) [Ep 28 · 31:18](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=1878)
- "The biggest problem in technique is surgeons don't give themselves good exposure and start dissection too low, injuring or resecting the dentate line, or they overstretch the sphincters with aggressive exposure" — Marc Levitt (clinical) [Ep 28 · 33:55](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=2035)
- "The dissection must start 1 centimeter proximal to the dentate line, which by definition leaves behind 1 centimeter of aganglionic columnar epithelium and the internal sphincter, but ganglionic bowel can overcome this" — Marc Levitt (clinical) [Ep 28 · 35:42](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=2142)
- "Sequential stitches placed at the 6 o'clock position (in prone) as the bowel is pulled out helps maintain alignment and prevents twisting of the pull-through" — Marc Levitt (clinical) [Ep 28 · 48:34](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=2914)
- "Seromuscular laparoscopic biopsies can show ganglion cells in the seromuscular layer but miss hypertrophic nerves in the submucosa, potentially leading to a transition zone pull-through" — Marc Levitt (clinical) [Ep 28 · 40:48](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=2448)
- "Normal nerve size is 40 microns or less; anything bigger than 40 microns indicates transition zone bowel requiring higher resection" — Marc Levitt (clinical) [Ep 28 · 44:05](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=2645)
- "The concept of going 5 centimeters above the transition zone is inaccurate because transition zone is a spectrum ranging from 3 to 10 centimeters" — Marc Levitt (clinical) [Ep 28 · 44:14](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=2654)
- "Taking the IMA and preserving the marginal arcade makes the left colon and sigmoid straight down into the perineum, creating an easy-to-irrigate configuration" — Marc Levitt (clinical) [Ep 28 · 45:51](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=2751)
- "Many patients have not had enough of a pull-through when the entire sigmoid loop is still present, requiring redo surgery to remove more bowel" — Marc Levitt (clinical) [Ep 28 · 46:05](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=2765)
- "For transition zones proximal to the splenic flexure, colonic biopsies and ileostomy should be performed rather than relying on frozen section, which is notoriously fraught with errors in these cases" — Marc Levitt (clinical) [Ep 28 · 46:46](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=2806)
- "Postoperative feeding should be delayed until the abdomen is absolutely soft and flat with bowel function, usually 3-4 days, to prevent enterocolitis readmission" — Marc Levitt (clinical) [Ep 28 · 53:06](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=3186)
- "Abdominal distention can be subclinical, so an X-ray should be obtained before feeding to confirm the bowel is decompressed" — Marc Levitt (clinical) [Ep 28 · 53:23](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=3203)
- "Families must be taught irrigation technique preoperatively and made paranoid about distention so they will seek care immediately if it develops" — Marc Levitt (clinical) [Ep 28 · 54:02](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=3242)
- "Anal calibration (not true dilation) should be performed at one month using Hegar dilators, as the stimulation helps the baby more successfully empty" — Marc Levitt (clinical) [Ep 28 · 54:28](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=3268)
- "For hepatic flexure transition zones, the entire right colon must be taken down, the ileocolic vessel preserved, and the colon de-rotated so the cecum is at the hepatic liver bed to achieve adequate length" — Marc Levitt (clinical) [Ep 28 · 57:05](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=3425)
- "When bringing de-rotated colon down the left side of the abdomen, the ligament of Treitz must be mobilized to prevent the mesenteric vessel from draping across the third portion of the duodenum and causing obstruction" — Marc Levitt (clinical) [Ep 28 · 57:57](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=3477)
- "Infant presented with delayed passage of meconium of more than 48 hours" — Jafar (clinical) [Ep 4 · 0:41](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=41)
- "At day 7 of age, infant presented with signs and symptoms of Hirschsprung disease including abdominal distension, tight rectum with passage of explosive stool after removing examining finger" — Jafar (clinical) [Ep 4 · 0:53](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=53)
- "Full thickness rectal biopsy confirmed the absence of ganglion cells" — Jafar (clinical) [Ep 4 · 1:08](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=68)
- "Surgical exploration revealed malrotation with three bands: one between loops of bowel, one between bowel and liver, and one between bowel and abdominal wall" — Jafar (clinical) [Ep 4 · 1:22](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=82)
- "Biopsies from appendix and terminal ileum proved to be aganglionosis (Hirschsprung disease)" — Jafar (clinical) [Ep 4 · 1:56](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=116)
- "Infant was placed on special high-calorie formula (Ensure) with addition of vitamin B12" — Jafar (clinical) [Ep 4 · 2:17](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=137)
- "Infant developed multiple attacks of dehydration requiring hospital admission for IV fluid replacement" — Jafar (clinical) [Ep 4 · 2:28](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=148)
- "At 70 days of age, infant's weight was 3.5 kg" — Jafar (clinical) [Ep 4 · 2:37](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=157)
- "Only a few cases reported in literature of total colonic aganglionosis associated with malrotation: Philone had 4 patients, Kors had 1 patient, and 3 patients reported by others" — Jafar (epidemiological) [Ep 4 · 3:39](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=219)
- "No cases reported to have all three anomalies (total colonic aganglionosis, malrotation, and congenital bands)" — Jafar (epidemiological) [Ep 4 · 4:00](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=240)
- "Congenital bands are rare and only a few cases reported; etiology unknown but could be attributed to abnormal rotation of bowel" — Jafar (clinical) [Ep 4 · 4:08](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=248)
- "Malrotation and Hirschsprung disease can present together; typical scenario is child with bilious vomiting who undergoes Ladd procedure but then doesn't open up, leading to discovery of total colonic aganglionosis" (clinical) [Ep 4 · 5:42](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=342)
- "Teaching point: once Ladd procedure is done, if baby doesn't open up, must think about other potential causes for bilious vomiting including Hirschsprung disease" (clinical) [Ep 4 · 6:06](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=366)
- "When malrotation and Hirschsprung coexist, they are usually short-segment Hirschsprung, not usually total colonic" (clinical) [Ep 4 · 6:18](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=378)
- "For total colonic Hirschsprung disease, preferred operation is Duhamel because it is simple, safe, and provides a reservoir at the bottom which Soave does not" (opinion) [Ep 4 · 6:50](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=410)
- "Timing of definitive repair should be based on consistency of ileostomy output, not age or weight; prefer to wait until output firms up, which usually happens when infant gets onto solid food" (opinion) [Ep 4 · 7:05](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=425)
- "Infants don't do very well if definitive repair is done too early when ileostomy output is still very liquid" (clinical) [Ep 4 · 7:14](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=434)
- "For long-segment or total colonic Hirschsprung, should leave a relatively short piece of colon, almost making a small reservoir, not the long Martin modification element" (opinion) [Ep 4 · 7:36](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=456)
- "Good continence control in long-segment Hirschsprung disease is really about 50% of patients; the data really isn't that great" (clinical) [Ep 4 · 7:55](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=475)
- "Long-segment Hirschsprung involving more than 50 cm from the ileocecal valve is a much more progressive disease with bigger dysmotility element" (clinical) [Ep 4 · 8:22](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=502)
- "Cannot expect simple fix from classic operations when small bowel is significantly involved in Hirschsprung disease" (opinion) [Ep 4 · 8:36](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=516)
- "No evidence in literature that any particular procedure (Duhamel vs. Soave) is better for long-segment Hirschsprung; best approach is to do what you do best" — Sharif (opinion) [Ep 4 · 8:54](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=534)
- "Duhamel may have higher episodes of enterocolitis compared to other procedures" — Sharif (clinical) [Ep 4 · 9:09](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=549)
- "Poor weight gain in infant with ileostomy often due to sodium loss; unless sodium levels in effluent are checked, this will not be caught because serum sodium will be normal for many months" — Sharif (clinical) [Ep 4 · 10:01](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=601)
- "If ileostomy output contains more than 5 to 7 milliequivalents per liter of sodium, baby will not grow or gain weight" — Sharif (clinical) [Ep 4 · 10:21](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=621)
- "Must get baby gaining weight and growing before performing definitive procedure" — Sharif (opinion) [Ep 4 · 10:28](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=628)
- "Measuring urinary sodium is the best way to guide how much sodium replacement to give" (clinical) [Ep 4 · 10:34](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=634)
- "Every baby with an ileostomy should probably get sodium supplementation" (opinion) [Ep 4 · 10:49](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=649)
- "Iron deficiency is a big long-term issue in these patients that often gets forgotten" (clinical) [Ep 4 · 10:50](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=650)
- "For total colonic Hirschsprung, must wait until baby grows and ileostomy is thicker before doing definitive repair" (opinion) [Ep 4 · 11:10](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=670)
- "After Soave or other procedure for total colonic disease, can continue with bulking agents or anti-diarrheal agents to help patients" (clinical) [Ep 4 · 11:29](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=689)
- "Some patients who had Duhamel abroad came back with problems including enterocolitis, obstruction, and distension of the Duhamel pouch" (clinical) [Ep 4 · 11:44](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=704)
- "Most important thing is to monitor ileostomy output before deciding to do any definitive procedure" (opinion) [Ep 4 · 12:05](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=725)
- "Some patients with ileoanal anastomosis developed severe perianal erosion requiring protective ileostomy before further procedures" (clinical) [Ep 4 · 12:19](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=739)
- "Better to manage total colonic Hirschsprung patients in the long term rather than rushing to definitive repair" (opinion) [Ep 4 · 12:38](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=758)
- "Soave procedure for regular Hirschsprung disease patients (not total colonic) does not result in incontinence if procedure is followed carefully and sphincters are not damaged" (opinion) [Ep 4 · 13:04](https://library.globalcastmd.com/watch/tricks-total-colonic-aganglionosis-associated-with-malrotation-multiple-645?t=784)
- "97% of bilateral kidney tumors in children are Wilms tumor" — Tony Sandler (epidemiological) [Ep 5 · 9:12](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=552)
- "Current protocol for bilateral Wilms is to start chemotherapy without biopsy, typically 2 cycles, and stop when tumor shrinkage plateaus (defined as less than 50% volume reduction)" — Tony Sandler (guideline) [Ep 5 · 1:32](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=92)
- "When bilateral Wilms tumors stop shrinking after chemotherapy, it is usually due to mesenchymal differentiation rather than anaplastic transformation" — Tony Sandler (clinical) [Ep 5 · 4:30](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=270)
- "Bilateral nephron-sparing surgery for Wilms can be performed using on-ice technique with vascular clamping and sharp dissection" — Tony Sandler (clinical) [Ep 5 · 4:53](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=293)
- "Wilms tumors are heterogeneous and biopsy may miss foci of anaplasia" — Dan (clinical) [Ep 5 · 3:27](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=207)
- "Anaplastic Wilms tumor recurrence portends a very bad outcome and salvage is difficult despite chemotherapy" — Dan (clinical) [Ep 5 · 6:48](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=408)
- "Multifocal Wilms tumors raise concern about underlying embryologic kidney abnormalities and risk for developing additional tumors" — Dan (clinical) [Ep 5 · 8:15](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=495)
- "If gastroschisis fascia is not cut during closure, umbilical hernias will typically close spontaneously and do not require repair" — Tony Sandler (clinical) [Ep 5 · 13:05](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=785)
- "Gastroschisis with atresia typically presents with pristine bowel at the atresia site, unlike inflamed gastroschisis bowel" — Tony Sandler (clinical) [Ep 5 · 19:14](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1154)
- "Ambient intra-abdominal pressure is lower when gastroschisis fascia is not closed compared to fascial closure" — Tony Sandler (clinical) [Ep 5 · 19:26](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1166)
- "Gastroschisis bowel can transform from inflamed appearance to normal intestine within 2 weeks, earlier than the traditional 4-6 week teaching" — Tony Sandler (clinical) [Ep 5 · 22:23](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1343)
- "STEP registry data discourages performing STEP procedures in the perinatal period due to poor outcomes" — Greg (guideline) [Ep 5 · 26:24](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1584)
- "Patients with gastroschisis have motility disorders that make STEP procedures less beneficial" — Greg (clinical) [Ep 5 · 26:33](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1593)
- "Bianchi procedure is preferred over STEP because it allows subsequent STEP if needed, whereas STEP limits future lengthening options" — Greg (opinion) [Ep 5 · 26:46](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1606)
- "In neonates with questionable short gut, plication is preferred over tapering to preserve bowel for potential future lengthening procedures" — Tony Sandler (clinical) [Ep 5 · 28:12](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1692)
- "Spring-loaded Bianchi silos may enlarge the fascial defect because the outward forces from ring compression exceed the reduction forces" — Todd (opinion) [Ep 5 · 14:27](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=867)
- "Tegaderm dressing for gastroschisis is typically left in place for 3 days, then converted to dry dressing when bowel is adherent" — Tony Sandler (clinical) [Ep 5 · 15:06](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=906)
- "Feeding can be started in gastroschisis when bowel function returns, without waiting for complete fascial closure" — Tony Sandler (clinical) [Ep 5 · 16:08](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=968)
- "Umbilical ostomy technique involves sewing dilated atretic bowel to the fascial ring at the umbilicus with downstream bowel tacked adjacent, waiting 2-4 weeks, then coring out and anastomosing" (clinical) [Ep 5 · 16:42](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1002)
- "Primary anastomosis of gastroschisis-associated atresia is risky because the bowel size discrepancy creates a tenuous anastomosis in air-exposed bowel" (clinical) [Ep 5 · 18:36](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1116)
- "The frequency and incidence of abdominal wall defects appears to be increasing" (epidemiological) [Ep 29 · 0:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=0)
- "With gastroschisis, the main issue is that the bowel gets damaged through fetal life" — Jacob Langer (clinical) [Ep 29 · 4:36](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=276)
- "Most gastroschisis patients don't have any other associated anomalies" — Jacob Langer (clinical) [Ep 29 · 4:46](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=286)
- "It's pretty rare to have other anomalies or abnormal chromosomes with gastroschisis" — Jacob Langer (clinical) [Ep 29 · 4:52](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=292)
- "Many studies have failed to show an advantage to cesarean section for gastroschisis" — Jacob Langer (clinical) [Ep 29 · 6:13](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=373)
- "Most people nowadays would not do routine cesarean section for gastroschisis" — Jacob Langer (opinion) [Ep 29 · 6:18](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=378)
- "There has not been any large randomized trial looking specifically at the issue of early delivery for gastroschisis" — Jacob Langer (clinical) [Ep 29 · 6:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=389)
- "Toronto delivers gastroschisis patients at around 37 weeks unless they've already gone into spontaneous labor" — Jacob Langer (clinical) [Ep 29 · 6:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=418)
- "The mean gestational age of onset of labor is earlier in gastroschisis pregnancies, possibly due to inflammatory mediators produced by inflamed bowel" — Jacob Langer (clinical) [Ep 29 · 7:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=427)
- "In gastroschisis pregnancies, labor induction at 37 weeks is usually successful, unlike regular pregnancies" — Jacob Langer (clinical) [Ep 29 · 7:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=461)
- "Most evidence from the CapsNet database suggests that delivery in a perinatal center is beneficial for gastroschisis" — Jacob Langer (clinical) [Ep 29 · 8:36](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=516)
- "During transport, gastroschisis babies should be nursed on their side, usually right side down, to prevent kinking of the mesentery and bowel ischemia" — Jacob Langer (clinical) [Ep 29 · 10:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=601)
- "Bedside closure is the first choice for gastroschisis if the bowel is not too thickened and there's not too much peel" — Jacob Langer (clinical) [Ep 29 · 10:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=657)
- "Using forceps at the bedside to push bowel back in can damage the bowel" — Jacob Langer (clinical) [Ep 29 · 11:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=689)
- "Intraabdominal pressure should be kept below 20 during gastroschisis reduction" — Jacob Langer (clinical) [Ep 29 · 12:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=734)
- "The incidence of intestinal atresia in gastroschisis is between 5 and 10%" — Jacob Langer (epidemiological) [Ep 29 · 18:51](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1131)
- "There are two different kinds of intestinal atresia in gastroschisis: early-onset atresia and late-onset atresia associated with vanishing gastroschisis" — Jacob Langer (clinical) [Ep 29 · 19:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1141)
- "Vanishing gastroschisis occurs when the abdominal wall defect gets very small as the baby grows, causing ischemia and necrosis of the exteriorized bowel" — Jacob Langer (clinical) [Ep 29 · 19:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1174)
- "The prognosis for short bowel syndrome has improved dramatically over the last 10-15 years due to intestinal failure centers, better TPN, and improved sepsis control" — Jacob Langer (clinical) [Ep 29 · 20:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1215)
- "There is no good evidence for how to manage atresia in gastroschisis—whether to repair at initial closure, create stomas, or delay repair" — Jacob Langer (opinion) [Ep 29 · 21:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1275)
- "Neonatal stomas prolapse no matter what technique is used" — Jacob Langer (clinical) [Ep 29 · 23:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1380)
- "Three weeks is average for gastroschisis patients to start having bowel movements" — Jacob Langer (clinical) [Ep 29 · 24:30](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1470)
- "A UK study showed that cisapride shortened the period of intestinal dysmotility in gastroschisis, but cisapride is no longer available" — Jacob Langer (clinical) [Ep 29 · 25:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1502)
- "Metoclopramide can be given intravenously, ensuring the patient receives the medication even with poor intestinal absorption" — Jacob Langer (clinical) [Ep 29 · 25:20](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1520)
- "Going in too early to explore for mechanical obstruction in gastroschisis with prolonged dysmotility is a mistake" — Jacob Langer (opinion) [Ep 29 · 27:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1641)
- "In gastroschisis, the exteriorized testis is usually the right testis" — Jacob Langer (clinical) [Ep 29 · 28:03](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1683)
- "In about half of gastroschisis cases with exteriorized testis, the testis finds its way down into the scrotum after reduction" — Jacob Langer (clinical) [Ep 29 · 28:18](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1698)
- "Omphalocele has a much higher incidence of associated anomalies and chromosomal abnormalities compared to gastroschisis" — Jacob Langer (clinical) [Ep 29 · 28:43](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1723)
- "Small omphaloceles without liver are more likely to be associated with abnormal chromosomes than large omphaloceles" — Jacob Langer (clinical) [Ep 29 · 29:47](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1787)
- "There is no rationale for routine cesarean section or preterm delivery for small omphaloceles" — Jacob Langer (opinion) [Ep 29 · 30:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1805)
- "Small omphaloceles are simple to repair from a surgical point of view" — Jacob Langer (clinical) [Ep 29 · 30:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1829)
- "Giant omphaloceles are associated with pulmonary hypoplasia, which is difficult to diagnose prenatally" — Jacob Langer (clinical) [Ep 29 · 31:55](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1915)
- "The pressure guideline of 20 for abdominal wall defect closure was established by Stuart Lacy in the 1980s based on rabbit studies and then validated in children" — Jacob Langer (clinical) [Ep 29 · 33:28](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2008)
- "Intraabdominal pressure can be measured through the nasogastric tube or via Foley catheter measuring intravesical pressure" — Jacob Langer (clinical) [Ep 29 · 34:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2042)
- "The trend of intraabdominal pressure is more important than the absolute number during reduction" — Jacob Langer (clinical) [Ep 29 · 34:17](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2057)
- "The Montreal group described using the omphalocele sac as a silo by sequentially ligating it over several days" — Jacob Langer (clinical) [Ep 29 · 35:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2107)
- "Spring-loaded silos create outward pressure as you push down, causing the abdominal wall defect to become larger over time" — Todd Ponsky (clinical) [Ep 29 · 18:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1090)
- "A larger abdominal wall defect after silo use takes longer to close on its own after bowel reduction" — Jacob Langer (clinical) [Ep 29 · 18:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1121)
- "Using Duoderm to gradually reduce giant omphaloceles appears to achieve reduction more quickly than other methods" — Jacob Langer (clinical) [Ep 29 · 37:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2254)
- "Indications for escharotic therapy in omphalocele include prematurity, severe cardiac disease, pulmonary hypoplasia, multiple anomalies, chromosomal abnormalities, or extremely large size" — Jacob Langer (clinical) [Ep 29 · 38:12](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2292)
- "Mushroom-shaped omphaloceles with a small abdominal wall defect but large external component will never reduce spontaneously" — Jacob Langer (clinical) [Ep 29 · 41:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2470)
- "In mushroom-shaped omphaloceles, enlarging the abdominal wall defect as a first step can allow more spontaneous reduction before definitive repair" — Jacob Langer (clinical) [Ep 29 · 41:20](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2480)
- "In delayed omphalocele repair, the defect often extends to the costal margin, requiring patch closure of the upper portion" — Jacob Langer (clinical) [Ep 29 · 43:35](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2615)
- "Surgisis patch fails to provide adequate closure in approximately 50% of omphalocele repairs" — Jacob Langer (clinical) [Ep 29 · 44:04](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2644)
- "Omphalocele may be part of pentalogy of Cantrell, commonly associated with diaphragmatic hernia of Morgagni" — Jacob Langer (clinical) [Ep 29 · 44:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2684)
- "Reflux is very common in omphalocele patients, especially those with cardiac disease or pulmonary hypoplasia" — Jacob Langer (clinical) [Ep 29 · 46:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2768)
- "Interventional radiology can usually place a G-tube lateral to a giant omphalocele defect under fluoroscopy" — Jacob Langer (clinical) [Ep 29 · 46:30](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2790)
- "Performing fundoplication in a child with an unreduced giant omphalocele is extremely difficult because the liver is midline and blocks access to the hiatus" — Jacob Langer (clinical) [Ep 29 · 47:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2835)
- "In giant omphaloceles, the midline liver can compress the duodenum or pylorus, causing mechanical gastric outlet obstruction" — Jacob Langer (clinical) [Ep 29 · 48:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2888)
- "Non-rotation in omphalocele is not associated with risk of midgut volvulus" — Jacob Langer (clinical) [Ep 29 · 48:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2929)
- "Children with omphalocele who develop appendicitis may have delayed diagnosis due to abnormal appendix location" — Jacob Langer (clinical) [Ep 29 · 49:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2954)
- "Hepatic veins in omphalocele are very superficial and can be injured during fascial dissection if not carefully identified" — Jacob Langer (clinical) [Ep 29 · 50:16](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3016)
- "The frequency and incidence of abdominal wall defects appears to be increasing" (epidemiological) [Ep 10 · 0:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=0)
- "Most gastroschisis patients don't have any other associated anomalies and it's rare to have abnormal chromosomes" — Jacob Langer (clinical) [Ep 10 · 4:46](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=286)
- "Early papers showed benefit to cesarean section for gastroschisis, but those cesarean sections were usually done early at 36-37 weeks, raising the question of whether timing rather than mode of delivery gave the benefit" — Jacob Langer (clinical) [Ep 10 · 5:46](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=346)
- "Many studies have failed to show an advantage to cesarean section for gastroschisis and most people nowadays would not do routine cesarean section" — Jacob Langer (clinical) [Ep 10 · 6:13](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=373)
- "There has not been any large randomized trial looking specifically at the issue of early delivery for gastroschisis" — Jacob Langer (clinical) [Ep 10 · 6:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=389)
- "Toronto delivers gastroschisis patients at around 37 weeks unless they've already gone into spontaneous labor" — Jacob Langer (clinical) [Ep 10 · 6:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=418)
- "The mean gestational age of onset of labor is earlier in gastroschisis pregnancies, possibly because of inflammatory mediators produced by inflamed bowel" — Jacob Langer (clinical) [Ep 10 · 7:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=427)
- "Labor can usually be successfully induced at 37 weeks in gastroschisis pregnancies, unlike regular pregnancies" — Jacob Langer (clinical) [Ep 10 · 7:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=461)
- "Most evidence suggests that delivery in a perinatal center is beneficial for gastroschisis" — Jacob Langer (clinical) [Ep 10 · 8:36](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=516)
- "During transport, gastroschisis babies should be nursed on their side, usually right side down, to prevent kinking of the mesentery and bowel ischemia" — Jacob Langer (clinical) [Ep 10 · 10:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=601)
- "Bedside closure is the first choice for gastroschisis if the bowel is not too thickened and there's not too much peel" — Jacob Langer (opinion) [Ep 10 · 10:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=657)
- "Adrian Bianchi first described bedside closure for gastroschisis" — Jacob Langer (clinical) [Ep 10 · 11:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=681)
- "Using forceps at the bedside to push bowel back in can damage the bowel in a squiggling baby" — Jacob Langer (clinical) [Ep 10 · 11:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=689)
- "Intra-abdominal pressure should be kept below 20 mmHg during gastroschisis reduction" — Jacob Langer (clinical) [Ep 10 · 12:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=734)
- "The sutureless closure technique using the umbilical cord stump to cover the defect is based on Anthony Sandler's experience, who trained in Toronto" — Jacob Langer (clinical) [Ep 10 · 13:40](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=820)
- "A study by Dr. Baird showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair" — Todd Ponsky (clinical) [Ep 10 · 14:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=859)
- "Spring-loaded silos create outward pressure as you push down, making the defect larger over time" — Todd Ponsky (clinical) [Ep 10 · 18:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1090)
- "The incidence of intestinal atresia in gastroschisis is between 5 and 10%" — Jacob Langer (epidemiological) [Ep 10 · 18:51](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1131)
- "There are two types of intestinal atresia in gastroschisis: early-onset atresia with dilated but not thick-walled bowel, and late atresia from progressive constriction causing ischemia" — Jacob Langer (clinical) [Ep 10 · 19:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1141)
- "Vanishing gastroschisis occurs when the abdominal wall defect becomes very small and the majority of small bowel becomes necrotic and disappears" — Jacob Langer (clinical) [Ep 10 · 19:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1174)
- "The prognosis for short bowel syndrome has improved dramatically over the last 10-15 years due to intestinal failure centers, better TPN that doesn't damage the liver, and control of sepsis" — Jacob Langer (clinical) [Ep 10 · 20:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1215)
- "Three management options for atresia in gastroschisis: repair at time of closure, bring out stomas, or reduce everything and repair atresia later" — Jacob Langer (clinical) [Ep 10 · 20:54](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1254)
- "There is no good evidence for management of atresia in gastroschisis because it's rare, so treatment should be individualized" — Jacob Langer (opinion) [Ep 10 · 21:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1275)
- "The umbilicus is the preferred site for neonatal stomas because it leaves a scar that would have been there anyway and is convenient for appliance placement" — Jacob Langer (opinion) [Ep 10 · 22:50](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1370)
- "Neonatal stomas prolapse no matter where they are placed" — Jacob Langer (clinical) [Ep 10 · 23:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1380)
- "Three weeks is average time to bowel function in gastroschisis, so investigations typically aren't started until 4 weeks" — Jacob Langer (clinical) [Ep 10 · 24:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1467)
- "Metoclopramide can be given intravenously, which is advantageous over oral prokinetics in patients with motility problems" — Jacob Langer (clinical) [Ep 10 · 25:17](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1517)
- "A randomized prospective trial is underway to determine if intravenous metoclopramide can shorten the period of hypomotility in gastroschisis" — Jacob Langer (clinical) [Ep 10 · 25:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1537)
- "Contrast enema and upper GI studies at 4 weeks may not give clear answers about mechanical obstruction versus hypomotility in gastroschisis" — Jacob Langer (clinical) [Ep 10 · 25:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1557)
- "Laparotomy for persistent ileus in gastroschisis is usually performed around 6 weeks if the patient hasn't opened up" — Jacob Langer (clinical) [Ep 10 · 26:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1604)
- "Going in too early for persistent ileus in gastroschisis is a mistake" — Jacob Langer (opinion) [Ep 10 · 27:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1641)
- "The exteriorized testis in gastroschisis is usually the right testis" — Jacob Langer (clinical) [Ep 10 · 28:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1680)
- "In about half of gastroschisis cases with exteriorized testis, the testis finds its way down into the scrotum after reduction" — Jacob Langer (clinical) [Ep 10 · 28:18](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1698)
- "Omphalocele has a much higher incidence of associated anomalies and chromosomal abnormalities compared to gastroschisis" — Jacob Langer (clinical) [Ep 10 · 28:38](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1718)
- "Small omphaloceles without liver are more likely to be associated with abnormal chromosomes than large omphaloceles" — Jacob Langer (clinical) [Ep 10 · 29:47](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1787)
- "There is no rationale for routine cesarean section, delivery at a perinatal center, or preterm delivery for small omphaloceles" — Jacob Langer (clinical) [Ep 10 · 30:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1805)
- "Most surgeons recommend cesarean section for giant omphaloceles, although this is not evidence-based" — Jacob Langer (opinion) [Ep 10 · 31:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1881)
- "Pulmonary hypoplasia is associated with giant omphaloceles and is very difficult to diagnose prenatally" — Jacob Langer (clinical) [Ep 10 · 31:55](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1915)
- "Intra-abdominal pressure monitoring is very helpful in omphalocele reduction, with a target pressure below 20 mmHg" — Jacob Langer (clinical) [Ep 10 · 33:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1994)
- "Stuart Lacy established the pressure guideline of 20 mmHg in the 1980s based on rabbit studies and then prospectively validated it in children with abdominal wall defects" — Jacob Langer (clinical) [Ep 10 · 33:28](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2008)
- "The Montreal group first described using the omphalocele sac as a silo with sequential ligation" — Jacob Langer (clinical) [Ep 10 · 35:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2107)
- "Using Duoderm to gradually reduce omphalocele appears to achieve reduction more quickly than sac ligation" — Jacob Langer (clinical) [Ep 10 · 37:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2254)
- "Indications for escharotic therapy in omphalocele include prematurity, bad cardiac disease, pulmonary hypoplasia, multiple anomalies, abnormal chromosomes, or giant size" — Jacob Langer (clinical) [Ep 10 · 38:12](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2292)
- "Mushroom-shaped omphaloceles with small abdominal wall defects but large external contents will never reduce spontaneously" — Jacob Langer (clinical) [Ep 10 · 41:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2470)
- "For mushroom-shaped omphaloceles, enlarging the abdominal wall defect as a first step can allow more spontaneous reduction before definitive repair" — Jacob Langer (clinical) [Ep 10 · 41:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2479)
- "Component separation in pediatric patients is controversial, with concerns about devascularization and worsening the situation" — Jacob Langer (opinion) [Ep 10 · 43:06](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2586)
- "In omphalocele repair, the defect often extends to the costal margin where closure is impossible, requiring patch placement in the upper portion" — Jacob Langer (clinical) [Ep 10 · 43:35](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2615)
- "Surgisis patch fails about 50% of the time in omphalocele repair, requiring replacement with non-absorbable mesh" — Jacob Langer (clinical) [Ep 10 · 44:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2641)
- "Pentalogy of Cantrell may include missing pericardium or Morgagni hernia associated with omphalocele" — Jacob Langer (clinical) [Ep 10 · 44:52](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2692)
- "Reflux is very common in omphalocele patients, especially those with cardiac disease or pulmonary hypoplasia" — Jacob Langer (clinical) [Ep 10 · 46:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2768)
- "GJ tubes placed by interventional radiology lateral to the omphalocele defect allow feeding despite severe reflux" — Jacob Langer (clinical) [Ep 10 · 46:30](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2790)
- "Fundoplication in a child with a large omphalocele defect is extremely difficult because the midline liver makes hiatus access almost impossible" — Jacob Langer (clinical) [Ep 10 · 47:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2835)
- "In omphalocele babies, the midline liver can put pressure on the duodenum or pylorus, causing mechanical gastric outlet obstruction that worsens reflux" — Jacob Langer (clinical) [Ep 10 · 48:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2888)
- "Non-rotation in omphalocele is not associated with risk of midgut volvulus, so Ladd's procedure is not needed" — Jacob Langer (clinical) [Ep 10 · 48:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2929)
- "Inversion appendectomy during omphalocele repair makes sense if performing Ladd's procedure, but appendix should be preserved if renal abnormality exists that might require Mitrofanoff" — Jacob Langer (clinical) [Ep 10 · 49:06](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2946)
- "Hepatic veins in omphalocele are very superficial and can be injured during fascial dissection if not careful" — Jacob Langer (clinical) [Ep 10 · 50:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=3010)
- "97% of bilateral large kidney tumors in children are Wilms tumor" — Tony Sandler (epidemiological) [Ep 12 · 9:12](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=552)
- "For bilateral Wilms tumors, chemotherapy is started without biopsy and continued until tumor shrinkage stops, typically defined as less than 50% volume reduction" — Tony Sandler (guideline) [Ep 12 · 1:32](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=92)
- "When bilateral Wilms tumors stop shrinking with chemotherapy, it is usually due to mesenchymal differentiation rather than anaplastic transformation" — Tony Sandler (clinical) [Ep 12 · 4:19](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=259)
- "Bilateral nephron-sparing surgery is achievable in most cases of large bilateral Wilms tumors using on-table renal hypothermia with ice and vascular clamping" — Tony Sandler (clinical) [Ep 12 · 4:44](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=284)
- "Wilms tumors are heterogeneous and biopsy may miss foci of anaplasia" — Dan (clinical) [Ep 12 · 3:27](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=207)
- "Anaplastic Wilms tumor recurrence portends a very bad outcome and salvage is difficult despite chemotherapy" — Dan (clinical) [Ep 12 · 6:48](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=408)
- "Most pathologists believe anaplasia in Wilms tumor is present primarily rather than induced by chemotherapy" — Tony Sandler (opinion) [Ep 12 · 7:56](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=476)
- "Multifocal renal tumors raise concern about underlying embryologic abnormalities and risk of developing additional tumors" — Dan (clinical) [Ep 12 · 8:15](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=495)
- "For gastroschisis with inflamed bowel, bedside reduction without intubation is possible in approximately 80% of cases" — Todd (clinical) [Ep 12 · 10:29](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=629)
- "Early delivery of gastroschisis cases results in less thick and matted bowel" (clinical) [Ep 12 · 11:11](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=671)
- "For gastroschisis closure without fascial incision, umbilical hernias that develop will typically close spontaneously over 3-5 years" — Tony Sandler (clinical) [Ep 12 · 12:54](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=774)
- "Spring-loaded Bianchi silos may enlarge the fascial defect due to outward radial forces from the compression ring" — Todd (opinion) [Ep 12 · 14:20](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=860)
- "Tegaderm dressing is left in place for approximately 3 days on gastroschisis closures, then converted to dry dressing when adherent" — Tony Sandler (clinical) [Ep 12 · 15:06](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=906)
- "Feeding can be started when bowel function returns in gastroschisis cases, without waiting for complete fascial closure" — Tony Sandler (clinical) [Ep 12 · 16:08](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=968)
- "For gastroschisis with atresia and pristine bowel, bringing an ostomy out through the umbilical fascial ring is technically advantageous" (clinical) [Ep 12 · 17:49](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1069)
- "Anastomosis in gastroschisis with atresia is technically difficult due to size mismatch between dilated proximal and decompressed distal bowel" (clinical) [Ep 12 · 18:36](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1116)
- "In gastroschisis with unclear atresia and inflamed bowel, reduction without anastomosis is preferred, with re-exploration at 4-6 weeks" — Tony Sandler (clinical) [Ep 12 · 19:14](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1154)
- "Closing fascia in gastroschisis increases intra-abdominal pressure compared to leaving it open with Tegaderm coverage" — Tony Sandler (clinical) [Ep 12 · 19:26](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1166)
- "Re-exploration at 2 weeks in complex gastroschisis can show transformation of inflamed bowel into viable intestine suitable for anastomosis" — Tony Sandler (clinical) [Ep 12 · 22:07](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1327)
- "For apple peel ileal atresia with ischemic distal bowel, resection is indicated rather than waiting for reperfusion if bowel does not pink up on the operating table" — Tony Sandler (clinical) [Ep 12 · 25:19](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1519)
- "Plication of dilated proximal bowel in neonatal atresia is preferred over tapering to preserve bowel length for potential future lengthening procedures" — Tony Sandler (clinical) [Ep 12 · 28:10](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1690)
- "The STEP registry discourages performing STEP procedures in the perinatal period due to poor outcomes" — Greg (guideline) [Ep 12 · 26:27](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1587)
- "STEP procedures in gastroschisis patients have limited benefit due to underlying motility disorders" — Greg (clinical) [Ep 12 · 26:33](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1593)
- "Bianchi procedure is preferred over STEP for initial bowel lengthening because it preserves the option for subsequent STEP, whereas STEP limits future lengthening options" — Greg (opinion) [Ep 12 · 26:46](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1606)
- "Infant presented with delayed passage of meconium of more than 48 hours" — Jafar (clinical) [Ep 13 · 0:18](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=18)
- "At day 7 of age, infant presented with signs and symptoms of Hirschsprung disease including abdominal distension, tight rectum with passage of explosive stool after removing examining finger" — Jafar (clinical) [Ep 13 · 0:30](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=30)
- "Full thickness rectal biopsy confirmed absence of ganglion cells" — Jafar (clinical) [Ep 13 · 0:44](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=44)
- "On laparotomy, malrotation with multiple bands was found: one band between loops of bowel, one between bowel and liver, and one between bowel and abdominal wall" — Jafar (clinical) [Ep 13 · 0:58](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=58)
- "Collapsed colon and anterior ileum with typical cone segment were observed" — Jafar (clinical) [Ep 13 · 1:14](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=74)
- "Biopsy from appendix and terminal ileum proved total colonic disease" — Jafar (clinical) [Ep 13 · 1:32](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=92)
- "Postoperatively, infant received IV fluids, antibiotics, total parenteral nutrition, and after bowel function returned, a high-calorie formula (Ensure) with vitamin B12 supplementation" — Jafar (clinical) [Ep 13 · 1:39](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=99)
- "Infant developed multiple attacks of dehydration requiring hospital admission for IV replacement" — Jafar (clinical) [Ep 13 · 2:04](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=124)
- "At 70 days of age, infant's weight was 3.5 kg" — Jafar (clinical) [Ep 13 · 2:13](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=133)
- "Only a few cases have been reported of total colonic Hirschsprung disease associated with malrotation (Philone had 4 patients, one other author had 1 patient, Zbra reported 3 patients)" — Jafar (epidemiological) [Ep 13 · 3:16](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=196)
- "No cases have been reported with all three anomalies (total colonic Hirschsprung, malrotation, and congenital bands)" — Jafar (epidemiological) [Ep 13 · 3:26](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=206)
- "Congenital bands are rare and only a few cases have been reported; etiology is unknown but could be attributed to antenatal perforation of the bowel" — Jafar (epidemiological) [Ep 13 · 3:46](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=226)
- "The usual scenario for malrotation with Hirschsprung disease is a child with bilious vomiting who gets a contrast study showing malrotation, undergoes Ladd procedure, but then doesn't open up, leading to discovery of total colonic Hirschsprung disease" (clinical) [Ep 13 · 5:20](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=320)
- "After a Ladd procedure, if the baby doesn't open up, you must think about other potential causes for bilious vomiting" (clinical) [Ep 13 · 5:42](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=342)
- "Hirschsprung disease associated with malrotation is usually short segment, not total colonic" (clinical) [Ep 13 · 5:54](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=354)
- "For total colonic Hirschsprung disease, preferred operation is Duhamel because it is simple, safe, and provides a reservoir at the bottom, which Soave does not" (opinion) [Ep 13 · 6:26](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=386)
- "Timing of definitive repair should be based on consistency of ileostomy output, not age or weight" (opinion) [Ep 13 · 6:41](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=401)
- "Infants don't do well if definitive repair is done too early when ileostomy output is still very liquid; better to wait until it firms up, which usually happens when they get onto solid food" (opinion) [Ep 13 · 6:50](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=410)
- "For long segment or total colonic Hirschsprung disease, a relatively short piece of colon should be left, creating a small reservoir rather than a long Martin modification element" (opinion) [Ep 13 · 7:13](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=433)
- "Good continence control in long segment Hirschsprung disease is achieved in only about 50% of patients" (epidemiological) [Ep 13 · 7:32](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=452)
- "When small bowel involvement extends more than 50 cm from the ileocecal valve, it represents a more progressive disease with a bigger dysmotility element" (clinical) [Ep 13 · 7:54](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=474)
- "There is no evidence in the literature that any particular procedure is definitively better for long segment Hirschsprung disease; surgeons should use the procedure they have the best results with" — Sharif (opinion) [Ep 13 · 8:31](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=511)
- "Poor weight gain in an infant with ileostomy receiving adequate calories and normal blood tests is often due to sodium loss" — Sharif (clinical) [Ep 13 · 9:18](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=558)
- "Serum sodium will remain normal for many months before decreasing, so sodium levels in the ileostomy effluent must be checked" — Sharif (clinical) [Ep 13 · 9:49](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=589)
- "If ileostomy effluent contains more than 5 to 7 mEq per liter of sodium, the baby will not gain weight" — Sharif (clinical) [Ep 13 · 9:57](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=597)
- "The baby must be gaining weight and growing before proceeding with definitive repair" — Sharif (opinion) [Ep 13 · 10:04](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=604)
- "Measuring urinary sodium is the best way to guide sodium replacement dosing" (opinion) [Ep 13 · 10:10](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=610)
- "Every baby with an ileostomy should probably receive sodium supplementation" (opinion) [Ep 13 · 10:10](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=610)
- "Iron deficiency is a long-term issue in children with ileostomies and any repairs performed" (clinical) [Ep 13 · 10:26](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=626)
- "For total colonic Hirschsprung disease, if doing Soave or other procedure, must wait until baby grows and ileostomy is thicker, then can continue with bulking agents or antidiarrheal agents" (opinion) [Ep 13 · 10:46](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=646)
- "Some patients who had Duhamel performed abroad came back with enterocolitis, obstruction, and distension of the Duhamel pouch" (clinical) [Ep 13 · 11:20](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=680)
- "Monitoring ileostomy output before deciding on any procedure is critical" (opinion) [Ep 13 · 11:42](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=702)
- "Some patients who had ileal-anal anastomosis developed severe erosive perianal skin breakdown requiring protective ileostomy before further procedures" (clinical) [Ep 13 · 11:42](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=702)
- "In regular (non-total colonic) Hirschsprung disease patients treated with Soave, incontinence is not seen if the procedure is performed well without damaging sphincters" (opinion) [Ep 13 · 12:40](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=760)
- "Abdominal wall forms around 4th week of gestation, before most women know they are pregnant" — Joyce (clinical) [Ep 14 · 0:31](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=31)
- "During 6th week, rapid intestinal growth and liver expansion causes herniation of midgut into umbilical cord" — Joyce (clinical) [Ep 14 · 0:40](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=40)
- "Around 10th week, herniated bowel loops return to abdominal cavity and assume fixed position" — Joyce (clinical) [Ep 14 · 0:50](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=50)
- "Gastroschisis is more common than omphalocele" — Joyce (epidemiological) [Ep 14 · 1:20](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=80)
- "In gastroschisis, umbilical cord is located to the left of the defect; in omphalocele it is in the center" — Joyce (clinical) [Ep 14 · 1:24](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=84)
- "With gastroschisis, bowel is exposed in utero causing it to be thickened, matted and inflamed" — Joyce (clinical) [Ep 14 · 1:32](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=92)
- "Associated anomalies occur in 10% of gastroschisis cases but 60-75% of omphalocele cases" — Joyce (epidemiological) [Ep 14 · 1:52](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=112)
- "Gastroschisis defect is usually found lateral to umbilicus on the right more than left, approximately 4 cm in size" — Joyce (clinical) [Ep 14 · 2:21](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=141)
- "Etiology of gastroschisis remains unknown; theories propose vascular event involving right umbilical vein or right omphalomesenteric artery causing necrosis and abdominal wall weakening" — Joyce (clinical) [Ep 14 · 2:40](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=160)
- "Incidence of gastroschisis has risen over last 20 years to approximately 5 per 10,000 live births" — Joyce (epidemiological) [Ep 14 · 3:06](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=186)
- "Gastroschisis is associated with young maternal age, prematurity, and low birth weight" — Joyce (epidemiological) [Ep 14 · 3:16](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=196)
- "Risk factors include young age (<20 years), smoking, and use of vasoconstrictive medications" — Joyce (epidemiological) [Ep 14 · 3:37](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=217)
- "Approximately 90% of gastroschisis cases are diagnosed prenatally on routine ultrasound" — Joyce (epidemiological) [Ep 14 · 3:51](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=231)
- "There is no evidence in literature to support either C-section or vaginal delivery in regards to outcome" — Joyce (guideline) [Ep 14 · 4:48](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=288)
- "Gastroschisis patients may require as much as 140-150 mL/kg/day of fluids to deal with losses" — Joyce (clinical) [Ep 14 · 16:54](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1014)
- "There is approximately 10% associated occurrence of intestinal atresia with gastroschisis" — Joyce (epidemiological) [Ep 14 · 7:10](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=430)
- "Atresia can be treated at time of abdominal wall closure with resection and primary anastomosis, or bowel can be reduced with atresia intact and repaired 4-12 weeks later" — Joyce (clinical) [Ep 14 · 7:17](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=437)
- "At Cincinnati Children's, almost exclusively perform staged closures with silos - only handful of small defects closed primarily out of 41 patients in last 3 years" — Joyce (clinical) [Ep 14 · 8:52](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=532)
- "Lucille Packard Children's Hospital uses sutureless technique with silo reduction followed by Mepilex and Tegaderm dressings until fully healed in about 6 weeks" — Joyce (clinical) [Ep 14 · 9:37](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=577)
- "With non-sutured repair, have never had a ventral hernia; 10-20% get umbilical hernia which usually resolves by 3-5 years of age" — Todd (clinical) [Ep 14 · 10:38](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=638)
- "Approximately 75% of pediatric surgeons who participated in survey do non-sutured (Tegaderm) closure" — Todd (epidemiological) [Ep 14 · 11:03](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=663)
- "For non-sutured closure: place silo on everyone, reduce at bedside if possible, tie umbilical cord with suture and lay in circle over hole, apply gauze and Tegaderm, change dressing every 4 days" — Todd (clinical) [Ep 14 · 12:01](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=721)
- "Complications of primary closure stem mainly from increased abdominal pressure leading to decreased venous return and possible abdominal compartment syndrome with ischemic injury" — Joyce (clinical) [Ep 14 · 13:06](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=786)
- "Literature shows debate about closure method - some report earlier feeding and decreased length of stay with primary closure, others report decreased ventilator time, shorter stay, and lower cost for silo reduction" — Joyce (clinical) [Ep 14 · 15:06](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=906)
- "Overall survival rate is good at greater than 95% regardless of closure type" — Joyce (epidemiological) [Ep 14 · 15:28](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=928)
- "Dysmotility is the most universal complication of gastroschisis" — Joyce (clinical) [Ep 14 · 19:56](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1196)
- "Prognosis mainly dependent on severity of associated problems like prematurity, complications during initial post-op period, and degree of motility dysfunction" — Joyce (clinical) [Ep 14 · 20:08](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1208)
- "NEC is reported in about 5-10% of patients with gastroschisis, tends to occur later in course" — Joyce (epidemiological) [Ep 14 · 20:30](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1230)
- "No correlation between development of NEC and type of closure performed" — Joyce (clinical) [Ep 14 · 20:44](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1244)
- "Do not use bladder pressures - not terribly accurate in this size patient. Use peak airway pressures as primary assessment if intubated" — Todd (opinion) [Ep 14 · 29:25](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1765)
- "If baby not peeing or not acting right, there's never downside to releasing silo and letting things back out" — Todd (opinion) [Ep 14 · 29:57](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1797)
- "Do not routinely look at bladder pressures. Peak airway pressures are very good, or if pressure control ventilation, watch for significant changes in tidal volume" — Dean (opinion) [Ep 14 · 30:15](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1815)
- "Majority of gastroschisis care is done by advanced practitioners - fluid management, advancement of feeds, wound care" — Jenny (clinical) [Ep 14 · 30:59](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1859)
- "Typical feeding protocol: start enteral feeds 24 hours after NG removal at 1 mL/hour, increase by 1 mL/hour daily until day 5, then BID increases, then every 8 hour increases by day 8 if tolerating" — Joyce (clinical) [Ep 14 · 33:46](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2026)
- "From 2010 to present, 36 patients required long-term TPN (>30 days): 22 simple gastroschisis averaged 35 days TPN with 3 still on TPN at 1 year; 4 with atresia averaged 146 days TPN but all off within 10 months" — Joyce (epidemiological) [Ep 14 · 36:31](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2191)
- "About 1/3 of children with gastroschisis are below 10th percentile for weight at one year but without neurodevelopmental delays" — Joyce (epidemiological) [Ep 14 · 37:24](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2244)
- "Gestational age <37 weeks and development of cholestasis independently linked to poor growth; small for gestational age or low birth weight was not" — Joyce (clinical) [Ep 14 · 38:06](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2286)
- "In Cincinnati series of 71 infants (2006-2009), enteral feedings started around day 16, median length of stay 42 days, 6 patients discharged on TPN and 24% on tube feedings" — Joyce (epidemiological) [Ep 14 · 38:30](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2310)
- "In Cincinnati series of 58 infants (2006-2008), 40% readmitted at least once within first year; most common reason was bowel obstruction and abdominal pain/distention" — Joyce (epidemiological) [Ep 14 · 39:35](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2375)
- "67% of patients with primary closures were readmitted vs 20% with silo reductions (did not reach statistical significance)" — Joyce (epidemiological) [Ep 14 · 40:50](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2450)
- "Volume of NG output less critical than color - can have large volume of spit but still be ready to feed if not bilious" — Todd (clinical) [Ep 14 · 43:01](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2581)
- "There is no clear predictive information to identify which NEC patients will progress to require surgical intervention" (clinical) [Ep 16 · 1:09](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=69)
- "Rate of feeding advancement does not correlate with developing necrotizing enterocolitis" (clinical) [Ep 16 · 2:34](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=154)
- "Probiotics have the most study and have shown pretty good evidence that may help prevent NEC" (clinical) [Ep 16 · 2:51](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=171)
- "The most recent Cochrane database supports the use of probiotics and argues that it provides a benefit" (guideline) [Ep 16 · 2:59](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=179)
- "Many places within the United States do not routinely use probiotics despite the evidence" (epidemiological) [Ep 16 · 3:31](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=211)
- "Focal abdominal wall erythema is one of the most sensitive indicators for underlying dead bowel" (clinical) [Ep 16 · 11:40](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=700)
- "Every patient operated on with a red abdomen had a piece of dead bowel underneath it" (clinical) [Ep 16 · 12:43](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=763)
- "Free air is the only single factor that would take the panel to the operating room; otherwise they need two or three different findings" (opinion) [Ep 16 · 12:27](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=747)
- "There is no reason to change surgical approach based on size alone" (opinion) [Ep 16 · 7:35](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=455)
- "Worsening ventilatory status, worsening blood gas, worsening acidosis, and increasing ventilator pressures are in the same category as hemodynamic instability for operative indication" (clinical) [Ep 16 · 8:10](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=490)
- "Taking a 600g baby to the OR increases their risk of demise just with the travel and ventilatory parameters and getting out of the NICU" — Tim (clinical) [Ep 16 · 14:32](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=872)
- "Approximately 30% of babies who receive peritoneal drainage never need an operation" (clinical) [Ep 16 · 15:37](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=937)
- "The concept of drainage was originally a temporary maneuver to stabilize the baby before taking to the operating room, but over 25-30 years has transitioned to definitive therapy" (clinical) [Ep 16 · 15:03](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=903)
- "Primary anastomosis in NEC is not commonly performed; the child would have to be pretty healthy to consider it" (opinion) [Ep 16 · 21:10](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=1270)
- "The concern with primary anastomosis is that patients are still sick when done operating and it is difficult to know if there is a leak or evaluate the belly after a tenuous anastomosis" (clinical) [Ep 16 · 21:26](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=1286)
- "The earliest timing for stoma takedown is 4 weeks if that is what is holding the baby up or they are having complications from not being on full feeds" (clinical) [Ep 16 · 26:04](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=1564)
- "Data from Andrew Badillo showed that early anastomosis can be done much earlier than the traditional 8 weeks minimum" (clinical) [Ep 16 · 25:53](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=1553)
- "Waiting 6-8 weeks for reanastomosis allows the inflammatory response to subside and adhesions to become more flimsy" (clinical) [Ep 16 · 28:17](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=1697)
- "Bringing stomas out side by side rather than separated means only disturbing the area around the stomas at reoperation, leaving the rest of the bowel intact" (clinical) [Ep 16 · 26:33](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=1593)
- "There is not actually a child with NEC totalis that has successfully survived to transplant" (clinical) [Ep 16 · 33:18](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=1998)
- "The lower threshold of bowel length to not just close has dropped to potentially 20 centimeters, with some using even less" (clinical) [Ep 16 · 33:39](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=2019)
- "Having 20cm of small bowel with the whole colon is more favorable than small bowel alone" (clinical) [Ep 16 · 33:52](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=2032)
- "The study used a trauma database to track non-accidental trauma patients and examined their hospital course, injuries, consults, discharge instructions, and actual follow-up visits over one year" — Brittany Johnson (clinical) [Ep 33 · 1:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=104)
- "Follow-up rates for child physical abuse victims were actually quite high, representing an opportunity since families are trying to make appointments" — Brittany Johnson (clinical) [Ep 33 · 2:19](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=139)
- "Pediatric surgery could adopt the model used for children with complex medical conditions where all appointments are scheduled on one day to decrease burden on families" — Brittany Johnson (opinion) [Ep 33 · 3:18](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=198)
- "85% follow-up rate was observed in the child physical abuse cohort" — Paul Tam (clinical) [Ep 33 · 3:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=238)
- "The UK NEC study was a whole population-based study including all 27 pediatric surgery centers in the UK over one year" — Nigel Hall (clinical) [Ep 33 · 5:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=315)
- "Primary outcomes measured were death or parental nutrition requirement at 28 days after surgery" — Nigel Hall (clinical) [Ep 33 · 5:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=347)
- "About 130 babies with NEC were included, with approximately half having bowel perforation" — Nigel Hall (clinical) [Ep 33 · 6:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=417)
- "Of babies without perforation, one-third were critically ill and proceeded quickly to surgery, while two-thirds eventually had surgery for failed medical treatment" — Nigel Hall (clinical) [Ep 33 · 7:08](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=428)
- "Babies in the failed medical treatment group had the longest time from presentation to operation and the worst outcomes" — Nigel Hall (clinical) [Ep 33 · 7:30](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=450)
- "There are currently no objective clinical markers or novel biomarkers to help make earlier surgical decisions in NEC" — Rod Gerardo (clinical) [Ep 33 · 8:32](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=512)
- "The bowel management program at Nationwide Children's started recording outcomes in a standardized way in 2015 using standardized definitions and patient-reported outcome measures" — Richard Wood (clinical) [Ep 33 · 10:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=637)
- "One-year measurement was chosen instead of one week because it demonstrates sustained changes within the patient's normal environment" — Richard Wood (clinical) [Ep 33 · 11:32](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=692)
- "Children who achieved continence had significantly improved quality of life, while those who remained incontinent showed no quality of life improvement" — Richard Wood (clinical) [Ep 33 · 11:59](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=719)
- "30% of patients in the bowel management program still struggled with fecal incontinence after one year" — Ellen Encisco (clinical) [Ep 33 · 12:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=732)
- "70% of children in bowel management programs do well, requiring focus on the remaining 30% who do not improve" — Richard Wood (clinical) [Ep 33 · 12:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=776)
- "The Italian anorectal malformation study analyzed 350 patients between 1999 and 2019, representing one of the largest series" — Ellen Encisco (clinical) [Ep 33 · 14:59](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=899)
- "The study demonstrated a close relation between spinal cord abnormalities and spinal bone anomalies in anorectal malformation patients" — Ellen Encisco (clinical) [Ep 33 · 15:29](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=929)
- "Patients without sacral or vertebral anomalies can still have spinal cord abnormalities, making MRI necessary for complete evaluation" — Ellen Encisco (clinical) [Ep 33 · 15:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=944)
- "Radiographs are not a good substitute for ultrasound or MRI in detecting spinal cord abnormalities" — Paul Tam (clinical) [Ep 33 · 16:34](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2021-4661?t=994)
- "Surgeons have historically been incentivized based on work RVUs, which is important for clinical productivity but does not capture other academic strengths" — Gail Besner (opinion) [Ep 38 · 1:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=101)
- "The concept of academic RVUs was first described 12-13 years ago but without a clear incentivization framework" — Gail Besner (clinical) [Ep 38 · 2:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=175)
- "Nationwide Children's Hospital implemented a point-based academic RVU system for publications, presentations, and other academic pursuits" — Gail Besner (clinical) [Ep 38 · 3:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=187)
- "External federal funding increased from $750,000 to $5.7 million, a 7.7-fold increase, after implementing the academic RVU system" — Rod Gerardo (clinical) [Ep 38 · 3:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=238)
- "The academic RVU system at Nationwide resulted in increased presentations, peer-reviewed publications, and external federal research funding" (clinical) [Ep 38 · 3:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=224)
- "At Akron, the bonus structure required the entire group to reach a certain RVU threshold for 50% of bonus, eliminating competition for individual cases" — Todd (clinical) [Ep 38 · 5:03](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=303)
- "The BC Children's Hospital gastroschisis study compared outcomes before and after implementation of a protocol in 2012, using data from 2008-2019" (clinical) [Ep 38 · 5:51](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=351)
- "At Saint Justine, gastroschisis treatment differed from other institutions with very low silo use and attempts at immediate bedside sutureless closure for nearly every patient" — Charza Jaharifard (clinical) [Ep 38 · 7:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=432)
- "Approximately 75% of gastroschisis babies can be closed immediately, either in the OR with fascial closure pre-protocol or at bedside post-protocol" — Charza Jaharifard (clinical) [Ep 38 · 7:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=477)
- "With silo reduction, parents cannot hold their baby for 5-6 days while looking at intestines through the silo" — Charza Jaharifard (clinical) [Ep 38 · 8:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=507)
- "With immediate closure, parents can hold their baby within 48 hours if intubated, or immediately if managed without intubation" — Charza Jaharifard (clinical) [Ep 38 · 8:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=523)
- "Prior myelomeningocele studies used two separate in utero surgeries: one to create the defect and one to repair it with PMSCs" (clinical) [Ep 38 · 10:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=626)
- "The current study performed a single operation at approximately 100 days gestational age, creating and repairing the defect simultaneously with PMSCs placed directly on the spinal cord" (clinical) [Ep 38 · 10:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=643)
- "PMSCs did not persist in placentas, uteri, or lambs at 3 months post-treatment" (clinical) [Ep 38 · 11:23](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=683)
- "There was no histological evidence of abnormal growth or tumor development from PMSC treatment" (clinical) [Ep 38 · 11:30](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=690)
- "Human trials using PMSCs for myelomeningocele repair have begun with the first two patients" (clinical) [Ep 38 · 11:52](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=712)
- "The curation process reviews 33 journals including top pediatric, surgical, and clinical journals (NEJM, Lancet, JAMA), averaging 1200 articles monthly" — Todd (clinical) [Ep 41 · 1:53](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=113)
- "Upper GI contrast study is very dependent on the person who performs it and availability varies by institution" (opinion) [Ep 41 · 8:08](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=488)
- "Reversal of vessels at the root of the mesentery on ultrasound is not a very reliable way to make the diagnosis of malrotation" (clinical) [Ep 41 · 8:35](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=515)
- "Presence of an appendicolith has about a 50% failure rate with non-operative management of appendicitis" — Todd (clinical) [Ep 41 · 10:22](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=622)
- "Most surgeons use the presence of appendicolith as a contraindication for non-operative management" — Todd (clinical) [Ep 41 · 10:43](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=643)
- "In the non-surgical appendicitis management group, 46% of patients required appendectomy during 5-year follow-up" — Todd (clinical) [Ep 41 · 11:52](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=712)
- "The surgical appendicitis group had no readmissions while half of the non-surgical group presented to the emergency room" — Todd (clinical) [Ep 41 · 12:04](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=724)
- "Complete resection of intermediate risk neuroblastoma doesn't provide any surgical benefit" (clinical) [Ep 41 · 13:59](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=839)
- "In stage 4 high-risk neuroblastoma, 5-year event-free survival and overall survival were significantly higher with complete resection" (clinical) [Ep 41 · 14:29](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=869)
- "Local progression in stage 4 neuroblastoma was lower with complete resection compared with incomplete resection" (clinical) [Ep 41 · 14:36](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=876)
- "Fetal endoscopic tracheal occlusion (FETO) resulted in 40% survival to discharge versus 15% with expectant care for severe left CDH" (clinical) [Ep 41 · 16:36](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=996)
- "FETO was associated with increased risk of preterm pre-labor rupture of membranes and preterm labor" (clinical) [Ep 41 · 16:44](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1004)
- "Whole blood transfusion as adjunct to component therapy resulted in decreased transfusion volume at 24 hours" — Todd (clinical) [Ep 41 · 18:33](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1113)
- "The whole blood group required fewer ventilation days compared to component therapy alone" — Todd (clinical) [Ep 41 · 18:33](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1113)
- "Mortality, length of stay, and major complications were the same between whole blood and component therapy groups" — Todd (clinical) [Ep 41 · 18:33](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1113)
- "Ambulance rigs nationwide in adults are starting to travel with whole blood capabilities and use it earlier" — Todd (clinical) [Ep 41 · 19:40](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1180)
- "Current ATLS guidelines suggest initial bolus with normal saline or crystalloid solution before moving to blood products" — Todd (guideline) [Ep 41 · 19:51](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1191)
- "Some centers are limiting whole blood use to males and children older than 15 years" — Todd (clinical) [Ep 41 · 21:10](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1270)
- "Pediatric centers don't use massive transfusion protocols as frequently as adult centers" — Todd (clinical) [Ep 41 · 20:49](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1249)
- "Gastric volvulus is associated with CDH about 17% of the time" — Rod Gerardo (epidemiological) [Ep 43 · 1:18](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=78)
- "Gastric volvulus is associated with eventration of the diaphragm about 25% of the time" — Rod Gerardo (epidemiological) [Ep 43 · 1:18](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=78)
- "60% of gastric volvulus cases happen in the first year of life in the pediatric population" — Jason Frischer (epidemiological) [Ep 43 · 1:33](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=93)
- "About 21% of pediatric gastric volvulus cases occur in the first month of life" — Jason Frischer (epidemiological) [Ep 43 · 1:33](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=93)
- "Acute gastric volvulus in young infants (around 4 months old) is more likely than chronic presentation" — Jason Frischer (clinical) [Ep 43 · 1:58](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=118)
- "Acute gastric volvulus is usually due to anatomic problems like CDH" — Rod Gerardo (clinical) [Ep 43 · 2:13](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=133)
- "Unrepaired CDH patients can volvulize their stomach and need urgent surgical correction" — Beth Rymeski (clinical) [Ep 43 · 2:24](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=144)
- "Key presentation findings include inability to advance the NG tube, bloody aspirate from the NG tube, and abnormal-looking stomach bubble on X-ray" — Beth Rymeski (clinical) [Ep 43 · 2:38](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=158)
- "Chronic gastric volvulus is related to laxity of the gastric ligaments" — Jason Frischer (clinical) [Ep 43 · 3:10](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=190)
- "The stomach has ligamentous attachments including gastrophrenic, gastrosplenic, gastrocolic, and gastropatic ligaments" — Jason Frischer (clinical) [Ep 43 · 3:10](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=190)
- "Without ligamentous attachments, the stomach is only fixed at two points: the GE junction and the pylorus" — Rod Gerardo (clinical) [Ep 43 · 3:27](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=207)
- "Organoaxial volvulus is the first and most common type of gastric volvulus" — Jason Frischer (clinical) [Ep 43 · 3:43](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=223)
- "In organoaxial volvulus, the stomach rotates around an axis between the GE junction and pylorus, with the greater curvature flipping superior to the lesser curvature" — Jason Frischer (clinical) [Ep 43 · 3:55](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=235)
- "In mesenteroaxial volvulus, rotation occurs around a line through the middle of the stomach from lesser to greater curvature" — Jason Frischer (clinical) [Ep 43 · 4:18](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=258)
- "In mesenteroaxial volvulus with contrast, the pylorus appears next to or near the GE junction and above the body of the stomach" — Jason Frischer (clinical) [Ep 43 · 4:46](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=286)
- "Typical presentation includes non-bilious emesis, gastric distention, and possible history of CDH" — Rod Gerardo (clinical) [Ep 43 · 4:58](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=298)
- "Patients with gastric volvulus typically have issues with NG tube passage" — Rod Gerardo (clinical) [Ep 43 · 5:10](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=310)
- "Plain films may show significant gastric distention in gastric volvulus" — Rod Gerardo (clinical) [Ep 43 · 5:10](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=310)
- "Contrast study is the next diagnostic step after plain films" — Rod Gerardo (clinical) [Ep 43 · 5:21](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=321)
- "On upper GI, contrast may not pass beyond the stomach or may not make it into the stomach in gastric volvulus" — Ellen Encisco (clinical) [Ep 43 · 5:32](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=332)
- "A classic bird's beak appearance may be seen when contrast is in the esophagus or at the GE junction" — Rod Gerardo (clinical) [Ep 43 · 5:49](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=349)
- "If contrast enters the stomach in organoaxial volvulus, the greater curvature appears flipped up" — Ellen Encisco (clinical) [Ep 43 · 6:02](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=362)
- "In mesenteroaxial volvulus, the duodenum may fill above or superior to the GE junction" — Rod Gerardo (clinical) [Ep 43 · 6:08](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=368)
- "Laparoscopic approach should be attempted for surgical management" — Carolina Pinzon Guzman (clinical) [Ep 43 · 7:09](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=429)
- "If the stomach is herniated into the chest, it must be reduced back into the abdomen" — Carolina Pinzon Guzman (clinical) [Ep 43 · 7:11](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=431)
- "G-tube placement is used to pexy the stomach to the abdominal wall to prevent recurrent twisting" — Carolina Pinzon Guzman (clinical) [Ep 43 · 7:26](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=446)
- "Gastropexy should be performed at at least one additional location beyond the G-tube site" — Rod Gerardo (clinical) [Ep 43 · 7:34](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=454)
- "The goal of multiple gastropexy sites is to fix the stomach in multiple planes to reduce recurrence risk" — Rod Gerardo (clinical) [Ep 43 · 7:37](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=457)
- "Fundoplication is not required in pediatric gastric volvulus repair, unlike in adult practice" — Rod Gerardo (clinical) [Ep 43 · 7:47](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=467)
- "Viability of the stomach must always be assessed intraoperatively, especially if chronically volvulized" — Jason Frischer (clinical) [Ep 43 · 8:40](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=520)
- "Patients may have latent onset with volvulus present longer than clinically apparent" — Rod Gerardo (clinical) [Ep 43 · 8:53](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=533)
- "In acute presentation with sick infant, initial management focuses on ABCs and obtaining two points of IV access" — Chris Pastor (clinical) [Ep 43 · 9:38](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=578)
- "Full set of labs should be sent during resuscitation" — Rod Gerardo (clinical) [Ep 43 · 9:49](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=589)
- "Malrotation is more common than gastric volvulus and should be high on the differential for acute presentation" — Chris Pastor (clinical) [Ep 43 · 10:14](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=614)
- "Urgent upper GI study should be obtained while resuscitating the patient to establish diagnosis" — Chris Pastor (clinical) [Ep 43 · 10:20](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=620)
- "The front of a baby's belly does not form properly during early pregnancy in gastroschisis" (clinical) [Ep 54 · 0:06](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=6)
- "Gastroschisis presents as an opening on the right side of the belly button" (clinical) [Ep 54 · 0:11](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=11)
- "The baby's intestines pass through the abdominal opening in gastroschisis" (clinical) [Ep 54 · 0:16](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=16)
- "Gastroschisis is classed as a rare birth defect" (epidemiological) [Ep 54 · 0:19](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=19)
- "The cause of gastroschisis is unknown" (clinical) [Ep 54 · 0:24](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=24)
- "Gastroschisis may mean that the intestines are not able to work properly" (clinical) [Ep 54 · 0:27](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=27)
- "Gastroschisis is not usually associated with other malformations" (clinical) [Ep 54 · 0:32](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=32)
- "A diagnosis of gastroschisis can be made before birth using ultrasound" (clinical) [Ep 54 · 0:36](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=36)
- "Many babies with gastroschisis are born prematurely (before 37 weeks)" (epidemiological) [Ep 54 · 0:45](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=45)
- "Care should be provided at a specialist center by a dedicated team with knowledge and experience of gastroschisis" (guideline) [Ep 54 · 0:51](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=51)
- "Gastroschisis is a serious condition and can be life threatening before and after birth" (clinical) [Ep 54 · 1:03](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=63)
- "Most babies with gastroschisis do survive" (epidemiological) [Ep 54 · 1:10](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=70)
- "Some babies may be transferred to a dedicated intensive care unit if they are born prematurely" (guideline) [Ep 54 · 1:18](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=78)
- "The baby's intestines are wrapped in a sterile bag to avoid damage" (clinical) [Ep 54 · 1:24](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=84)
- "Babies with gastroschisis receive fluid via a tube that delivers it through a vein" (clinical) [Ep 54 · 1:24](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=84)
- "When the baby is stable, surgery is performed to place the intestines back in the belly and close the opening" (clinical) [Ep 54 · 1:33](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=93)
- "Primary repair is a single operation to close gastroschisis" (clinical) [Ep 54 · 1:41](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=101)
- "Staged repair involves several steps to close gastroschisis" (clinical) [Ep 54 · 1:49](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=109)
- "Further surgery may be needed if other malformations are also present" (clinical) [Ep 54 · 1:54](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=114)
- "While the intestines recover, the baby receives feed through a tube that delivers it through a vein (parenteral nutrition)" (clinical) [Ep 54 · 1:59](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=119)
- "Hospital stay duration depends on the severity of gastroschisis, complications, and response to treatment" (clinical) [Ep 54 · 2:10](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=130)
- "Hospital stay often ranges between 2 to 10 weeks but may be longer if needed" (epidemiological) [Ep 54 · 2:20](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=140)
- "Follow-up care by a multidisciplinary team is required to monitor growth and development" (guideline) [Ep 54 · 2:25](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=145)
- "Some babies may experience ongoing difficulties that require different types and levels of care" (clinical) [Ep 54 · 2:37](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=157)
- "Identifying any complications or difficulties early is very important" (opinion) [Ep 54 · 2:43](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=163)
- "Some babies may require parenteral nutrition for a longer period to promote continued growth" (clinical) [Ep 54 · 2:49](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=169)
- "Peer support can be accessed through patient and family support groups" (guideline) [Ep 54 · 2:55](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=175)
- "Remote ischemic conditioning has been shown to decrease rates of necrotizing enterocolitis in a rat model." — Alex Halpern (clinical) [Ep 64 · 0:00](https://library.globalcastmd.com/watch/remote-ischemic-conditioning-decreases-the-incidence-and-severity-of-necrotizing-enterocolitis-validation-in-a-large-animal-model-10417?t=0)
- "Gadal used an established piglet NEC model to test whether RIC works in a large animal model." — Alex Halpern (clinical) [Ep 64 · 0:16](https://library.globalcastmd.com/watch/remote-ischemic-conditioning-decreases-the-incidence-and-severity-of-necrotizing-enterocolitis-validation-in-a-large-animal-model-10417?t=16)
- "Piglets were randomly assigned to receive RIC or serve as controls." — Alex Halpern (clinical) [Ep 64 · 0:20](https://library.globalcastmd.com/watch/remote-ischemic-conditioning-decreases-the-incidence-and-severity-of-necrotizing-enterocolitis-validation-in-a-large-animal-model-10417?t=20)
- "RIC was initiated at 24 hours of life and consisted of 4 cycles of 4 minutes of arterial occlusion followed by reperfusion." — Alex Halpern (clinical) [Ep 64 · 0:24](https://library.globalcastmd.com/watch/remote-ischemic-conditioning-decreases-the-incidence-and-severity-of-necrotizing-enterocolitis-validation-in-a-large-animal-model-10417?t=24)
- "Cycles were repeated every 24 hours in the low-frequency group and every 12 hours in the high-frequency group." — Alex Halpern (clinical) [Ep 64 · 0:31](https://library.globalcastmd.com/watch/remote-ischemic-conditioning-decreases-the-incidence-and-severity-of-necrotizing-enterocolitis-validation-in-a-large-animal-model-10417?t=31)
- "38 piglets were randomized into the control group, 26 into the low-frequency group, and 22 into the high-frequency group." — Alex Halpern (clinical) [Ep 64 · 0:37](https://library.globalcastmd.com/watch/remote-ischemic-conditioning-decreases-the-incidence-and-severity-of-necrotizing-enterocolitis-validation-in-a-large-animal-model-10417?t=37)
- "High-frequency RIC significantly reduced the incidence of NEC when compared to controls." — Alex Halpern (clinical) [Ep 64 · 0:45](https://library.globalcastmd.com/watch/remote-ischemic-conditioning-decreases-the-incidence-and-severity-of-necrotizing-enterocolitis-validation-in-a-large-animal-model-10417?t=45)
- "Low-frequency RIC did not significantly reduce the incidence of NEC." — Alex Halpern (clinical) [Ep 64 · 0:50](https://library.globalcastmd.com/watch/remote-ischemic-conditioning-decreases-the-incidence-and-severity-of-necrotizing-enterocolitis-validation-in-a-large-animal-model-10417?t=50)
- "High-frequency RIC protects against NEC in a piglet model." — Alex Halpern (clinical) [Ep 64 · 0:53](https://library.globalcastmd.com/watch/remote-ischemic-conditioning-decreases-the-incidence-and-severity-of-necrotizing-enterocolitis-validation-in-a-large-animal-model-10417?t=53)
- "The STAT trial was a randomized controlled trial in 12 centers worldwide." — Lizzie Lee (clinical) [Ep 65 · 0:13](https://library.globalcastmd.com/watch/stat-trial-stoma-or-intestinal-anastomosis-for-necrotizing-enterocolitis-a-multicentre-randomized-controlled-trial-10427?t=13)
- "The trial looked at newborns who underwent laparotomy for necrotizing enterocolitis requiring intestinal resection from 2010 to 2020." — Lizzie Lee (clinical) [Ep 65 · 0:13](https://library.globalcastmd.com/watch/stat-trial-stoma-or-intestinal-anastomosis-for-necrotizing-enterocolitis-a-multicentre-randomized-controlled-trial-10427?t=13)
- "Patients were randomized to two surgical approaches: either anastomosis or stoma formation." — Lizzie Lee (clinical) [Ep 65 · 0:26](https://library.globalcastmd.com/watch/stat-trial-stoma-or-intestinal-anastomosis-for-necrotizing-enterocolitis-a-multicentre-randomized-controlled-trial-10427?t=26)
- "Infants undergoing primary anastomosis had a significantly less duration of requiring parenteral nutrition compared to those with stoma formation." — Lizzie Lee (clinical) [Ep 65 · 0:31](https://library.globalcastmd.com/watch/stat-trial-stoma-or-intestinal-anastomosis-for-necrotizing-enterocolitis-a-multicentre-randomized-controlled-trial-10427?t=31)
- "There was no difference in mortality between primary anastomosis and stoma formation groups." — Lizzie Lee (clinical) [Ep 65 · 0:31](https://library.globalcastmd.com/watch/stat-trial-stoma-or-intestinal-anastomosis-for-necrotizing-enterocolitis-a-multicentre-randomized-controlled-trial-10427?t=31)
- "There was no difference in unplanned surgeries between primary anastomosis and stoma formation groups." — Lizzie Lee (clinical) [Ep 65 · 0:31](https://library.globalcastmd.com/watch/stat-trial-stoma-or-intestinal-anastomosis-for-necrotizing-enterocolitis-a-multicentre-randomized-controlled-trial-10427?t=31)
- "Primary anastomosis is superior for enhancing recovery from necrotizing enterocolitis in infants and does not increase adverse outcomes." — Lizzie Lee (opinion) [Ep 65 · 0:43](https://library.globalcastmd.com/watch/stat-trial-stoma-or-intestinal-anastomosis-for-necrotizing-enterocolitis-a-multicentre-randomized-controlled-trial-10427?t=43)
- "This is a retrospective study using educational data from children born between 1991 and 2022" — Lizzie Lee (clinical) [Ep 66 · 0:11](https://library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437?t=11)
- "The study compared 208 children with gastroschisis and over 2000 age-matched controls" — Lizzie Lee (clinical) [Ep 66 · 0:18](https://library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437?t=18)
- "Researchers used odds ratio and subgroup analysis to compare school performance using the Early Development Instrument or EDI and grade level assessments" — Lizzie Lee (clinical) [Ep 66 · 0:18](https://library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437?t=18)
- "Children with gastroschisis, even those with the simpler form, were significantly more likely to fail middle school assessments" — Lizzie Lee (clinical) [Ep 66 · 0:33](https://library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437?t=33)
- "Children with gastroschisis may face long-term learning challenges and could benefit from early educational support" — Lizzie Lee (opinion) [Ep 66 · 0:41](https://library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437?t=41)
- "80 patients with severe airway collapse after esophageal atresia repair represents a huge number; most pediatric surgeons won't see 10 such patients in their career" — George W. Holcomb III (epidemiological) [Ep 67 · 2:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=137)
- "90% of patients showed complete airway collapse on dynamic bronchoscopy" — George W. Holcomb III (clinical) [Ep 67 · 2:34](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=154)
- "Three-quarters of tracheobronchopexy procedures used a posterior approach" — George W. Holcomb III (clinical) [Ep 67 · 2:40](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=160)
- "Over half of procedures involved thoracic trachea alone, but 40% required extension onto the bronchi" — George W. Holcomb III (clinical) [Ep 67 · 2:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=164)
- "94% of patients avoided tracheostomy with a mortality rate of 5%" — George W. Holcomb III (clinical) [Ep 67 · 2:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=177)
- "Tracheobronchopexy significantly reduced pressure ventilation and ventilator dependence" — George W. Holcomb III (clinical) [Ep 67 · 2:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=177)
- "Canada's population is smaller than California but it is the second largest country in the world geographically" — Eric Skarsgard (epidemiological) [Ep 67 · 5:28](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=328)
- "The majority of Canada's population lives within 200 kilometers of the US border" — Eric Skarsgard (epidemiological) [Ep 67 · 5:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=338)
- "Outreach services were present in only 7 out of 10 provinces in Canada" — Preet Bir (epidemiological) [Ep 67 · 6:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=403)
- "Only 8 out of 18 children's hospitals (44%) provided outreach services" — Preet Bir (epidemiological) [Ep 67 · 6:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=403)
- "A significant number of outreach services are located within 50 kilometers of a children's hospital" — Em Gootee (epidemiological) [Ep 67 · 6:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=417)
- "In most places in Canada, no one would transfer a 16 or 17 year old with appendicitis to a children's hospital for surgery" — Eric Skarsgard (clinical) [Ep 67 · 7:36](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=456)
- "The Canadian healthcare system does not ensure timely care; children wait for surgery beyond their wait time target" — Eric Skarsgard (clinical) [Ep 67 · 8:01](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=481)
- "Newfoundland and Labrador has only two pediatric surgeons but has the most well-established outreach clinic system in Canada" — Eric Skarsgard (epidemiological) [Ep 67 · 8:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=496)
- "5% of all pediatric procedures in the NSQIP database were G-tube placements" — Sean Kunisaki (epidemiological) [Ep 67 · 11:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=716)
- "The study analyzed 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023" — Em Gootee (epidemiological) [Ep 67 · 12:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=762)
- "77% of G-tube cases were first-time placements as opposed to redos" — Anusha Maturu / Derek Wakeman (epidemiological) [Ep 67 · 12:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=766)
- "Upper GI studies were obtained in 45% of first-time G-tube cases" — Em Gootee (clinical) [Ep 67 · 13:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=784)
- "Interhospital variability in upper GI use ranged from 0 to 99%" — Em Gootee (clinical) [Ep 67 · 13:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=784)
- "14% of G-tube cases resulted in an ED visit within 0 to 30 days" — Em Gootee (clinical) [Ep 67 · 13:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=825)
- "5.2% of G-tubes were dislodged within 0 to 30 days" — Em Gootee (clinical) [Ep 67 · 13:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=825)
- "An additional 5.5% of G-tubes were dislodged in the 31 to 60 day period" — Anusha Maturu / Derek Wakeman (clinical) [Ep 67 · 13:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=835)
- "Dislodgement rates are higher than readmission rates or IR intervention rates" — Anusha Maturu / Derek Wakeman (clinical) [Ep 67 · 13:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=835)
- "If dislodgements can be reduced, ED visits will decrease correspondingly" — Anusha Maturu / Derek Wakeman (opinion) [Ep 67 · 14:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=855)
- "A 12 year old female presented with a three month history of intermittent pain and weight loss with an acute worsening of her symptoms" (clinical) [Ep 71 · 0:08](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=8)
- "A CT scan showed evidence of a mid gut volvulus" (clinical) [Ep 71 · 0:15](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=15)
- "The patient was positioned in a Dorsal lithotomy position with the surgeon positioned between the patient's legs" (clinical) [Ep 71 · 0:18](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=18)
- "5 millimeter ports were used for the procedure" (clinical) [Ep 71 · 0:29](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=29)
- "There was an internal hernia and a complete twist of the bowel" (clinical) [Ep 71 · 0:51](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=51)
- "The ability to dissect grasp tissue and then seal and divide the tissue safely in close proximity to the bowel wall is key to the success of this operation" (opinion) [Ep 71 · 1:06](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=66)
- "The ability to have the Trinity device activated while laying on the bowel wall without any injury is key to the success of this procedure" (opinion) [Ep 71 · 2:13](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=133)
- "The anatomy in this case is quite confusing because of the 360 degree twist of the bowel as well as the internal hernia" (clinical) [Ep 71 · 2:38](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=158)
- "The key to this operation is to operate in front of the camera and eventually run the bowel in front of the camera instead of chasing the bowel around the abdomen" (opinion) [Ep 71 · 2:52](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=172)
- "Operating in front of the camera prevents disorientation and allows the surgeon to keep a clear view of the affected area" (opinion) [Ep 71 · 3:02](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=182)
- "The superior mesenteric vessels were quite engorged because they had been twisted" (clinical) [Ep 71 · 3:13](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=193)
- "It is critical that the bowel be completely run from the duodenojejunal junction all the way to the ileocecal valve to ensure that all of these bands have been released" (opinion) [Ep 71 · 4:00](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=240)
- "The key to this operation is making sure that the mesentery has been broadly widened to prevent a twist in the future" (opinion) [Ep 71 · 6:29](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=389)
- "One should be able to see the superior mesenteric artery and vein coming straight down into the middle of the abdomen with no twists or obstruction" (opinion) [Ep 71 · 6:39](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=399)
- "The final positioning places all the small bowel on the patient's right and the colon on the patient's left" (clinical) [Ep 71 · 7:17](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=437)
- "The appendix is divided with a single application of the 5 millimeter stapler, which allows keeping all ports at 5 millimeters and not upsizing to a 12 millimeter port for a larger stapler" (clinical) [Ep 71 · 7:37](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=457)
- "The operation took approximately 90 minutes, and the patient did well" (clinical) [Ep 71 · 7:58](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=478)
- "The infant presented with repetitive bilious vomiting" (clinical) [Ep 70 · 0:00](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=0)
- "Upper GI series showed a redundant duodenum which did not cross the midline" (clinical) [Ep 70 · 0:09](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=9)
- "The surgeon positions at the end of the table with the baby brought down to the foot to allow alignment with the foregut" (clinical) [Ep 70 · 0:16](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=16)
- "A 4 or 5 millimeter port is placed in the umbilicus with right and left hand operating ports placed either side" (clinical) [Ep 70 · 0:28](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=28)
- "In a small infant, the right hand port is placed above the umbilicus to prevent conflict between the right hand and the scope" (clinical) [Ep 70 · 0:36](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=36)
- "A very dilated proximal duodenum was visualized under the liver" (clinical) [Ep 70 · 0:47](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=47)
- "The 3 millimeter sealer can be used to safely grasp the bowel and act as an atraumatic forceps" (clinical) [Ep 70 · 1:00](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=60)
- "The first portion of the duodenum is extremely dilated" (clinical) [Ep 70 · 1:22](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=82)
- "Dense adhesions to the proximal duodenum can be safely taken down using the sealer by dissecting them off the bowel, then sealing and gently tearing them off the duodenal surface" (clinical) [Ep 70 · 1:33](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=93)
- "The minimal energy spread of the sealer makes it very safe to dissect in this fashion" (clinical) [Ep 70 · 1:51](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=111)
- "The bowel can be grasped immediately after the sealer is activated without any evidence of heat injury" (clinical) [Ep 70 · 1:58](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=118)
- "The sealer is more useful than using a hook, which has significant energy spread and cannot be used to grasp the bowel" (opinion) [Ep 70 · 2:10](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=130)
- "The dissection is continued in a proximal to distal fashion, exposing the second portion of the duodenum" (clinical) [Ep 70 · 2:23](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=143)
- "There is minimal bleeding using this technique and no injury to the bowel" (clinical) [Ep 70 · 2:56](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=176)
- "As is common in these cases, the duodenum goes towards the retroperitoneum, and this is the most difficult part to mobilize" (clinical) [Ep 70 · 3:13](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=193)
- "Adhesions between the transverse colon and the second and third portions of the duodenum, some consistent with Ladd bands, can be extremely thick and dense" (clinical) [Ep 70 · 3:35](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=215)
- "Complete mobilization of the transverse and proximal ascending colon is necessary due to posterior attachments" (clinical) [Ep 70 · 4:08](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=248)
- "Lateral wall attachments between the cecum and retroperitoneum are extremely flimsy and easily taken down" (clinical) [Ep 70 · 4:19](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=259)
- "Ladd's bands were seen crossing portions of the ileum, causing a partial obstruction" (clinical) [Ep 70 · 4:59](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=299)
- "The minimal energy spread from the sealer allows use in close proximity to the small bowel without risk of injury" (clinical) [Ep 70 · 5:19](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=319)
- "The duodenum was seen doubling back on itself" (clinical) [Ep 70 · 5:52](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=352)
- "The posterior attachments of the duodenum could not be reached until the Ladd's bands had been completely divided" (clinical) [Ep 70 · 7:01](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=421)
- "The area where the duodenum transitioned in the proximal portion was extremely dilated" (clinical) [Ep 70 · 7:24](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=444)
- "The sealer can act as an atraumatic bowel grasper during bowel running, though the jaws are not quite as large as the 3 millimeter bowel grasper" (clinical) [Ep 70 · 7:39](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=459)
- "The sealer is used during bowel running because other bands are often encountered, allowing immediate sealing and division" (clinical) [Ep 70 · 7:56](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=476)
- "Enlarged lymph nodes in the mesentery and chylous appearance within the bowel show evidence of chronic mild obstruction" (clinical) [Ep 70 · 8:29](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=509)
- "At completion of the Ladd's procedure, all of the colon is on the left and the small bowel is on the right" (clinical) [Ep 70 · 8:56](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=536)
- "In a small infant with a small appendix, the appendix can be brought out through the right trochar site and amputated extracorporeally" (clinical) [Ep 70 · 9:06](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=546)
- "The START trial randomized 140 infants with biliary atresia to high-dose steroids (13-week course) versus placebo after Kasai portoenterostomy" — Daniel von Allmen (clinical) [Ep 26 · 2:56](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=176)
- "High-dose steroid therapy following Kasai did not result in statistically significant treatment difference in bile drainage at 6 months: 58.6% treatment group versus 48.6% placebo" — Daniel von Allmen (clinical) [Ep 26 · 4:01](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=241)
- "Survival without liver transplant at 24 months was not statistically different: 58.7% steroid group versus 49.4% placebo group" — Daniel von Allmen (clinical) [Ep 26 · 4:39](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=279)
- "Adverse events occurred in near 80% of patients in both steroid and placebo groups, attributed largely to severe underlying liver dysfunction" — Daniel von Allmen (clinical) [Ep 26 · 4:55](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=295)
- "Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia" — Daniel von Allmen (clinical) [Ep 26 · 5:10](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=310)
- "The study was powered to detect a 25% absolute treatment difference in outcomes" — Daniel von Allmen (clinical) [Ep 26 · 3:46](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=226)
- "Steroids are proposed to work through two mechanisms: reducing ongoing inflammation to preserve bile ductules, and acting as a choleretic to maintain bile flow" — Daniel von Allmen (clinical) [Ep 26 · 8:59](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=539)
- "Washington State registry study included over 50 hospitals and analyzed clean-contaminated operations over 18 months beginning January 2011" — Whit Holcomb (clinical) [Ep 26 · 12:02](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=722)
- "Overall surgical site infection rate was 4.6%, varying by procedure: 6.6% colorectal, 1.4% bariatric, 1.5% other" — Whit Holcomb (epidemiological) [Ep 26 · 13:05](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=785)
- "No single antiseptic agent was associated with lower risk of surgical site infection than any other agent" — Whit Holcomb (clinical) [Ep 26 · 13:39](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=819)
- "Isopropyl alcohol provided no benefit: 4.5% SSI rate without alcohol versus 4.6% with alcohol" — Whit Holcomb (clinical) [Ep 26 · 13:49](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=829)
- "Registry data could not identify surgical site infections diagnosed after discharge, likely underestimating true SSI rate" — Whit Holcomb (clinical) [Ep 26 · 14:20](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=860)
- "Recent reports show 50% or more surgical site infections are diagnosed after discharge" — Whit Holcomb (epidemiological) [Ep 26 · 14:40](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=880)
- "Most surgical site infections occur 3 to 10 days after operation" — Whit Holcomb (clinical) [Ep 26 · 14:48](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=888)
- "Chlorhexidine prep dries faster than betadine, allowing cases to start sooner" — Whit Holcomb (clinical) [Ep 26 · 18:33](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1113)
- "Appendicitis pilot RCT enrolled 50 patients aged 5-15 years with non-perforated appendicitis: 26 randomized to operation, 24 to antibiotics" — Whit Holcomb (clinical) [Ep 26 · 22:58](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1378)
- "Of 24 patients randomized to non-operative treatment, 2 underwent appendectomy during primary treatment course and 1 had appendectomy at 9 months for recurrent appendicitis" — Whit Holcomb (clinical) [Ep 26 · 23:14](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1394)
- "An additional 6 patients in the non-operative group underwent appendectomy for recurrent abdominal pain or parental desire during 1-year follow-up, with no appendicitis found on histology" — Whit Holcomb (clinical) [Ep 26 · 23:32](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1412)
- "Total of 9 of 24 patients (38%) initially randomized to antibiotic therapy underwent appendectomy within first year, making success rate 62%" — Whit Holcomb (clinical) [Ep 26 · 24:10](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1450)
- "Median time to discharge was significantly shorter in surgical group than non-operative group, possibly due to stipulated 48-hour minimum hospitalization for non-operative patients" — Whit Holcomb (clinical) [Ep 26 · 24:35](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1475)
- "Cost for initial inpatient stay was significantly lower in non-operative treatment group despite longer hospitalizations" — Whit Holcomb (clinical) [Ep 26 · 24:55](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1495)
- "Immunosuppressed cancer patients with typhlitis are sometimes treated non-operatively and most resolve with antibiotics" — Whit Holcomb (clinical) [Ep 26 · 27:00](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1620)
- "PIFCON study included 272 patients from 14 multidisciplinary intestinal rehab programs with median 33-month follow-up" — Aaron Lipskar (clinical) [Ep 26 · 32:32](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1952)
- "Enteral autonomy was achieved in 43% of intestinal failure cohort, 13% remained PN-dependent, and 43% died or underwent transplantation" — Aaron Lipskar (epidemiological) [Ep 26 · 32:40](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1960)
- "Necrotizing enterocolitis diagnosis, care at intestinal rehab facility without transplant center, and presence of ileocecal valve were associated with statistically significant higher rates of enteral autonomy" — Aaron Lipskar (clinical) [Ep 26 · 32:58](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1978)
- "Residual small bowel length was a statistically significant but less impressive predictor of enteral autonomy" — Aaron Lipskar (clinical) [Ep 26 · 33:19](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1999)
- "The protective effect of necrotizing enterocolitis on enteral autonomy goes against understanding of that inflammatory illness" — Aaron Lipskar (opinion) [Ep 26 · 33:55](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2035)
- "A companion paper in same journal showed necrotizing enterocolitis was a poor predictor of growth outcome in infants with short bowel syndrome" — Aaron Lipskar (clinical) [Ep 26 · 35:12](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2112)
- "FDA established SmartTots partnership with International Anesthesia Research Society in 2009 to study anesthesia-related neurotoxicity" — Aaron Lipskar (guideline) [Ep 26 · 37:19](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2239)
- "SmartTots 2012 consensus statement recommended avoiding elective surgical procedures under anesthesia in children less than 3 years when possible" — Aaron Lipskar (guideline) [Ep 26 · 37:34](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2254)
- "Commonly used anesthetics including propofol, etomidate, sevoflurane, isoflurane, and ketamine produce profound neurotoxic effects in laboratory animals from nematodes to nonhuman primates" — Aaron Lipskar (clinical) [Ep 26 · 38:09](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2289)
- "Observational studies in children undergoing early anesthesia offer conflicting results but suggest some children may have deficits, though causation difficult to establish" — Aaron Lipskar (clinical) [Ep 26 · 38:43](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2323)
- "June 2014 SmartTots statement concluded animal data sufficiently convincing that large-scale clinical studies are warranted" — Aaron Lipskar (guideline) [Ep 26 · 39:06](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2346)
- "Updated recommendation is to avoid surgical procedures under anesthesia in children under 3 years unless situation is urgent or potentially harmful if not attended to" — Aaron Lipskar (guideline) [Ep 26 · 39:14](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2354)
- "Regional anesthesia blocks can diminish amount of potentially neurotoxic medications in almost every laparoscopic, thoracoscopic, or open operation" — Aaron Lipskar (clinical) [Ep 26 · 42:00](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2520)
- "Rule of two suggested: defer elective operations until after age 2 and try not to have two anesthetics in one year" — Todd Ponsky (opinion) [Ep 26 · 42:16](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2536)
- "Survey of 150 parents in primary care pediatrics office found vast majority did not know anesthetic neurotoxicity was a major issue" — Aaron Lipskar (epidemiological) [Ep 26 · 43:17](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2597)
- "Despite 6 decades of research, the exact cause of NEC is unknown and there is no absolute cure" — Gail Besner (clinical) [Ep 9 · 2:11](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=131)
- "Indomethacin predisposes babies to both isolated ileal perforation and necrotizing enterocolitis" — Gail Besner (clinical) [Ep 9 · 3:53](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=233)
- "PPIs and H2 blockers that neutralize gastric acid may predispose to NEC" — Gail Besner (clinical) [Ep 9 · 4:44](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=284)
- "Neutropenia is more concerning than elevated white blood cell count in NEC, suggesting overwhelming sepsis" — Gail Besner (clinical) [Ep 9 · 7:17](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=437)
- "Thrombocytopenia can result from endotoxemia and gram-negative septicemia in NEC" — Gail Besner (clinical) [Ep 9 · 7:33](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=453)
- "Cross-table lateral or lateral decubitus films are necessary to detect subtle free air" — Gail Besner (clinical) [Ep 9 · 8:50](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=530)
- "Free air is an absolute indication for surgical intervention (drain or laparotomy)" — Gail Besner (clinical) [Ep 9 · 9:38](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=578)
- "Fixed loops of intestine on serial X-rays are not an absolute indication for surgery but are a concerning sign" — Gail Besner (clinical) [Ep 9 · 10:02](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=602)
- "Portal venous air is worrisome but not an absolute indication for surgery; some patients improve with medical management" — Gail Besner (clinical) [Ep 9 · 10:16](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=616)
- "Medical management of NEC includes NPO status, orogastric decompression, broad-spectrum antibiotics, and serial monitoring" — Gail Besner (clinical) [Ep 9 · 10:58](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=658)
- "Small feeding tubes are inadequate for gastric decompression; an orogastric tube should be placed" — Gail Besner (clinical) [Ep 9 · 12:05](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=725)
- "There is tremendous diversity in antibiotic regimens for NEC across the United States" — Gail Besner (epidemiological) [Ep 9 · 12:43](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=763)
- "Abdominal X-rays should be obtained at intervals (approximately every 8 hours) during medical management" — Gail Besner (clinical) [Ep 9 · 13:37](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=817)
- "Medical NEC management should continue for at least 1 week to 10 days before attempting feeds" — Gail Besner (clinical) [Ep 9 · 14:15](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=855)
- "Strictures after medical NEC typically occur in the colon, usually near the splenic flexure, but can occur anywhere" — Gail Besner (clinical) [Ep 9 · 14:40](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=880)
- "Contrast enema should be performed before upper GI series when evaluating for post-NEC stricture" — Gail Besner (clinical) [Ep 9 · 15:17](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=917)
- "Serial abdominal exams are critical for determining operative timing in NEC without absolute indications" — Gail Besner (clinical) [Ep 9 · 16:23](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=983)
- "Worsening distention, peritoneal signs, increasing pressor requirements, and renal shutdown collectively indicate need for surgery" — Gail Besner (clinical) [Ep 9 · 16:43](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1003)
- "The MOSS and Piero trials showed no difference in overall mortality between peritoneal drainage and laparotomy for NEC" — Gail Besner (clinical) [Ep 9 · 19:44](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1184)
- "Babies with peritoneal drains may have worse neurological outcomes at 1-2 years compared to laparotomy" — Gail Besner (clinical) [Ep 9 · 20:14](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1214)
- "The NEST trial randomized 300 babies to drainage versus laparotomy and will assess neurological outcomes at 18-22 months" — Gail Besner (clinical) [Ep 9 · 20:34](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1234)
- "100% of European surgeons at a recent NEC conference perform laparotomy rather than peritoneal drainage" — Gail Besner (epidemiological) [Ep 9 · 19:10](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1150)
- "Removal of inflammatory necrotic tissue via laparotomy may lead to better neurological outcomes than drainage alone" — Gail Besner (opinion) [Ep 9 · 21:57](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1317)
- "There are no definitive criteria to guide the choice between peritoneal drainage and laparotomy" — Gail Besner (clinical) [Ep 9 · 22:58](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1378)
- "Isolated intestinal perforation can cause systemic inflammatory response syndrome as severe as NEC" — Gail Besner (clinical) [Ep 9 · 24:15](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1455)
- "Peritoneal drain placement can be performed at bedside with local anesthesia through a small right lower quadrant incision" — Gail Besner (clinical) [Ep 9 · 26:15](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1575)
- "A significant proportion of patients with peritoneal drains continue to decline and require laparotomy" — Gail Besner (clinical) [Ep 9 · 25:46](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1546)
- "Operating during peak inflammatory phase after drain placement can result in extensive adhesions and multiple enterotomies" — Gail Besner (clinical) [Ep 9 · 28:43](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1723)
- "Knowing when to abort an operation and create a proximal diversion is an important surgical decision" — Gail Besner (opinion) [Ep 9 · 29:03](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1743)
- "Peritoneal drains should be advanced out gradually over several days starting at 7-10 days postoperatively" — Gail Besner (clinical) [Ep 9 · 29:48](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1788)
- "Supraumbilical transverse incision is preferred for NEC laparotomy" — Gail Besner (clinical) [Ep 9 · 31:43](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1903)
- "Liver and spleen injury are critical risks in premature NEC surgery; even minor trauma can cause fatal subcapsular hematoma" — Gail Besner (clinical) [Ep 9 · 32:27](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=1947)
- "Spontaneous intestinal perforation presents as one small localized perforation, while NEC involves more diffuse disease with pneumatosis" — Gail Besner (clinical) [Ep 9 · 33:21](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2001)
- "Primary anastomosis is performed in some countries but US surgeons typically create stomas due to concerns about anastomotic healing" — Gail Besner (epidemiological) [Ep 9 · 34:04](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2044)
- "Stomas should be brought out through the laparotomy incision close together to facilitate later closure" — Gail Besner (clinical) [Ep 9 · 35:20](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2120)
- "Stomas should be tacked to fascia but not matured; the distal end may slough off" — Gail Besner (clinical) [Ep 9 · 35:42](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2142)
- "When bowel appears injured but not necrotic, it may be appropriate to avoid resection and perform a second-look operation in 24-48 hours" — Gail Besner (clinical) [Ep 9 · 37:12](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2232)
- "For multiple skip lesions, resection with multiple anastomoses distal to a proximal diverting stoma protects against anastomotic leak" — Gail Besner (clinical) [Ep 9 · 38:07](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2287)
- "Clip and drop technique (resecting dead bowel, clipping ends, returning to abdomen) can be life-saving in unstable patients" — Gail Besner (clinical) [Ep 9 · 38:46](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2326)
- "Stoma reversal is typically performed when baby reaches approximately 2000g, is stable, and feeding well" — Gail Besner (clinical) [Ep 9 · 39:32](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2372)
- "Earlier stoma reversal may be indicated for TPN-induced cholestasis or inability to nourish due to high stoma output" — Gail Besner (clinical) [Ep 9 · 39:53](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2393)
- "Refeeding through mucous fistula is done selectively for very high output stomas to reduce TPN dependence" — Gail Besner (clinical) [Ep 9 · 40:48](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2448)
- "Mucous fistulas often stricture, losing the opportunity for refeeding; a small catheter can be left in place to maintain access" — Gail Besner (clinical) [Ep 9 · 41:28](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2488)
- "The chance of a baby with NEC totalis surviving to receive small bowel-liver transplant is very close to zero" — Gail Besner (clinical) [Ep 9 · 42:32](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2552)
- "For NEC totalis in very small premature babies, comfort care is an appropriate option given lack of viable treatment" — Gail Besner (opinion) [Ep 9 · 42:56](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2576)
- "Months to years of TPN required after massive resection will irreversibly injure the liver" — Gail Besner (clinical) [Ep 9 · 43:42](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2622)
- "Pneumothorax can dissect through the diaphragm into the abdomen, mimicking intestinal perforation" — Gail Besner (clinical) [Ep 9 · 44:38](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2678)
- "Angiocatheter decompression of pneumoperitoneum is a useful temporizing measure in hemodynamically unstable patients" — Gail Besner (clinical) [Ep 9 · 45:06](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2706)
- "70% of volvulus cases occur in the first two months of life" (epidemiological) [Ep 2 · 27:30](https://library.globalcastmd.com/watch/malrotation-629?t=1650)
- "90% of volvulus cases occur by the first two years of life" (epidemiological) [Ep 2 · 27:30](https://library.globalcastmd.com/watch/malrotation-629?t=1650)
- "In 20% of cases with true malrotations of the fore and mid-gut, you have a normal barium enema" (clinical) [Ep 2 · 19:27](https://library.globalcastmd.com/watch/malrotation-629?t=1167)
- "A normal ultrasound does not rule out volvulus" (clinical) [Ep 2 · 19:55](https://library.globalcastmd.com/watch/malrotation-629?t=1195)
- "Ladd bands do not cause midgut volvulus" — Jack (opinion) [Ep 2 · 4:02](https://library.globalcastmd.com/watch/malrotation-629?t=242)
- "Ladd bands are continuation tissue along the mesentery that when divided allows the mesentery to splay out" — Todd (clinical) [Ep 2 · 4:25](https://library.globalcastmd.com/watch/malrotation-629?t=265)
- "You get Ladd bands if you have a shortened mesentery; the Ladd bands do not cause shortening of the mesentery" — Jack (opinion) [Ep 2 · 4:08](https://library.globalcastmd.com/watch/malrotation-629?t=248)
- "Complication rate in heterotaxy patients undergoing Ladd procedures is between 30 and 50%" (epidemiological) [Ep 2 · 24:59](https://library.globalcastmd.com/watch/malrotation-629?t=1499)
- "In heterotaxy patients without bilious emesis and symptoms, there were no cases of volvulus in 4 years of follow-up" (epidemiological) [Ep 2 · 25:50](https://library.globalcastmd.com/watch/malrotation-629?t=1550)
- "The key reason to operate on an asymptomatic patient is to avoid midgut volvulus" — Jack (opinion) [Ep 2 · 3:52](https://library.globalcastmd.com/watch/malrotation-629?t=232)
- "The key point is the distance between the ligament of Treitz and the ileocecal junction" — Jack (clinical) [Ep 2 · 1:53](https://library.globalcastmd.com/watch/malrotation-629?t=113)
- "If the distance between ligament of Treitz and ileocecal junction is less than half the diameter of the abdominal cavity, intervention is needed" — Jack (opinion) [Ep 2 · 39:27](https://library.globalcastmd.com/watch/malrotation-629?t=2367)
- "Dilated loops of bowel will always give you a low lying ligament of Treitz" — Todd (clinical) [Ep 2 · 11:53](https://library.globalcastmd.com/watch/malrotation-629?t=713)
- "Laparoscopic Ladd procedure can be performed effectively even in newborns" — Tim (opinion) [Ep 2 · 8:16](https://library.globalcastmd.com/watch/malrotation-629?t=496)
- "Cardiac patients with single ventricle physiology between first stage and Glenn procedure do not stratify out to be at higher risk for reflux complications" — Todd (clinical) [Ep 2 · 15:19](https://library.globalcastmd.com/watch/malrotation-629?t=919)
- "Ladd bands can cause compression of the duodenum but the band itself is not risky for volvulus" — Todd (opinion) [Ep 2 · 36:39](https://library.globalcastmd.com/watch/malrotation-629?t=2199)
- "The risk requiring operation is bilious vomiting and narrowing of the pedicle" — Todd (opinion) [Ep 2 · 36:53](https://library.globalcastmd.com/watch/malrotation-629?t=2213)
- "In patients with reversed mesenteric vessels on ultrasound, there was never a case where vessels were normal in a patient who had risk for volvulus with narrow base mesentery" — Jack (clinical) [Ep 2 · 41:15](https://library.globalcastmd.com/watch/malrotation-629?t=2475)
- "Ladd bands are teleologically an attempt of the body to fuse the cecum to the lateral peritoneal wall" — Wit (opinion) [Ep 2 · 37:16](https://library.globalcastmd.com/watch/malrotation-629?t=2236)
- "Patients with high-riding cecum are more likely to have obstructive or significant Ladd bands" — Wit (opinion) [Ep 2 · 37:10](https://library.globalcastmd.com/watch/malrotation-629?t=2230)
- "There are no clear predictive factors to identify which patients with early NEC will progress to require surgical intervention" — Jose Prince (clinical) [Ep 3 · 1:54](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=114)
- "Rate of feeding advancement does not correlate with developing necrotizing enterocolitis" (clinical) [Ep 3 · 3:11](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=191)
- "Probiotics have the most evidence for NEC prevention, supported by Cochrane database" (clinical) [Ep 3 · 3:35](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=215)
- "Many US institutions do not routinely use probiotics despite evidence, due to uncertainty about formulation and dosing" — Jose Prince (clinical) [Ep 3 · 4:19](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=259)
- "Focal abdominal wall erythema is one of the most sensitive indicators for underlying dead bowel" (clinical) [Ep 3 · 12:24](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=744)
- "Free air (pneumoperitoneum) is the only single factor that would prompt operation without additional findings" (clinical) [Ep 3 · 12:55](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=775)
- "Transporting a 600g infant to the OR increases risk of demise due to ventilatory changes, fluid administration, and patent ductus arteriosus" — Tim (clinical) [Ep 3 · 15:08](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=908)
- "Approximately 30% of patients treated with peritoneal drainage never require subsequent laparotomy" (clinical) [Ep 3 · 16:21](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=981)
- "One kilogram is used as a threshold weight above which laparotomy is preferred over drainage" (clinical) [Ep 3 · 19:06](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=1146)
- "Bilateral grade 4 intraventricular hemorrhage does not independently change surgical decision-making unless family wishes comfort measures" — Tim (opinion) [Ep 3 · 20:10](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=1210)
- "Primary anastomosis in NEC is not commonly performed due to inability to evaluate for anastomotic leak in sick neonates" (clinical) [Ep 3 · 22:01](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=1321)
- "The Shishka baby technique involves threading a tube through multiple segments of bowel with a few stitches, bringing both ends out as stomas" (clinical) [Ep 3 · 23:29](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=1409)
- "Stoma takedown can be performed as early as 4 weeks post-operation, earlier than the traditional 8-week waiting period" (clinical) [Ep 3 · 26:26](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=1586)
- "Bringing stomas out side-by-side rather than separated reduces bowel manipulation during subsequent takedown" (clinical) [Ep 3 · 27:00](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=1620)
- "Waiting 6 weeks for stoma reversal allows inflammatory response to subside and adhesions to become more flimsy" (clinical) [Ep 3 · 29:02](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=1742)
- "In cases of apparent total intestinal necrosis, a second-look operation at 48 hours may reveal viable bowel" (clinical) [Ep 3 · 30:55](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=1855)
- "Decompressing distended bowel may reduce ischemia and salvage additional segments" (clinical) [Ep 3 · 31:50](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=1910)
- "No child with NEC totalis has successfully survived intestinal transplantation" — Jose Prince (clinical) [Ep 3 · 33:54](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=2034)
- "Twenty centimeters of small bowel is now considered a potential threshold for attempting salvage rather than closure" — Jose Prince (clinical) [Ep 3 · 34:23](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=2063)
- "Most damage to the intestine in gastroschisis occurs in the last few weeks of pregnancy based on animal and clinical studies" — Jack (clinical) [Ep 1 · 2:45](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=165)
- "Delivering gastroschisis at 37 weeks results in better neonatal outcomes compared to later delivery" — Jack (clinical) [Ep 1 · 3:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=194)
- "Delivering gastroschisis too early (34-35 weeks) trades bowel problems for problems of prematurity" — Jack (clinical) [Ep 1 · 3:22](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=202)
- "The age at spontaneous onset of labor for gastroschisis pregnancy is 3 weeks earlier than the general population" — Jack (epidemiological) [Ep 1 · 3:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=224)
- "About half of gastroschisis pregnancies go into labor spontaneously before 37 weeks" — Jack (epidemiological) [Ep 1 · 3:56](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=236)
- "No perinatal center in Canada performs routine cesarean sections for gastroschisis" — Jack (epidemiological) [Ep 1 · 4:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=277)
- "Routine cesarean section for gastroschisis was standard of care 15-20 years ago but has gone out of favor" — Jack (guideline) [Ep 1 · 4:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=289)
- "Using a pre-formed silo allows gentle reduction of bowel without trauma from forceps manipulation" — Jack (clinical) [Ep 1 · 8:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=507)
- "Approximately one-third of gastroschisis cases can be reduced at bedside using the Bianchi technique with silo assistance" — Jack (clinical) [Ep 1 · 8:47](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=527)
- "Waiting for 10% body weight loss before reducing gastroschisis allows bowel edema to resolve" (clinical) [Ep 1 · 9:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=554)
- "Leaving a silo on for more than one day causes the fascial defect to enlarge significantly" — Jack (clinical) [Ep 1 · 9:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=581)
- "There are two types of intestinal atresia in gastroschisis: early-developing atresia without bowel thickening, and late-occurring atresia from small defect with matted bowel" — Jack (clinical) [Ep 1 · 15:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=958)
- "Bringing a stoma out through the umbilicus avoids creating an additional abdominal scar" — Jack (clinical) [Ep 1 · 17:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1039)
- "Umbilical stoma placement provides an easy location for appliance placement compared to lateral positions" — Jack (clinical) [Ep 1 · 17:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1061)
- "Silver sulfadiazine use in the first month of life can cause white blood count suppression and requires monitoring" — Jack (clinical) [Ep 1 · 26:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1618)
- "Intragastric pressure of 20 is suggested as the threshold for safe abdominal closure" — Jack (guideline) [Ep 1 · 30:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1802)
- "In older children with chronic omphalocele, the abdomen does not expand as rapidly as in newborns and requires more time for staged reduction" — Jack (clinical) [Ep 1 · 36:51](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=2211)
- "In right atrial isomerism there is a higher incidence of malrotation compared to left atrial isomerism" — Todd (epidemiological) [Ep 6 · 3:54](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=234)
- "Texas Children's study of 95 consecutive heterotaxy malrotation patients: three quarters underwent Ladd procedure with no post-op volvulus but 11% small bowel obstruction rate requiring admission and often surgery" — Kenneth Azarow (clinical) [Ep 6 · 5:57](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=357)
- "25% of heterotaxy malrotation patients were observed with no small bowel obstruction and no volvulus at 10-15 year follow-up" — Kenneth Azarow (clinical) [Ep 6 · 6:20](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=380)
- "Appendectomy is not without its obstruction rate in the long term from adhesions" — Kenneth Azarow (clinical) [Ep 6 · 6:56](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=416)
- "A low lying ligament of Treitz defines malrotation, not something crossing the midline, because something can be floppy when it crosses the midline and that does not exclude malrotation" — Kenneth Azarow (clinical) [Ep 6 · 8:59](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=539)
- "Overall success rate for meconium ileus contrast enemas is going down on first attempts in recent literature" — Kenneth Azarow (epidemiological) [Ep 6 · 14:41](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=881)
- "To achieve success rate above 60%, almost two-thirds to three-quarters, you need to do multiple enemas" — Kenneth Azarow (clinical) [Ep 6 · 15:11](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=911)
- "63% of successful meconium ileus enemas require more than one attempt in radiology" — Kenneth Azarow (epidemiological) [Ep 6 · 15:11](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=911)
- "A perforation in the meconium ileus setting complicates things tremendously" — Kenneth Azarow (clinical) [Ep 6 · 15:44](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=944)
- "Going to a hypertonic solution like gastrografin on second or third meconium ileus enema attempts has been the contrast of choice" — Kenneth Azarow (clinical) [Ep 6 · 16:23](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=983)
- "Current trend across the country is managing solid organ injuries based on hemodynamics rather than CT grade" — Kenneth Azarow (clinical) [Ep 6 · 19:08](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=1148)
- "Tachycardia in solid organ injury can be due to pain, overlying broken rib, or blood in the abdomen and splenic injury, requiring pain control to differentiate" — Kenneth Azarow (clinical) [Ep 6 · 20:34](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=1234)
- "Grade 5 splenic injury patient was discharged within 48 hours, something that never would have happened even last year without the new algorithm" — Kenneth Azarow (clinical) [Ep 6 · 21:13](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=1273)
- "Literature is fairly clear that solid organ injury patients don't need to be imaged any further after initial CT" — Kenneth Azarow (guideline) [Ep 6 · 22:55](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=1375)
- "Once you have a stable clot for about 3 weeks in solid organ injury, that's probably more stable than the remaining spleen" — Kenneth Azarow (clinical) [Ep 6 · 24:15](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=1455)
- "In adults, 2 centimeters for a mesenteric vessel pseudoaneurysm is the cutoff at which everybody's going to get nervous" — Todd (clinical) [Ep 6 · 26:19](https://library.globalcastmd.com/watch/malrotation-volvulus-meconium-ileus-solid-organ-injury-update-course-2015-673?t=1579)
- "Most intestinal damage in gastroschisis occurs in the last few weeks of pregnancy based on animal and clinical studies" (clinical) [Ep 15 · 2:45](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=165)
- "Neonatal outcomes are better if gastroschisis is delivered slightly early at 37 weeks" (clinical) [Ep 15 · 3:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=194)
- "Delivering gastroschisis too early at 34-35 weeks trades bowel problems for prematurity problems" (clinical) [Ep 15 · 3:22](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=202)
- "Age at spontaneous onset of labor for gastroschisis pregnancy is 3 weeks earlier than the general population" (epidemiological) [Ep 15 · 3:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=224)
- "About half of gastroschisis pregnancies go into labor spontaneously before 37 weeks" (epidemiological) [Ep 15 · 3:56](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=236)
- "No perinatal center in Canada performs routine cesarean sections for gastroschisis" (epidemiological) [Ep 15 · 4:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=277)
- "Routine cesarean section for gastroschisis was standard of care 15-20 years ago but has gone out of favor" (guideline) [Ep 15 · 4:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=289)
- "Using forceps and retractors for bedside reduction can harm the bowel" (clinical) [Ep 15 · 8:18](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=498)
- "Pre-formed silo allows bowel to be pushed back in without harming it" (clinical) [Ep 15 · 8:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=507)
- "Approximately one-third of gastroschisis cases can be reduced at bedside using silo technique without intubation" (clinical) [Ep 15 · 8:51](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=531)
- "Waiting for 10% body weight loss allows edema in bowel to resolve, making reduction easier" (clinical) [Ep 15 · 9:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=554)
- "Half of gastroschisis bowel goes back in spontaneously within 1-2 days if silo is suspended without tightening" (clinical) [Ep 15 · 9:20](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=560)
- "Leaving silo on for more than a day causes the fascial defect to get much bigger" (clinical) [Ep 15 · 9:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=581)
- "Larger fascial defect after prolonged silo use takes longer to contract and heal without surgical closure" (clinical) [Ep 15 · 9:48](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=588)
- "Plastic closure of gastroschisis produces extremely good results" (clinical) [Ep 15 · 11:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=697)
- "Plastic closure often results in small umbilical hernia, but vast majority close by age 2" (clinical) [Ep 15 · 11:40](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=700)
- "There are two types of intestinal atresia in gastroschisis: early-developing atresia without bowel thickening, and late-occurring atresia from small defect" (clinical) [Ep 15 · 15:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=958)
- "Bringing ostomy out through umbilicus avoids transposing defect and makes later closure easier" (clinical) [Ep 15 · 16:16](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=976)
- "Umbilical ostomy placement provides easy appliance application on front of abdomen" (clinical) [Ep 15 · 17:36](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1056)
- "Gord Cameron first described umbilical ostomies in the 1980s" (clinical) [Ep 15 · 17:53](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1073)
- "Abdominal compartment syndrome is difficult to assess clinically" (opinion) [Ep 15 · 28:22](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1702)
- "Intragastric pressure of 20 is the threshold number suggested by literature" (guideline) [Ep 15 · 30:04](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1804)
- "Omphaloceles with narrow opening and large contents behave differently than those with big opening" (clinical) [Ep 15 · 35:39](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=2139)
- "Omphaloceles with big opening that are painted gradually reduce spontaneously over 6 months to a year" (clinical) [Ep 15 · 35:45](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=2145)
- "In older children with omphalocele, abdomen does not expand rapidly like in newborns and requires time" (clinical) [Ep 15 · 36:51](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=2211)
- "Giant omphaloceles (5 cm or greater or liver in sac) have greater time to full feeds and require more TPN compared to routine omphaloceles" — Sean (clinical) [Ep 23 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "Giant omphaloceles have greater risk of respiratory insufficiency and higher incidence of chromosomal anomalies" — Sean (clinical) [Ep 23 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "56 of 97 giant omphalocele survivors were identified as having pulmonary hypertension, most diagnosed within first week of life" — Sean (epidemiological) [Ep 23 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "Five patients had no signs of pulmonary hypertension on first echo within first seven days but subsequently developed severe pulmonary hypertension, all associated with sepsis episodes" — Sean (clinical) [Ep 23 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "Two of the five patients with delayed pulmonary hypertension died, and one required pulmonary vasodilator for more than a year" — Sean (clinical) [Ep 23 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "One patient developed severe pulmonary hypertension 52 days after initial echo showed no pulmonary hypertension, triggered by single episode of sepsis" — Sean (clinical) [Ep 23 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "The sac-preserving hydrocolloid technique developed by Dr. Abello has been used in almost 40 patients over three years" — Miguel Gilfoyd (clinical) [Ep 23 · 5:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300)
- "97% of patients treated with sac-preserving technique achieved closure within 30 days, and 92% within 15 days" — Miguel Gilfoyd (clinical) [Ep 23 · 5:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300)
- "All patients treated with sac-preserving technique are kept in ICU, ventilated and completely paralyzed during reduction" — Miguel Gilfoyd (clinical) [Ep 23 · 5:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300)
- "The hydrocolloid dressing should be applied within first 24 hours before the sac becomes very stiff" — Miguel Gilfoyd (clinical) [Ep 23 · 6:47](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=407)
- "Three patients with ruptured omphalocele sacs were sutured and then had hydrocolloid dressing applied successfully" — Miguel Gilfoyd (clinical) [Ep 23 · 7:37](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=457)
- "Compressions can usually start within 48 hours if baby is stable" — Miguel Gilfoyd (clinical) [Ep 23 · 8:01](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=481)
- "Risk of adhesive bowel obstruction is higher with gastroschisis, but risk of midgut volvulus is higher in patients with omphalocele" — Sean (clinical) [Ep 23 · 9:16](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=556)
- "Patients with omphalocele have non-rotation or malrotation and will not have the same adhesions as gastroschisis" — Sean (clinical) [Ep 23 · 9:16](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=556)
- "If closure technique involves exposing the intestines, Ladd procedure may be worthwhile; if sac is maintained, not worth going through sac" — Sean (opinion) [Ep 23 · 10:31](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=631)
- "In diaphragmatic hernia repair, key move is to unroll bowel like a scroll to increase distance between ends of mesentery and decrease volvulus risk" — Todd (clinical) [Ep 23 · 13:10](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=790)
- "Non-rotation does not exclude possibility of unfavorable anatomy with narrow base of mesentery and two ends close together" — Sean (clinical) [Ep 23 · 14:33](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=873)
- "In gastroschisis, entire liver being out is not expected; when almost no abdominal domain exists, management becomes very challenging" — Saleem (clinical) [Ep 23 · 16:42](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1002)
- "Spring-loaded tech silo on giant abdominal wall defect can make defect much bigger over time as forces go outward" — Todd (clinical) [Ep 23 · 20:24](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1224)
- "Biologic mesh can be used as scaffold to allow skin epithelialization in giant defects" — Saleem (clinical) [Ep 23 · 21:23](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1283)
- "Prolene mesh can stay in place for months without removal, with 80% of giant defects closable within 2-3 months" — Miguel Gilfoyd (clinical) [Ep 23 · 24:18](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1458)
- "Tissue expanders placed subcutaneously can create redundant healthy skin, particularly important for cases initially treated with paint and wait" — Eric (clinical) [Ep 23 · 25:37](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1537)
- "Component separation technique involves separating tissue at external oblique about 1 cm beyond rectus sheath on both sides, creating significant space" — Sean (clinical) [Ep 23 · 26:33](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593)
- "UT Houston group reported component separation use in 9 children aged 7 days to 10 years, achieving fascial closure in vast majority" — Sean (clinical) [Ep 23 · 26:33](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593)
- "The Teodoro study examined pediatric trauma patients with gunshot wounds or MVCs presenting to a level one trauma center between 2009 and 2019" — Ellen Encisco (clinical) [Ep 49 · 0:20](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=20)
- "Gunshot wound victims were more likely to require immediate surgery and had increased mortality compared to MVC victims" — Ellen Encisco (clinical) [Ep 49 · 0:20](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=20)
- "Gunshot wound victims were 7.8 times more likely to die than MVC victims" — Ellen Encisco (clinical) [Ep 49 · 0:20](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=20)
- "In California statewide data from 2006 to 2015, the case fatality rate for gunshot wound victims was higher than for motor vehicle collisions" — Ellen Encisco (epidemiological) [Ep 49 · 0:20](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=20)
- "The case fatality rate for pediatric gunshot wounds increased from 2006 to 2015 in California" — Ellen Encisco (epidemiological) [Ep 49 · 1:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "The Petterson study examined 10 years of data comprising approximately 8800 pediatric trauma patients transported by helicopter or ground to pediatric trauma centers" — Britney Levy (clinical) [Ep 49 · 1:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "Children transported via helicopter had a higher injury severity score than those transported by ground" — Britney Levy (clinical) [Ep 49 · 1:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "1.3% of children transported by helicopter required an emergency operation" — Britney Levy (clinical) [Ep 49 · 1:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "Only 0.2% of children transported by ground required an emergency operation" — Britney Levy (clinical) [Ep 49 · 1:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "98.7% of children transported by helicopter did not require an emergency intervention" — Britney Levy (clinical) [Ep 49 · 1:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "Helicopter transport may be over-utilized in pediatric trauma" — Britney Levy (opinion) [Ep 49 · 1:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "The Miyata study used data from the Canadian Association of Pediatric Surgery Network for pediatric patients with gastroschisis who underwent bedside reduction and closure" — Rod Gerardo (clinical) [Ep 49 · 2:50](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=170)
- "There was no significant difference in the rate of successful primary closure between intubated and non-intubated neonates with gastroschisis" — Rod Gerardo (clinical) [Ep 49 · 2:50](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=170)
- "The Philips study was a retrospective study from 2015 to 2018 evaluating 117 patients from two trauma centers" — Cecilia Gigena (clinical) [Ep 49 · 3:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "Patients with massive transfusions had shortened alpha angles on TEG analysis" — Cecilia Gigena (clinical) [Ep 49 · 3:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "Patients with massive transfusions had lower maximum amplitude values on TEG analysis" — Cecilia Gigena (clinical) [Ep 49 · 3:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "Patients with massive transfusions had lower platelet counts" — Cecilia Gigena (clinical) [Ep 49 · 3:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "TEG may help identify hemorrhagic trauma patients who will benefit from cryoprecipitate or platelet transfusions" — Cecilia Gigena (clinical) [Ep 49 · 3:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "The life-threatening bleeding study was a prospective observational study of children presenting with life threatening bleeding events across 24 centers between the US, Canada, and Italy" (clinical) [Ep 51 · 0:20](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=20)
- "Children were eligible for the bleeding study if they received more than 40 ccs per kilo of total blood products over six hours, or if they were transfused under massive transfusion protocol" (clinical) [Ep 51 · 0:20](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=20)
- "The bleeding study compared patients presenting with traumatic bleeding, operative bleeding, and medical bleeding" — Em Tombash (clinical) [Ep 51 · 1:21](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=81)
- "The Western Pediatric Surgery Research Consortium conducted a prospective cohort study on children undergoing colorectal surgery across 10 hospitals in the US" (clinical) [Ep 51 · 1:43](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=103)
- "The colorectal surgery study utilized an eight-part perioperative care bundle and split children into either a high or low compliance group" (clinical) [Ep 51 · 1:43](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=103)
- "Children in the high compliance group had a statistically significant decrease in rates of superficial surgical site infection when compared to children in the low compliance group" — Em Tombash (clinical) [Ep 51 · 2:16](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=136)
- "Standardization of perioperative care may decrease morbidity and improve outcomes in colorectal surgery" — Em Tombash (opinion) [Ep 51 · 2:16](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=136)
- "The contrast enema study was a retrospective study done in Netherlands between 1998 and 2018" (clinical) [Ep 51 · 2:39](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=159)
- "The contrast enema study looked at patients under three years old that got a stoma reversal to see if they had contrast enema prior to it and if they were able to detect strictures" (clinical) [Ep 51 · 2:39](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=159)
- "The contrast enema study gathered 244 patients" (clinical) [Ep 51 · 2:39](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=159)
- "Of the 244 patients in the contrast enema study, 10% got strictures" (clinical) [Ep 51 · 2:39](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=159)
- "95% of patients with strictures had necrotizing enterocolitis" (clinical) [Ep 51 · 2:39](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=159)
- "Only 68% of all patients had a contrast enema prior to the stoma reversal" (clinical) [Ep 51 · 2:39](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=159)
- "Contrast enema was able to detect 92% of the strictures" (clinical) [Ep 51 · 2:39](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=159)
- "Contrast enema prior to stoma reversal is only useful if patients had necrotizing enterocolitis" — Em Tombash (opinion) [Ep 51 · 3:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=209)
- "Infants with gastroschisis often require prolonged hospitalization for surgical repair and then initiation and advancement of feeds" — Em Tombash (clinical) [Ep 50 · 1:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=60)
- "For babies with uncomplicated gastroschisis, feeds can be started immediately after sutureless abdominal closure, beginning with 10 to 20 milliliters per kilogram per day with advancements of 20 milliliters per kilogram per day if tolerated" — Em Tombash (guideline) [Ep 50 · 2:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=150)
- "Immediate feeding after gastroschisis closure has been shown to be associated with shorter length of stay and faster attainment of goal feeds" — Em Tombash (clinical) [Ep 50 · 3:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=180)
- "For babies with uncomplicated gastroschisis tolerating feeds for a few days, it is okay to continue with the feeding protocol even after one bout of emesis" — Em Tombash (guideline) [Ep 50 · 3:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=210)
- "High resolution esophageal manometry, esophagography, and endoscopy can help determine the diagnosis of congenital esophageal stenosis" — Em Tombash (clinical) [Ep 50 · 5:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=300)
- "Serial dilatations may be used to manage congenital esophageal stenosis if there is no cartilage component suspected in the stenotic area" — Em Tombash (guideline) [Ep 50 · 5:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=330)
- "Surgical resection for congenital esophageal stenosis can be reserved for patients where serial dilatations are unsuccessful or there is concern for cartilaginous component" — Em Tombash (guideline) [Ep 50 · 5:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=330)
- "A systematic review and meta-analysis found that overall recurrence rates and recurrences within 24 and 48 hours of intussusception were similar between inpatient and outpatient management groups after enema reduction" — Em Tombash (epidemiological) [Ep 50 · 7:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=450)
- "There was no significant difference in the rate of return to the emergency department between inpatient and outpatient management of intussusception after enema reduction" — Em Tombash (epidemiological) [Ep 50 · 8:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=480)
- "Both inpatient and outpatient groups had similar rates of requiring operative intervention after intussusception reduction" — Em Tombash (epidemiological) [Ep 50 · 8:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=480)
- "Outpatient management of intussusception after air enema reduction results in a shorter hospital stay with no difference in rate of returns to emergency department, recurrence, need for operation, or mortality" — Em Tombash (clinical) [Ep 50 · 8:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=510)
- "There is no compelling evidence in pediatric or adult literature to support mechanical bowel preparation for reducing surgical site infections in colorectal surgery" — Em Tombash (epidemiological) [Ep 50 · 9:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=570)
- "Recent adult studies have shown no benefit from mechanical bowel preparation in terms of reducing surgical site infections, and some studies showed an increase in wound infections" — Em Tombash (epidemiological) [Ep 50 · 10:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=600)
- "Case appropriate pre-operative IV antibiotics may reduce surgical site infection incidents in colorectal operations" — Em Tombash (guideline) [Ep 50 · 10:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=630)
- "Firearms are now the leading cause of death in all children and adolescents in the United States, overtaking motor vehicle crashes in 2019" — Em Tombash (epidemiological) [Ep 50 · 11:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=690)
- "Low-dose non-contrast CT of the chest has high sensitivity and specificity for identification of airway foreign bodies" — Em Tombash (clinical) [Ep 50 · 14:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=840)
- "CT bronchoscopy can avoid the cost and resources of taking a child to the operating room for a non-therapeutic bronchoscopy procedure" — Em Tombash (clinical) [Ep 50 · 14:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=870)
- "Death or neurodevelopmental impairment occurred in 69% of patients with necrotizing enterocolitis who underwent initial laparotomy versus 85% of those who underwent initial peritoneal drainage" — Em Tombash (epidemiological) [Ep 50 · 16:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=960)
- "A prospective randomized cohort study showed no difference in overall survival between laparotomy and peritoneal drainage for necrotizing enterocolitis, but did show improved long-term neurodevelopmental outcomes with laparotomy" — Em Tombash (epidemiological) [Ep 50 · 16:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=990)
- "Racism and sexism that manifest as microaggressions are commonly experienced by members of minority groups in medical settings" — Em Tombash (opinion) [Ep 50 · 18:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1080)
- "Microaggressions can harm trainees's performance and sense of belonging" — Em Tombash (opinion) [Ep 50 · 18:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1110)
- "In a 10-year retrospective review of isolated traumatic skull fractures with normal neurologic exam findings, 77% of patients were admitted for observation but none needed neurosurgical intervention or additional imaging during the index admission" — Em Tombash (epidemiological) [Ep 50 · 20:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1200)
- "Pediatric isolated skull fractures are low risk conditions with a low likelihood of complications and can be discharged safely from the emergency department without inpatient observation" — Em Tombash (clinical) [Ep 50 · 20:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1230)
- "In the IMPACT trial, patients with perforated appendicitis taking piperacillin-tazobactam had lower incidence of intra-abdominal abscesses, lower usage of CT scans, and fewer ED revisits compared to ceftriaxone and metronidazole combination therapy" — Em Tombash (epidemiological) [Ep 50 · 22:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1320)
- "Piperacillin-tazobactam monotherapy did not have an increase in antibiotic usage or increase in antibiotic related complications compared to combination therapy" — Em Tombash (epidemiological) [Ep 50 · 22:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1350)
- "The CDC Wonder database was used to examine data between 1999 and 2020 for pediatric firearm and automobile fatalities." — Ellen Encisco (epidemiological) [Ep 52 · 0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- "The Gifford's Law Center annual gun law scorecard between 2014 and 2020 was used to assess state gun law scores." — Ellen Encisco (epidemiological) [Ep 52 · 0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- "In recent years, the fatality rate for firearms has surpassed the fatality rate for automobiles in children." — Ellen Encisco (epidemiological) [Ep 52 · 0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- "Stronger gun laws were associated with decreased fatality rates, with a 55% lower firearm fatality rate for states with the strongest gun laws compared to those with the weakest gun laws." — Ellen Encisco (epidemiological) [Ep 52 · 0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- "Gabapentin is an anticonvulsant that is often used off label as part of multimodal pain control after major surgery." — Alex Halpern (clinical) [Ep 52 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "The Children's Hospital of LA study was a retrospective cohort study looking at kids age 2 to 18 who underwent appendectomy for perforated appendicitis between 2014 and 2019." — Alex Halpern (clinical) [Ep 52 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "Kids who received gabapentin had decreased postoperative opioid use after appendectomy for perforated appendicitis." — Alex Halpern (clinical) [Ep 52 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "Kids who received gabapentin had a decreased postoperative length of stay after appendectomy for perforated appendicitis." — Alex Halpern (clinical) [Ep 52 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "The Midwest Pediatric Surgery Consortium study followed 375 patients with gastroschisis who underwent closure between 2013 and 2016." — Cecilia Gigena (clinical) [Ep 52 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "The overall rate for periumbilical hernias after gastroschisis closure was 22.7%." — Cecilia Gigena (clinical) [Ep 52 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Periumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement." — Cecilia Gigena (clinical) [Ep 52 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Patients who underwent sutureless closures had 50% rates of persistent hernia." — Cecilia Gigena (clinical) [Ep 52 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Only 16.4% of patients who underwent sutured closure had a persistent hernia." — Cecilia Gigena (clinical) [Ep 52 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Spontaneous closure of periumbilical hernias after gastroschisis repair was seen in 38.8% of cases." — Cecilia Gigena (clinical) [Ep 52 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Only 31.8% of periumbilical hernias after gastroschisis closure needed surgery." — Cecilia Gigena (clinical) [Ep 52 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Sutureless closures lead to more periumbilical hernias but they can be managed as any other congenital umbilical hernia and have no additional risk." — Cecilia Gigena (opinion) [Ep 52 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Gastroschisis has a reported incidence of 1 in 6,000 to 1 in 10,000" (epidemiological) [Ep 18 · 0:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=0)
- "Gastroschisis is much more common in many parts of the U.S., including Southern California" (epidemiological) [Ep 18 · 0:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=0)
- "At two neonatal intensive care units, the practice treats 30 to 40 patients a year with gastroschisis" (epidemiological) [Ep 18 · 0:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=0)
- "Gastroschisis is second only to inguinal hernias as a congenital anomaly requiring surgical correction at their institution" (epidemiological) [Ep 18 · 0:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=0)
- "Traditional staged closure with sutured silastic silo carries risks of silo disruption, fascial dehiscence, and infectious complications" (clinical) [Ep 18 · 1:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=60)
- "The spring-loaded silo allows for fast, pain-free, suture-less silo placement without need for a formal operation" (clinical) [Ep 18 · 2:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=120)
- "Dr. James Fisher and colleagues from Loma Linda University were the first to publish a series of patients to undergo routine silo placement at the bedside" (clinical) [Ep 18 · 3:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=180)
- "A prospective randomized study comparing primary to stage closure of gastroschisis is in progress but results are not yet available" (clinical) [Ep 18 · 4:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=240)
- "Several retrospective studies from large centers in the U.S. have reported favorable results with spring-loaded silo staged closure compared to primary closure controls" (clinical) [Ep 18 · 4:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=240)
- "Routine silo placement with delayed closure showed decreased airway pressures compared to primary closure" (clinical) [Ep 18 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "Routine silo placement with delayed closure showed earlier extubation compared to primary closure" (clinical) [Ep 18 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "Routine silo placement with delayed closure showed decreased incidence of necrotizing enterocolitis compared to primary closure" (clinical) [Ep 18 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "Routine silo placement with delayed closure showed decreased infectious complications compared to primary closure" (clinical) [Ep 18 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "Routine silo placement with delayed closure showed more rapid return of bowel function compared to primary closure" (clinical) [Ep 18 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "Routine silo placement with delayed closure showed decreased length of stay compared to primary closure" (clinical) [Ep 18 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "Routine silo placement with delayed closure showed decreased hospital charges compared to primary closure" (clinical) [Ep 18 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "Most babies with gastroschisis are delivered vaginally after spontaneous onset of labor at their institution" (clinical) [Ep 18 · 7:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=420)
- "They do not perform routine cesarean section for gastroschisis" (clinical) [Ep 18 · 7:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=420)
- "They do not induce early labor for gastroschisis" (clinical) [Ep 18 · 7:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=420)
- "The baby is sedated with fentanyl and midazolam drips for silo placement" (clinical) [Ep 18 · 8:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=480)
- "A single dose of Vecuronium is given for the silo placement procedure" (clinical) [Ep 18 · 8:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=480)
- "Placement of the silo is feasible without sedation, intubation, or paralysis, but these interventions create optimal conditions" (opinion) [Ep 18 · 8:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=480)
- "The Bentec silo is available in seven sizes, from 3 cm to 15 cm diameter" (clinical) [Ep 18 · 9:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=540)
- "They typically choose a ring that is 2 cm larger than the diameter of the defect" (clinical) [Ep 18 · 9:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=540)
- "Most gastroschisis defects are 2 to 3 cm in diameter, making 4 and 5 cm silos the most commonly used" (clinical) [Ep 18 · 9:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=540)
- "Gastroschisis that involve an atresia typically contain severely distended bowel and often require a 7.5 cm silo" (clinical) [Ep 18 · 10:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=600)
- "A distal colon severely distended with meconium is a good indication of the probable absence of a proximal atresia or stenosis" (clinical) [Ep 18 · 11:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=660)
- "Evacuation of the colon is important as it will significantly decrease the size of the colon and allow for faster reduction" (clinical) [Ep 18 · 11:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=660)
- "If an obstruction exists without perforation, their policy is to proceed with silo placement and closure, followed by exploration four to six weeks later" (clinical) [Ep 18 · 12:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=720)
- "If the ring is too lax and allowed to sink in the abdomen, it may cause necrosis of the underlying duodenum or small bowel, especially if the silo is left in position for a prolonged period" (clinical) [Ep 18 · 15:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=900)
- "If the ring elevates the abdominal wall, it would lead to abdominal wall congestion and complicate the final closure" (clinical) [Ep 18 · 15:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=900)
- "The baby is maintained on sedation and mechanical ventilation but not paralyzed during the silo reduction period" (clinical) [Ep 18 · 16:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=960)
- "Resolution of bowel edema, accommodation by the abdominal cavity, and gravity result in gradual spontaneous reduction" (clinical) [Ep 18 · 16:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=960)
- "Active reduction is performed once or twice daily using umbilical tape to slowly ligate the silo with simultaneous reduction of contents" (clinical) [Ep 18 · 17:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1020)
- "Final closure is performed when the silo contents is within 2 cm of the abdominal wall" (clinical) [Ep 18 · 18:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1080)
- "They leave the silo in place for the shortest time possible" (clinical) [Ep 18 · 18:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1080)
- "Unnecessary prolongation of the silo duration has no advantages, may make closure more involved by slowly enlarging the defect, and may increase infectious and other potential complications" (opinion) [Ep 18 · 18:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1080)
- "The abdominal wall is stretched during closure to aid in a tension-free closure, which often produces some minor post-operative congestion of the abdominal wall" (clinical) [Ep 18 · 20:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1200)
- "The umbilical stump is preserved during closure" (clinical) [Ep 18 · 21:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1260)
- "The skin edge is often slightly ischemic and bites exactly in the skin edge are likely to cause skin necrosis and possible wound infection" (clinical) [Ep 18 · 23:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1380)
- "Complications are similar between sutureless and standard sutured gastroschisis repair" — Salim (clinical) [Ep 20 · 2:27](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=147)
- "Tony Sandler at Iowa originated sutureless repair when a large gastroschisis wound closed spontaneously after covering with umbilical cord and tachyderm" — Salim (clinical) [Ep 20 · 3:00](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=180)
- "Multiple retrospective studies reported sutureless repair patients eat quicker, go home faster, and are cheaper to manage" — Salim (clinical) [Ep 20 · 4:20](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=260)
- "The Brisoni randomized study from Stanford found sutureless repair patients took longer to eat and had longer hospital length of stay" — Salim (clinical) [Ep 20 · 4:50](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=290)
- "A subsequent 98-patient study from UCSF showed benefit for sutureless repair, conflicting with the Brisoni randomized trial" — Salim (clinical) [Ep 20 · 5:30](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=330)
- "Approximately 13% of sutureless repair patients require umbilical hernia repair at 4-5 years of age, higher than fascial closure patients" — Salim (clinical) [Ep 20 · 6:00](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=360)
- "Robert Baird's study from McGill showed everything was better about tape closure and had a lower umbilical hernia rate" — Todd (clinical) [Ep 20 · 6:19](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=379)
- "Fear of feeding after sutureless closure may drive increased length of stay due to hesitation about bowel distension and evisceration" — Todd (opinion) [Ep 20 · 7:20](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=440)
- "Natural selection bias may favor sutureless closure for easier cases, confounding outcome comparisons" — Salim (opinion) [Ep 20 · 7:58](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=478)
- "The UCSF study with 98 patients and 5-year follow-up found 13% required hernia repair when compared to historical sutured controls" — Salim (clinical) [Ep 20 · 9:45](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=585)
- "Patients with attempted fascial closure without silo have higher incidence of umbilical or ventral hernias requiring repair" — Salim (clinical) [Ep 20 · 10:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=640)
- "All general anesthetic agents in every class cause increased apoptosis and developmental issues in animal studies (rats, mice, sheep)" — Salim (clinical) [Ep 20 · 11:47](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=707)
- "The GAS trial and PANDA study with 5-year data show no difference in neurodevelopmental outcome between spinal and general anesthesia in human infants" — Salim (clinical) [Ep 20 · 12:30](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=750)
- "Tony Sandler no longer uses the umbilical cord for sutureless closure; it is not as important as once thought" — Salim (clinical) [Ep 20 · 15:06](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=906)
- "A silo can be placed, reduced, then followed by tape closure even if immediate reduction is not possible" — Salim (clinical) [Ep 20 · 15:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=940)
- "UCLA's UC fetal consortium standardized gastroschisis care without general anesthesia or intubation significantly decreased antibiotic use, intubation days, and opioid use, but did not decrease length of stay" (clinical) [Ep 20 · 16:02](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=962)
- "Gastroschisis patients should be delivered vaginally unless there is an obstetric indication for C-section" — Salim (guideline) [Ep 20 · 17:34](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1054)
- "The gastroschisis prognostic score (GPS) based on peel degree, bowel distension, and matting did not ultimately matter as much as hoped" — Salim (clinical) [Ep 20 · 18:10](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1090)
- "Gastroschisis with very thick peel, very distended bowel, and many loops should not undergo immediate closure; silo reduction is preferred" — Salim (clinical) [Ep 20 · 19:00](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1140)
- "There is no real need for fascial closure regardless of gastroschisis defect size; skin closure alone is adequate" — Salim (opinion) [Ep 20 · 19:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1180)
- "Restrictive transfusion protocols using a target hemoglobin of 7 instead of 8, 9, or 10 showed no difference in mortality" — Alex Gibbons (clinical) [Ep 22 · 0:26](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=26)
- "Exception to hemoglobin 7 transfusion threshold is sickle cell disease, where hematocrit needs to be around 30 or HbSS below 50%" (clinical) [Ep 22 · 1:45](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=105)
- "Early enteral feeding in pancreatitis decreases morbidity, infectious complications, and overall mortality" (clinical) [Ep 22 · 2:20](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=140)
- "Nasogastric feeding is equal to nasojejunal feeding in pancreatitis and is equally tolerated" (clinical) [Ep 22 · 2:20](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=140)
- "In ovarian torsion, even if the ovary looks black and dead after detorsion, leave it in place because ovaries can still have recovery and it helps preserve fertility" (clinical) [Ep 22 · 3:29](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=209)
- "Ultrasound is not a great tool for diagnosis of ovarian torsion" (clinical) [Ep 22 · 3:29](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=209)
- "For low bleeding risk trauma patients, VTE prophylaxis should include SCDs and low molecular weight heparin" (guideline) [Ep 22 · 4:05](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=245)
- "For high bleeding risk trauma patients, use SCDs until ambulatory, then do screening ultrasound on ICU day 7" (guideline) [Ep 22 · 4:05](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=245)
- "Institutional policy is to use VTE prophylaxis (SCDs and low molecular weight heparin if high risk) in trauma patients 12 years and older" (clinical) [Ep 22 · 4:53](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=293)
- "High risk for VTE includes femur fractures, cervical spine fracture, and intubated patients" (clinical) [Ep 22 · 4:53](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=293)
- "Children with IBD are probably the most at-risk group for deep venous thromboses" (clinical) [Ep 22 · 5:50](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=350)
- "Burnout directly impacts patient care and outcomes" (clinical) [Ep 22 · 6:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=362)
- "Support systems for physician wellness need to be established proactively during education and practice because burnt-out surgeons are unlikely to seek help" (opinion) [Ep 22 · 6:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=362)
- "Physicians should ask patients whether there's a firearm in the home and if so, whether it's safely stored" (guideline) [Ep 22 · 8:23](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=503)
- "Safe firearm storage means keeping guns under lock and key, unloaded, with ammunition stored separately, and controlling who has access" — Salim (guideline) [Ep 22 · 10:27](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=627)
- "Current strategy should be to continue isotonic fluids throughout hospitalization rather than switching to hypotonic fluids for maintenance, which decreases risk of hyponatremia" (clinical) [Ep 22 · 11:27](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=687)
- "Isotonic fluid continuation applies to pyloric stenosis patients as well" (clinical) [Ep 22 · 13:07](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=787)
- "Pediatric nephrology division at Indiana did not want universal switch to isotonic fluids for all patients, preferring a more tailored measured approach" — Fred Rescorla (opinion) [Ep 22 · 14:05](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=845)
- "In Wilms tumor surgery, failure to remove lymph nodes automatically upstages the patient" (clinical) [Ep 22 · 14:30](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=870)
- "Wilms tumor has both local and systemic staging, and pulmonary metastasis does not preclude doing a primary nephrectomy" (clinical) [Ep 22 · 14:30](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=870)
- "Even in Wilms tumor with stage 4 disease (lung mets), it is important to take nodes because you treat the local disease and it impacts treatment for abdominal disease" — Dan (clinical) [Ep 22 · 15:37](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=937)
- "For Wilms tumor, take nodes from both sides of the cava and the aorta, but do not need to dissect into renal hilum on contralateral side or open Gerota's fascia" (clinical) [Ep 22 · 23:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1381)
- "Non-operative management of uncomplicated appendicitis has decreased days of hospitalization, decreased days of disability, and equal outcome measures" (clinical) [Ep 22 · 16:41](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1001)
- "In the APAC trial of adults, 41% of the non-operative appendicitis group underwent appendectomy at 5 years" — Todd Ponsky (epidemiological) [Ep 22 · 17:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1036)
- "Parents surveyed for PCORI study said they would accept 50% success rate for non-operative appendicitis management" — Todd Ponsky (epidemiological) [Ep 22 · 17:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1036)
- "Opioid crisis recommendations include reducing total opioids prescribed, using non-opioid analgesia, non-pharmacological approaches, and educating on disposal of unused opioids" (guideline) [Ep 22 · 23:29](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1409)
- "For well-appearing full-term infant with intact omphalocele and no maternal fever or chorioamnionitis, preoperative antibiotic given one hour before incision and discontinued within 72 hours is most appropriate" — Liz Byerly (guideline) [Ep 22 · 26:19](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1579)
- "Babies with ruptured omphalocele or gastroschisis have an open abdomen and should receive antibiotics, but intact omphalocele does not require antibiotics until OR" (clinical) [Ep 22 · 28:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1682)
- "Children with duodenal atresia going to OR within 24-48 hours probably don't need antibiotics if well-appearing" (clinical) [Ep 22 · 28:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1682)
- "In pediatric sepsis, give 20 mL/kg boluses of isotonic fluid up to 60 mL/kg total, with goal of perfusion improvement" — Salim Islam (guideline) [Ep 22 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "Stop fluid boluses if seeing over-perfusion such as rales on auscultation or hepatomegaly" — Salim Islam (guideline) [Ep 22 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "Must start broad-spectrum antibiotics in sepsis within first hour; waiting over 3 hours decreases survival" — Salim Islam (clinical) [Ep 22 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "If hemoglobin less than 10 in septic patient, transfusion may be indicated" — Salim Islam (clinical) [Ep 22 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "For pediatric sepsis vasopressor choice, epinephrine is preferred over dopamine based on two randomized trials showing better mortality and more rapid sustained blood pressure improvement" — Salim Islam (clinical) [Ep 22 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "Hydrocortisone is indicated for vasopressor-refractory hypotension in sepsis" — Salim Islam (guideline) [Ep 22 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "Broad-spectrum antibiotics for sepsis means extended-spectrum penicillin like piperacillin-tazobactam or ampicillin-sulbactam to cover everything empirically" — Salim Islam (clinical) [Ep 22 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "Draw blood for lactate and cultures just prior to starting antibiotics in sepsis, but don't delay antibiotics waiting for cultures" — Salim Islam (guideline) [Ep 22 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "Odds ratio for not starting antibiotics within 3 hours in pediatric sepsis is 3.92 for mortality - almost 4 times more likely to die" — Salim Islam (epidemiological) [Ep 22 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "Source control is key in sepsis management - if abscess or perforated appendicitis, must address surgical source" — Salim Islam (clinical) [Ep 22 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "ECMO survival for severe sepsis with recalcitrant hypotension is about 46% overall, which is better than zero" — Salim Islam (epidemiological) [Ep 22 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "Updated APSA blunt liver-spleen injury guidelines recommend treating based on patient's hemodynamic status, not injury grade" — Stephen Lee (guideline) [Ep 22 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "Modified pediatric shock index (heart rate over systolic blood pressure) can determine if patient is still bleeding" — Stephen Lee (clinical) [Ep 22 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "Hemodynamically stable liver-spleen injury patients admitted to ward need only one repeat hemoglobin check at 6 hours, can have regular diet, and have no activity restrictions" — Stephen Lee (guideline) [Ep 22 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "After first 20 mL/kg normal saline bolus in trauma, if patient still requires fluids, give blood (10 mL/kg packed red blood cells)" — Stephen Lee (guideline) [Ep 22 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "Angioembolization in stable patients with contrast blush does not need to be done, particularly in splenic injuries which do not continue to bleed" — Stephen Lee (clinical) [Ep 22 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "Operative threshold for blunt liver-spleen injury is greater than 40 mL/kg of packed red blood cells transfused" — Stephen Lee (guideline) [Ep 22 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "ATOMAC (Arkansas, Texas, Oklahoma, Memphis, Arizona) is a consortium of level 1 pediatric trauma centers studying trauma questions prospectively since 2010" — Stephen Lee (epidemiological) [Ep 22 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "Cervical spine injury occurs in about 1-2% of all pediatric traumas" — Meera Kotagal (epidemiological) [Ep 22 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "In children 8 years and younger, 50% of cervical spine injuries are bony fractures and 50% are ligamentous injuries, dislocations, or SCIWORA" — Meera Kotagal (epidemiological) [Ep 22 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "In older children, 70-80% of cervical spine injuries are bony injuries, following adult patterns" — Meera Kotagal (epidemiological) [Ep 22 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "60-80% of vertebral injuries in children are in the cervical spine, compared to 30-40% in adults" — Meera Kotagal (epidemiological) [Ep 22 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "AAST cervical spine injury score for children under 3 years uses GCS less than 14, motor vehicle crash involvement, and age greater than or equal to 2 years as predictors; score 0-1 has negative predictive value over 99%" — Meera Kotagal (clinical) [Ep 22 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "46% of institutions do not have a protocol for cervical spine clearance in children" — Meera Kotagal (epidemiological) [Ep 22 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "Patients with abnormal neurological exam cannot be clinically cleared and need MRI for cervical spine evaluation" — Meera Kotagal (guideline) [Ep 22 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "CT is not commonly used for pediatric cervical spine injury because most injuries are ligamentous not bony, so move towards MRI for cross-sectional imaging" — Meera Kotagal (clinical) [Ep 22 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "Tony Sandler published the first manuscript about sutureless closures utilizing natural umbilical properties to close the gastroschisis defect by itself in 2004" — Rod Gerardo (clinical) [Ep 31 · 1:44](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=104)
- "The study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016" — Rod Gerardo (clinical) [Ep 31 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "The study included a total of 315 patients" — Rod Gerardo (epidemiological) [Ep 31 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Patients were divided into sutured versus sutureless abdominal wall closure groups with subgroup analysis for those who received silos" — Rod Gerardo (clinical) [Ep 31 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure showed no difference in days on TPN compared to sutured closure" — Rod Gerardo (clinical) [Ep 31 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure showed no difference in time to goal feeds compared to sutured closure" — Rod Gerardo (clinical) [Ep 31 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure showed no difference in time to initial feeds compared to sutured closure" — Rod Gerardo (clinical) [Ep 31 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure showed no difference in length of stay compared to sutured closure" — Rod Gerardo (clinical) [Ep 31 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had less antibiotic use than sutured closure patients" — Rod Gerardo (clinical) [Ep 31 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had fewer surgical site and deep space infections than sutured closure patients" — Rod Gerardo (clinical) [Ep 31 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had fewer episodes of general anesthetics than sutured closure patients" — Rod Gerardo (clinical) [Ep 31 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had less ventilator use than sutured closure patients" — Rod Gerardo (clinical) [Ep 31 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Patients able to undergo primary repair probably had more favorable bowel" — Jason Frischer (opinion) [Ep 31 · 7:20](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=440)
- "Patients with more favorable bowel theoretically would have less hospital stay and feed faster" — Jason Frischer (opinion) [Ep 31 · 7:20](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=440)
- "Many sutureless repair patients were done in more recent cohorts and tended towards less interventions" — Jason Frischer (opinion) [Ep 31 · 7:20](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=440)
- "In sutured repair, mobilizing flaps from skin and fascia causes redness and bruising around the incision" — Jason Frischer (clinical) [Ep 31 · 8:05](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=485)
- "Tissue manipulation in sutured repair puts patients at higher risk for potential infection or erythema" — Jason Frischer (clinical) [Ep 31 · 8:05](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=485)
- "The finding of increased antibiotics needed after sutured repair was expected" — Jason Frischer (opinion) [Ep 31 · 8:05](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=485)
- "Several small studies show that some sutureless patients had a high umbilical hernia repair rate or at least a high umbilical hernia rate" — Jason Frischer (epidemiological) [Ep 31 · 8:50](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=530)
- "Long-term follow-up data on the same patients examining growth and umbilical hernia repair rates has been completed and will be analyzed soon" — Jason Frischer (clinical) [Ep 31 · 8:50](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=530)
- "Gastroschisis is now more like a safe bedside procedure rather than necessitating a trip to the OR" — Rod Gerardo (opinion) [Ep 31 · 11:22](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=682)
- "Patient is a two-day-old boy with duodenal atresia" (clinical) [Ep 32 · 0:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=0)
- "Transverse right abdominal incision allows access to duodenum and small intestine" (clinical) [Ep 32 · 0:20](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=20)
- "Duodenal atresia type III is present" (clinical) [Ep 32 · 1:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=60)
- "Malrotation is identified intraoperatively" (clinical) [Ep 32 · 1:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=60)
- "Small and large intestine should be inspected for any other level atresia or rotational anomalies" (clinical) [Ep 32 · 0:50](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=50)
- "The proximal opening should be made at the most dependent part" (clinical) [Ep 32 · 2:20](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=140)
- "The distal limb should be opened on the anterolateral surface to avoid injury to the opening of the common bile and pancreatic ducts" (clinical) [Ep 32 · 2:45](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=165)
- "Bile coming out on opening of the distal limb confirms communication with biliary system" (clinical) [Ep 32 · 3:05](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=185)
- "The technique creates two diamond-shaped openings with perpendicular axes" (clinical) [Ep 32 · 3:15](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=195)
- "Distal patency should be checked by injecting saline and observing its filling to the whole bowel" (clinical) [Ep 32 · 3:30](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=210)
- "The anastomosis uses opposing borders of the diamonds for the posterior wall and far-facing borders for the anterior wall" (clinical) [Ep 32 · 3:50](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=230)
- "Posterior wall suturing starts from the inside until angles are joined, then anterior wall is sutured from the outside" (clinical) [Ep 32 · 4:10](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=250)
- "5-0 absorbable sutures are used for the anastomosis" (clinical) [Ep 32 · 4:40](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=280)
- "Posterior wall sutures are full thickness interrupted sutures" (clinical) [Ep 32 · 4:35](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=275)
- "Angle sutures are placed from the outside in an extramucosal fashion" (clinical) [Ep 32 · 5:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=300)
- "Anterior wall sutures are placed in an extramucosal fashion starting from the angles and working towards the middle" (clinical) [Ep 32 · 5:40](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=340)
- "The proximal dilated pouch is brought downwards to meet the distal limb during anterior wall closure" (clinical) [Ep 32 · 5:55](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=355)
- "Widening of the root of the mesentery is performed to address malrotation" (clinical) [Ep 32 · 6:20](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=380)
- "Superior mesenteric vessels should be visualized during mesenteric root widening" (clinical) [Ep 32 · 6:25](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=385)
- "Peritoneal covering is carefully dissected to allow adequate widening of mesenteric root" (clinical) [Ep 32 · 6:30](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=390)
- "Appendectomy is performed as part of the procedure" (clinical) [Ep 32 · 6:40](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=400)
- "Final bowel positioning places colon in the left side and duodenojejunal junction in a straight direction" (clinical) [Ep 32 · 6:48](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=408)
- "Gastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover" — Foong-Yen Lim (clinical) [Ep 37 · 0:55](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=55)
- "Omphalocele is right through the middle of the umbilicus and has a membranous cover" — Foong-Yen Lim (clinical) [Ep 37 · 0:55](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=55)
- "Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development" — Foong-Yen Lim (clinical) [Ep 37 · 0:55](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=55)
- "Very high level of alpha fetal protein is associated with gastroschisis or omphalocele" — Foong-Yen Lim (clinical) [Ep 37 · 1:54](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "Ultrasound imaging is needed to definitively diagnose abdominal wall defects" — Foong-Yen Lim (clinical) [Ep 37 · 1:54](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "For omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies" — Foong-Yen Lim (guideline) [Ep 37 · 1:54](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "Fetal growth is tracked monthly because there is concern for significant growth restriction" — Foong-Yen Lim (guideline) [Ep 37 · 1:54](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "Biophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise can occur in these patients" — Foong-Yen Lim (clinical) [Ep 37 · 2:56](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=176)
- "Gastroschisis affects approximately one in every 2,200 live births" — Todd Ponsky (epidemiological) [Ep 37 · 3:15](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=195)
- "Gastroschisis is most common among babies born to young mother of low gravity and usually first pregnancy, with 75% being first born" — Foong-Yen Lim (epidemiological) [Ep 37 · 3:27](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "Nearly 60% of gastroschisis cases are premature" — Foong-Yen Lim (epidemiological) [Ep 37 · 3:27](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "More than 90% of gastroschisis infants are born less than 2,500 grams in weight" — Foong-Yen Lim (epidemiological) [Ep 37 · 3:27](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "Pseudoephedrine and acetaminophen have an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7" — Foong-Yen Lim (epidemiological) [Ep 37 · 3:27](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "Other risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions" — Foong-Yen Lim (epidemiological) [Ep 37 · 3:27](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "Mothers with omphalocele are usually advanced in their age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3" — Foong-Yen Lim (epidemiological) [Ep 37 · 4:19](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=259)
- "Trisomy 13, 18, and 21 occur in anywhere between 35 and 90% of patients with omphalocele" — Foong-Yen Lim (epidemiological) [Ep 37 · 4:19](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=259)
- "Minimizing heat loss and fluid loss in these babies is crucial immediately after birth, otherwise they can show up extremely dehydrated and cold" — Foong-Yen Lim (clinical) [Ep 37 · 5:02](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=302)
- "These babies can have significant acidosis and pulmonary hypertension" — Foong-Yen Lim (clinical) [Ep 37 · 5:02](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=302)
- "Primary closure is considered if bowel looks pristine, non-thickened, non-inflammatory, with only small amount on the outside and enough abdominal domain" — Foong-Yen Lim (guideline) [Ep 37 · 5:34](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=334)
- "Staged closure is favored if the defect is large or there's issue with the bowel" — Foong-Yen Lim (guideline) [Ep 37 · 6:07](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=367)
- "Some patients can have atresia, compromised bowel, or perforation" — Foong-Yen Lim (clinical) [Ep 37 · 6:07](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=367)
- "Patients can develop intestinal perforation after only two days to four days of enteral feeding" — Foong-Yen Lim (clinical) [Ep 37 · 6:07](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=367)
- "Majority of babies in the last four and a half years at Cincinnati Children's are being managed using a sutureless closure" — Todd Ponsky (clinical) [Ep 37 · 6:34](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=394)
- "In sutureless closure, after pushing the bowel back in, the umbilical cord is put over and then dressing over, without taking babies to the operating room to close with suture" — Foong-Yen Lim (clinical) [Ep 37 · 6:58](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=418)
- "With sutureless closure, skin will grow over and the umbilical defect can close spontaneously over time" — Foong-Yen Lim (clinical) [Ep 37 · 6:58](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=418)
- "For small bowel atresia, management options include tapering the dilated portion of bowel or resecting the bowel before tapering" — Foong-Yen Lim (opinion) [Ep 37 · 7:29](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=449)
- "For omphalocele with no significant respiratory issues, sequential reduction using meshes is the best option" — Foong-Yen Lim (guideline) [Ep 37 · 7:57](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=477)
- "Meshes are sewn to the edges of the fascia without interrupting the membrane" — Foong-Yen Lim (clinical) [Ep 37 · 7:57](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=477)
- "At Cincinnati Children's, Duoderm silo is done on top of the skin using plastic clips to sequentially clip it down until it's flush to the abdominal skin" — Foong-Yen Lim (clinical) [Ep 37 · 8:17](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=497)
- "After sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin" — Foong-Yen Lim (clinical) [Ep 37 · 8:17](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=497)
- "Gastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover" — Fung Lim (clinical) [Ep 39 · 0:55](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=55)
- "Omphalocele is right through the middle of the umbilicus and has a membranous cover" — Fung Lim (clinical) [Ep 39 · 0:55](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=55)
- "Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development" — Fung Lim (clinical) [Ep 39 · 0:55](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=55)
- "Very high level of alpha fetal protein is associated with gastroschisis or omphalocele" — Fung Lim (clinical) [Ep 39 · 1:54](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=114)
- "Ultrasound imaging is needed to definitively diagnose abdominal wall defects" — Fung Lim (clinical) [Ep 39 · 1:54](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=114)
- "For omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because patients may have other associated anomalies" — Todd Ponsky (guideline) [Ep 39 · 2:12](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=132)
- "Fetal growth is tracked monthly in these cases because there is concern for significant growth restriction" — Todd Ponsky (guideline) [Ep 39 · 2:12](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=132)
- "In utero growth restriction as well as in utero fetal demise can occur in these patients" — Fung Lim (clinical) [Ep 39 · 2:51](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=171)
- "Gastroschisis affects approximately one in every 2200 live births" — Todd Ponsky (epidemiological) [Ep 39 · 3:15](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=195)
- "Gastroschisis is most common among babies born to young mother of low gravity and usually first pregnancy, with 75% being first born" — Fung Lim (epidemiological) [Ep 39 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Nearly 60% of gastroschisis cases are premature" — Fung Lim (epidemiological) [Ep 39 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "More than 90% of gastroschisis infants are born less than 2500 grams in weight" — Fung Lim (epidemiological) [Ep 39 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Pseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7" — Fung Lim (epidemiological) [Ep 39 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "For omphalocele, mothers are usually advanced in their age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3" — Fung Lim (epidemiological) [Ep 39 · 4:21](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=261)
- "The major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele" — Fung Lim (epidemiological) [Ep 39 · 4:21](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=261)
- "Minimizing heat loss and fluid loss are crucial immediately after birth, otherwise babies can show up extremely dehydrated and cold" — Fung Lim (clinical) [Ep 39 · 5:02](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=302)
- "These babies can have significant acidosis and pulmonary hypertension" — Fung Lim (clinical) [Ep 39 · 5:02](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=302)
- "Primary closure is considered if bowel looks pristine, non-thickened, non-inflammatory, with only small amount on the outside and enough abdominal domain" — Fung Lim (clinical) [Ep 39 · 5:32](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=332)
- "Staged closure is favored if the defect is large or there's issue with the bowel, including atresia, compromised bowel, or perforation" — Fung Lim (clinical) [Ep 39 · 6:03](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=363)
- "Some patients develop intestinal perforation after only two to four days of enteral feeding" — Fung Lim (clinical) [Ep 39 · 6:03](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=363)
- "Majority of babies at Cincinnati Children's in the last four and a half years are managed using sutureless closure" — Fung Lim (clinical) [Ep 39 · 6:46](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=406)
- "In sutureless closure, after pushing bowel back in, umbilical cord is put over with dressing, and skin will grow over, with small umbilical defects closing spontaneously over time" — Fung Lim (clinical) [Ep 39 · 6:46](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=406)
- "For omphalocele without significant respiratory issues, sequential reduction using meshes is the best option" — Fung Lim (clinical) [Ep 39 · 7:54](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=474)
- "At Cincinnati Children's, Duoderm silo is placed on top of the skin and sequentially clipped down with plastic clips until flush to abdominal skin" — Fung Lim (clinical) [Ep 39 · 7:54](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=474)
- "The Update Course has approximately 2000 people signed up" (epidemiological) [Ep 42 · 0:00](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=0)
- "MMP7 could be used to distinguish biliary atresia from other cholestatic diseases" — Rod Gerardo (clinical) [Ep 42 · 3:47](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=227)
- "Intraoperative ICG can be used to determine biliary flow or identify a transaction" — Rod Gerardo (clinical) [Ep 42 · 3:47](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=227)
- "26% of respondents use ICG to visualize the biliary tree, 23% use it in select patients, and 51% do not use it" (epidemiological) [Ep 42 · 4:45](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=285)
- "MMP7 testing is often a send-out test at non-freestanding children's hospitals" — Rod Gerardo (clinical) [Ep 42 · 5:48](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=348)
- "Children with biliary atresia presenting at five weeks have limited time to achieve best outcomes" — Rod Gerardo (clinical) [Ep 42 · 5:48](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=348)
- "For pediatric trauma patients, early blood therapy and massive transfusion protocol are where ATLS and literature are leading" — Rod Gerardo (guideline) [Ep 42 · 8:30](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=510)
- "There is currently no great definition of what constitutes massive transfusion protocol in pediatric patients" — Rod Gerardo (clinical) [Ep 42 · 8:30](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=510)
- "Balanced resuscitation should be initiated when approaching 40 cc per kg blood transfusion" — Rod Gerardo (clinical) [Ep 42 · 8:30](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=510)
- "Hypertonic saline is the most common sclerotherapy choice at 46%, with phenol, ethyl alcohol, and dextrose in water at 10-16% each" — Rod Gerardo (epidemiological) [Ep 42 · 10:35](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=635)
- "Getting phenol into the operating room for sclerotherapy is not always easy due to institutional and pharmacy restrictions" (clinical) [Ep 42 · 10:50](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650)
- "There are case reports showing mucosal sloughing with phenol use" (clinical) [Ep 42 · 10:50](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650)
- "Deflux, used by urology for vesicoureteral reflux, has been reported in case reports for rectal prolapse" (clinical) [Ep 42 · 10:50](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650)
- "3% sotradecol is used as an alternative sclerotherapy agent" — Rod Gerardo (clinical) [Ep 42 · 11:48](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=708)
- "D50 from the code cart is easier to acquire than 3% saline in some operating rooms" — Rod Gerardo (clinical) [Ep 42 · 11:56](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=716)
- "50% of respondents always use sutureless closure for large abdominal wall defects, 39% use it in select patients, and only 11% do not use it" (epidemiological) [Ep 42 · 12:23](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=743)
- "ERAS is a bundle of interventions to help patients get through the hospital faster with less pain and less narcotics" — Rod Gerardo (clinical) [Ep 42 · 16:14](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=974)
- "ERAS includes a carbohydrate drink two hours before surgery, changing from traditional NPO protocols" — Rod Gerardo (clinical) [Ep 42 · 16:14](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=974)
- "ERAS implementation requires anesthesiologist buy-in because it represents a big change from traditional practice" — Rod Gerardo (opinion) [Ep 42 · 16:42](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1002)
- "ERAS protocols are difficult to implement because they require the whole hospital to adopt a different culture and philosophy" — Rod Gerardo (opinion) [Ep 42 · 17:55](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1075)
- "Surgical pathways created for ERAS are used more by hospitalists and pediatric residents than any other pathways" — Rod Gerardo (clinical) [Ep 42 · 19:09](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1149)
- "Surgical pathways have led to decreased cost, antibiotic utilization, and decreased length of stay" — Rod Gerardo (clinical) [Ep 42 · 19:09](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1149)
- "Starting with one component like decreasing opioid use intraoperatively and perioperatively can be an entry point for larger ERAS implementation" — Rod Gerardo (opinion) [Ep 42 · 19:42](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1182)
- "For pulmonary vessel bleeding during thoracoscopic lobectomy, energy sources work well as initial hemostasis because it is a low-pressure system" — Rod Gerardo (clinical) [Ep 42 · 21:18](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1278)
- "Multiple hemostasis options including energy, clips, and sutures should be available for thoracoscopic vessel bleeding" — Rod Gerardo (clinical) [Ep 42 · 21:38](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1298)
- "Most institutions are either addressing social determinants of health or working on it, with few saying no" (epidemiological) [Ep 42 · 21:50](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1310)
- "Despite six decades of research, the exact cause of necrotizing enterocolitis is unknown and there is no absolute cure for the disease" — Gail Besner (clinical) [Ep 40 · 1:53](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=113)
- "Indomethacin administration predisposes babies to both isolated ileal perforation and necrotizing enterocolitis" — Todd Ponsky (clinical) [Ep 40 · 4:25](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=265)
- "Acid suppression medications (PPIs and H2 blockers) should be avoided as neutralizing gastric acid may increase NEC risk" — Gail Besner (clinical) [Ep 40 · 4:46](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=286)
- "In premature babies with patent processus vaginalis, intestinal contents can leak into the scrotum causing swelling and discoloration" — Gail Besner (clinical) [Ep 40 · 5:24](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=324)
- "Neutropenia and low white blood cell count in suspected NEC is more concerning than elevated WBC as it may indicate overwhelming sepsis" — Gail Besner (clinical) [Ep 40 · 7:14](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=434)
- "Thrombocytopenia can result from endotoxemia and gram-negative septicemia in NEC patients" — Gail Besner (clinical) [Ep 40 · 7:45](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=465)
- "Cross-table lateral or lateral decubitus films are essential to detect subtle free air that may be missed on plain films alone" — Gail Besner (clinical) [Ep 40 · 8:48](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=528)
- "Fixed loops of intestine on serial x-rays are not an absolute indication for surgery but are a concerning sign of clinical deterioration" — Gail Besner (clinical) [Ep 40 · 9:58](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=598)
- "Portal venous air is a worrisome sign but not an absolute indication for surgery, as some patients with portal venous air improve with medical management" — Gail Besner (clinical) [Ep 40 · 10:25](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=625)
- "Medical management of NEC includes NPO status, orogastric tube decompression, broad-spectrum antibiotics, and serial monitoring" — Gail Besner (clinical) [Ep 40 · 11:01](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=661)
- "Small French feeding tubes are inadequate for gastric decompression and should be replaced with larger orogastric tubes" — Gail Besner (clinical) [Ep 40 · 11:46](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=706)
- "There is tremendous diversity in antibiotic regimens for NEC across the United States, possibly depending on local bacterial colonization patterns" — Gail Besner (epidemiological) [Ep 40 · 12:35](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=755)
- "Abdominal x-rays should be obtained at regular intervals (approximately every 8 hours) rather than waiting 12-24 hours between films" — Gail Besner (clinical) [Ep 40 · 13:39](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=819)
- "Babies should remain NPO for at least 7-10 days (preferably 10 days) after medical NEC treatment before resuming feeds" — Gail Besner (clinical) [Ep 40 · 14:16](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=856)
- "Post-NEC strictures typically occur in the colon, usually near the splenic flexure, but can occur anywhere" — Gail Besner (clinical) [Ep 40 · 14:38](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=878)
- "Contrast enema should be performed before upper GI with small bowel follow-through when evaluating for post-NEC strictures, as strictures are more common in the colon" — Gail Besner (clinical) [Ep 40 · 15:18](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=918)
- "Serial abdominal exams showing worsening distension, peritoneal irritation, hemodynamic instability with increasing pressor needs, and renal shutdown indicate need for surgery" — Gail Besner (clinical) [Ep 40 · 17:14](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=1034)
- "The difference in mortality between peritoneal drainage and laparotomy for NEC is essentially indecipherable" — Gail Besner (clinical) [Ep 40 · 18:50](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=1130)
- "In Europe, 100% of surgeons polled perform laparotomy for NEC and no one uses peritoneal drainage" — Gail Besner (epidemiological) [Ep 40 · 19:10](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=1150)
- "The MOSS and Piero trials showed no difference in overall mortality between drain and laparotomy but did not examine delayed neurological outcomes" — Gail Besner (clinical) [Ep 40 · 19:42](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=1182)
- "Babies who receive peritoneal drains may have worse neurological outcomes at 18-22 months compared to those who undergo laparotomy" — Gail Besner (clinical) [Ep 40 · 20:20](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=1220)
- "The NEST trial randomized 300 babies to drainage versus laparotomy and will assess neurological outcomes at 18-22 months" — Gail Besner (clinical) [Ep 40 · 20:50](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=1250)
- "Babies can become equally sick and hemodynamically unstable from spontaneous intestinal perforation as from necrotizing enterocolitis due to systemic inflammatory response syndrome" — Gail Besner (clinical) [Ep 40 · 24:07](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=1447)
- "Peritoneal drain placement uses a quarter-inch Penrose drain inserted through a small right lower quadrant transverse incision under local anesthesia at bedside" — Gail Besner (clinical) [Ep 40 · 26:17](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=1577)
- "Making the drain incision too large can result in hernia formation after drain removal" — Gail Besner (clinical) [Ep 40 · 27:00](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=1620)
- "When converting from drain to laparotomy after prolonged drainage, extensive adhesions may make dissection extremely difficult with risk of multiple serosal tears and enterotomies" — Gail Besner (clinical) [Ep 40 · 28:38](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=1718)
- "When encountering extensive adhesions and serosal tears during laparotomy, the smartest decision may be to create a proximal diverting stoma and abort further dissection" — Gail Besner (opinion) [Ep 40 · 29:10](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=1750)
- "Peritoneal drains should be advanced out gradually over several days starting at 7-10 days post-placement rather than removed all at once" — Gail Besner (clinical) [Ep 40 · 29:50](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=1790)
- "Laparotomy for NEC uses a supraumbilical transverse incision with extreme care to avoid liver and spleen injury in premature infants" — Gail Besner (clinical) [Ep 40 · 32:00](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=1920)
- "Even minimal trauma to the liver in premature babies can cause subcapsular hematoma leading to exsanguination" — Gail Besner (clinical) [Ep 40 · 32:40](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=1960)
- "Spontaneous intestinal perforation is diagnosed by one small localized perforation area, while NEC involves more diffuse disease with pneumatosis affecting multiple areas" — Gail Besner (clinical) [Ep 40 · 33:20](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2000)
- "Some surgeons worldwide perform primary anastomosis for limited NEC, but US surgeons more commonly create stomas due to concerns about anastomotic healing" — Gail Besner (epidemiological) [Ep 40 · 34:00](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2040)
- "Stomas are typically brought out through the laparotomy incision close together to facilitate easier closure at 2000 grams weight" — Gail Besner (clinical) [Ep 40 · 35:03](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2103)
- "Stomas are not matured but are tacked to fascia to prevent retraction, with careful monitoring as the distal end may slough off" — Gail Besner (clinical) [Ep 40 · 35:40](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2140)
- "When bowel appears injured with pneumatosis and thin walls but not clearly necrotic, it may be appropriate to avoid resection and perform a second-look operation in 24-48 hours" — Gail Besner (clinical) [Ep 40 · 37:13](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2233)
- "For multiple skip lesions, resection with multiple anastomoses distal to a proximal diverting stoma protects against anastomotic leak complications" — Gail Besner (clinical) [Ep 40 · 38:06](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2286)
- "Clip-and-drop technique (resecting dead bowel, clipping ends, and returning for second operation) can be lifesaving in unstable patients without time for multiple anastomoses" — Gail Besner (clinical) [Ep 40 · 38:48](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2328)
- "Stoma reversal is typically performed at approximately 2000 grams weight, though earlier reversal is indicated for TPN-induced cholestasis or inability to nourish due to high stoma output" — Gail Besner (clinical) [Ep 40 · 39:28](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2368)
- "Refeeding through mucous fistula is done selectively for very high output stomas rather than routinely" — Gail Besner (clinical) [Ep 40 · 40:41](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2441)
- "A small soft catheter can be left in the mucous fistula post-operatively to maintain access for refeeding, as the opening often strictures" — Gail Besner (clinical) [Ep 40 · 41:23](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2483)
- "The chance of a baby with NEC totalis surviving long enough to receive small bowel-liver transplant is very close to zero" — Gail Besner (clinical) [Ep 40 · 42:20](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2540)
- "Babies with NEC totalis requiring months to years of TPN will develop irreversible liver injury, and small bowel transplant results remain suboptimal" — Gail Besner (clinical) [Ep 40 · 43:39](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2619)
- "Pneumothorax can dissect through the diaphragm into the abdomen causing pneumoperitoneum that mimics intestinal perforation" — Gail Besner (clinical) [Ep 40 · 44:22](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2662)
- "In hemodynamically unstable patients with pneumoperitoneum, inserting an angiocatheter through the abdominal wall to release pressure is a useful temporizing maneuver" — Gail Besner (clinical) [Ep 40 · 44:50](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2690)
- "NEST trial results published in fall 2021 showed no overall difference in death or neurodevelopmental impairment between laparotomy and drainage groups" — Rod Gerardo (clinical) [Ep 40 · 46:18](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2778)
- "In the NEST trial, neonates diagnosed with NEC (versus isolated perforation) had approximately 20% decrease in death rate with laparotomy compared to drainage" — Rod Gerardo (clinical) [Ep 40 · 46:50](https://library.globalcastmd.com/watch/stay-current-throwbacks-necrotizing-enterocolitis-with-dr-gail-besner-5402?t=2810)
- "The Chilean Society of Pediatric Surgery screens 1,200 articles each month, with only 3% relevant to pediatric surgery" — Jose Campos (epidemiological) [Ep 44 · 1:38](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=98)
- "A multi-institutional prospective randomized trial compared piperacillin-tazobactam to ceftriaxone plus metronidazole for perforated appendicitis" — Jose Campos (clinical) [Ep 44 · 4:00](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=240)
- "At 75% enrollment, interim analysis favored piperacillin-tazobactam and the study was stopped" — Jose Campos (clinical) [Ep 44 · 5:00](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=300)
- "Intra-abdominal abscess formation was significantly lower in the piperacillin-tazobactam group with an odds ratio of 4.8" — Jose Campos (clinical) [Ep 44 · 5:20](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=320)
- "The number needed to treat with piperacillin-tazobactam to prevent one intra-abdominal abscess was 5.7" — Jose Campos (clinical) [Ep 44 · 5:50](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=350)
- "One of the two hospitals in the trial did not see a difference in abscess rate in their cohort" — Sean (clinical) [Ep 44 · 7:04](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=424)
- "The overall study results were swayed entirely by Phoenix's experience" — Sean (clinical) [Ep 44 · 7:30](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=450)
- "NSQIP-P national data does not show a difference in abscess rates between ceftriaxone-metronidazole and piperacillin-tazobactam" — Sean (clinical) [Ep 44 · 7:45](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=465)
- "A 20-center randomized controlled trial compared initial laparotomy versus peritoneal drainage for NEC, enrolling 310 premature newborns" — Jose Campos (clinical) [Ep 44 · 10:50](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=650)
- "At 18 to 22 months corrected age, the composite of death and neurodevelopmental impairment was similar in both groups in frequentist analysis" — Jose Campos (clinical) [Ep 44 · 11:20](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=680)
- "Bayesian analysis showed a high probability of laparotomy being superior to peritoneal drainage" — Jose Campos (clinical) [Ep 44 · 11:40](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=700)
- "Most patients who received peritoneal drainage went to laparotomy shortly after drain placement" — Sean (clinical) [Ep 44 · 13:07](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=787)
- "In the original drain papers by Ziggy Hein, a third of patients died, a third got laparotomy" (clinical) [Ep 44 · 13:51](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=831)
- "Peritoneal drainage started as a temporizing measure and morphed into definitive management in approximately 40-50% of surgeons' minds" (opinion) [Ep 44 · 14:10](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=850)
- "A systematic review examined 900 publications on gastrostomy insertion, with 58 used for final recommendations" — Jose Campos (clinical) [Ep 44 · 18:20](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1100)
- "Twelve studies directly compared outcomes between laparoscopic and percutaneous endoscopic gastrostomy" — Jose Campos (clinical) [Ep 44 · 18:50](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1130)
- "Major complication rates were significantly less common with laparoscopic gastrostomy placement" — Jose Campos (clinical) [Ep 44 · 19:10](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1150)
- "The number needed to treat to prevent one major complication from PEG is 24" — Jose Campos (clinical) [Ep 44 · 19:30](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1170)
- "PEG was invented before widespread laparoscopy, which influenced practice patterns favoring PEG" — Todd (opinion) [Ep 44 · 16:52](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1012)
- "PEG placement is blind, putting something through the belly without looking" — Todd (opinion) [Ep 44 · 17:14](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1034)
- "Children with PEG tubes often require a second anesthetic to change from PEG to button tube under endoscopic guidance" — Meera Kotagal (clinical) [Ep 44 · 20:29](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1229)
- "The Teen Labs Consortium has been conducting prospective NIH-funded trials on adolescent bariatric surgery since 2007" (clinical) [Ep 44 · 24:10](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1450)
- "Sleeve gastrectomy is a very safe operation in adolescents with resolution of comorbidities, especially in pre-diabetic and diabetic patients" (clinical) [Ep 44 · 23:14](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1394)
- "Average time adolescents are in bariatric surgery programs before surgery is around nine months" (clinical) [Ep 44 · 25:11](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1511)
- "A database comparison of 3,000 patients found no survival difference between total thyroidectomy and thyroid lobectomy for differentiated papillary thyroid cancer" — Jose Campos (clinical) [Ep 44 · 25:49](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1549)
- "Microaggressions are verbal, nonverbal, environmental slights, snubs, invalidations, or insults that send hostile, derogatory, or negative messages to individuals based solely on their marginalized group membership" — Craig Lillehei (clinical) [Ep 45 · 3:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=210)
- "Microaggressions have a cumulative impact causing isolation and self-doubt despite being termed 'micro'" — Craig Lillehei (clinical) [Ep 45 · 4:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=240)
- "In the TOTAL trial for severe CDH, FETO significantly improved survival" — Craig Lillehei (clinical) [Ep 45 · 10:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=600)
- "In the TOTAL trial for moderate CDH, FETO showed some improvement in survival but did not approach statistical significance" — Craig Lillehei (clinical) [Ep 45 · 10:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=620)
- "The TOTAL trial was conducted over an 11-year period at multiple centers with variable CDH management protocols" — Craig Lillehei (clinical) [Ep 45 · 10:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=650)
- "FETO is associated with prematurity and premature rupture of membranes as complications" — Craig Lillehei (clinical) [Ep 45 · 11:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=680)
- "NPO guidelines for children are based on very poor evidence and vary significantly between institutions" (clinical) [Ep 45 · 15:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=900)
- "Pulmonary aspiration during elective pediatric surgery is very rare and usually occurs in emergency surgeries in high-risk children" (epidemiological) [Ep 45 · 15:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=920)
- "Clear liquids containing carbohydrates empty the stomach very quickly regardless of patient age" (clinical) [Ep 45 · 15:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=950)
- "British and Irish consensus recommends one hour NPO for clear liquids, four hours for breast milk, six hours for solid foods in children under 17" (guideline) [Ep 45 · 16:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=970)
- "ASA currently recommends two hours for clear liquids, four hours for breast milk, six hours for non-human milk and light meals, eight hours for heavy meals" (guideline) [Ep 45 · 16:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1000)
- "European Society of Anesthesia recommends one hour for clear liquids, three hours for breast milk, four hours for formula, six hours for everything else" (guideline) [Ep 45 · 17:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1030)
- "Prolonged NPO periods cause ketone body generation, hypoglycemia, and patient irritability" (clinical) [Ep 45 · 17:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1060)
- "In standard C-arm configuration, the x-ray source is below the table and the image intensifier is above" (clinical) [Ep 45 · 23:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1400)
- "Placing lead shields on top of the patient during fluoroscopy does nothing to protect them because radiation comes from below the table" (clinical) [Ep 45 · 23:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1420)
- "If a shield is in the fluoroscopy field, automatic brightness control increases x-ray energy, increasing patient exposure" (clinical) [Ep 45 · 24:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1450)
- "Collimation focuses the x-ray beam to a specific area, increasing detail while decreasing total patient dose by reducing the irradiated surface area" (clinical) [Ep 45 · 25:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1500)
- "Magnification setting on fluoroscopy significantly increases radiation dose to both patient and room personnel" (clinical) [Ep 45 · 25:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1530)
- "Pulse mode fluoroscopy is feasible for most pediatric surgery applications and reduces radiation compared to continuous mode" (clinical) [Ep 45 · 25:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1550)
- "CT scan for suspected airway foreign body has 94% accuracy in identifying foreign bodies when present" (clinical) [Ep 45 · 33:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2000)
- "CT scan can identify non-radiopaque foreign bodies including plastic" (clinical) [Ep 45 · 33:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2020)
- "In the Midwest Pediatric Surgery Consortium study of 521 primary lung lesions, none of the prenatally diagnosed lesions were malignant" (clinical) [Ep 45 · 36:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2200)
- "Approximately 10% of postnatally diagnosed lung lesions were malignant in the consortium study" (epidemiological) [Ep 45 · 37:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2230)
- "About half of malignant lung lesions were associated with DICER1 mutation" (clinical) [Ep 45 · 37:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2250)
- "No malignant lung lesion had a systemic feeding vessel in the consortium study" (clinical) [Ep 45 · 37:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2270)
- "CT scan sensitivity and specificity for detecting malignancy in lung lesions was poor with low inter-rater reliability among radiologists" (clinical) [Ep 45 · 38:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2290)
- "The IMPACT study showed piperacillin-tazobactam had significantly lower postoperative abscess rate, ER visit rate, and CT scan rate compared to ceftriaxone-metronidazole for perforated appendicitis" (clinical) [Ep 45 · 43:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2600)
- "A NSQIP study of 654 patients showed opposite results, suggesting ceftriaxone-metronidazole was preferred over piperacillin-tazobactam" (clinical) [Ep 45 · 44:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2640)
- "Mechanical bowel preparation has no effect on surgical site infection rates" — Paul Yzotrak (clinical) [Ep 45 · 50:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3000)
- "Some data suggests mechanical bowel prep actually increases surgical site infections" — Paul Yzotrak (clinical) [Ep 45 · 50:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3020)
- "The NEC trial showed neurodevelopmental outcomes are improved with laparotomy compared to peritoneal drainage" — Paul Yzotrak (clinical) [Ep 45 · 53:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3200)
- "The NEC trial cutoff for laparotomy was approximately one kilogram" — Paul Yzotrak (clinical) [Ep 45 · 53:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3230)
- "Neuroblastoma with segmental chromosomal abnormalities but no MYCN amplification is now classified as high risk based on 2020-21 COG data" — Paul Yzotrak (guideline) [Ep 45 · 62:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3750)
- "Several hospitals have changed their gastroschisis protocols based on recent publications" — Todd (clinical) [Ep 46 · 0:00](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=0)
- "Some protocols say to start feeding when NG output is 20 mL/kg/day" — Justin (clinical) [Ep 46 · 1:45](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=105)
- "Some published protocols say to start feeding when the baby has had a bowel movement" — Jason Frischer (clinical) [Ep 46 · 3:10](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=190)
- "Some protocols say to start feeding when NG output is clear" — Jason Frischer (clinical) [Ep 46 · 3:10](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=190)
- "Some protocols say to start feeding when you clamp the NG and there is no output" — Jason Frischer (clinical) [Ep 46 · 3:10](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=190)
- "One institution does not intubate gastroschisis babies at all for dressing placement" — Jason Frischer (clinical) [Ep 46 · 3:10](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=190)
- "If you empty the stomach, squish out the colon, go slow, give the baby sweeties, and have nurses help relax the baby, you can reduce gastroschisis without sedation" — Jason Frischer (clinical) [Ep 46 · 5:13](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=313)
- "Some institutions use full general anesthesia for gastroschisis reduction" — Bindi (clinical) [Ep 46 · 5:52](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=352)
- "In parts of the world without TPN access, they must feed gastroschisis babies immediately" — Jason Frischer (clinical) [Ep 46 · 6:19](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=379)
- "Cincinnati introduced sham feeding into their gastroschisis protocol because babies had poor oral feeding skills from delayed access to feeding" — Beth Rymeski (clinical) [Ep 46 · 6:52](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=412)
- "Cincinnati tried ad-lib feeding for gastroschisis for about a year but abandoned it after reviewing results" — Beth Rymeski (clinical) [Ep 46 · 6:52](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=412)
- "Cincinnati's gastroschisis feeding protocol has been in place for approximately four years" — Beth Rymeski (clinical) [Ep 46 · 6:52](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=412)
- "Feeding protocols are important because they reduce care variation and allow nurses and residents to advance feeds without calling a doctor every time" — Todd (opinion) [Ep 46 · 9:10](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=550)
- "In the multi-institutional study, roughly two-thirds of patients were fed by protocol and one-third were not" — Beth Rymeski (epidemiological) [Ep 46 · 10:01](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=601)
- "Protocol-fed infants had fewer surgical site infections" — Beth Rymeski (epidemiological) [Ep 46 · 10:01](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=601)
- "The study was inconclusive due to lots of different feeding protocols used across member institutions" — Jason Frischer (epidemiological) [Ep 46 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=630)
- "The SSI reduction was probably because protocol-fed patients had less variability and fewer changes in care" — Jason Frischer (opinion) [Ep 46 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=630)
- "Cincinnati's average length of stay for gastroschisis was 49 days, astronomically higher than other NICUs in their cooperative network" — Jason Frischer (epidemiological) [Ep 46 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=630)
- "After instituting a feeding protocol, Cincinnati dropped gastroschisis length of stay by 10 days over two years" — Jason Frischer (epidemiological) [Ep 46 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=630)
- "Cincinnati is starting to see a decrease in time from first feed to full feeds" — Jason Frischer (clinical) [Ep 46 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=630)
- "Cincinnati has not seen a change in days from admission to first feed, although 2020 showed improvement before bouncing back" — Jason Frischer (epidemiological) [Ep 46 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=630)
- "Some neonatologists prefer continuous feeds, which can lead to babies not taking anything orally and developing oral aversion, prolonging length of stay" — Justin (clinical) [Ep 46 · 13:06](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=786)
- "Cincinnati tries to do intermittent feeds to start, though the protocol does not specifically mandate it" — Beth Rymeski (clinical) [Ep 46 · 13:51](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=831)
- "Approximately two-thirds of Cincinnati's gastroschisis babies go home with an NG or G-tube" — Beth Rymeski (epidemiological) [Ep 46 · 13:51](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=831)
- "Cincinnati has only been doing sham feeds for about a year, too early to see if it makes a difference" — Beth Rymeski (clinical) [Ep 46 · 13:51](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=831)
- "Some people will ignore bilious emesis completely in gastroschisis patients" — Jason Frischer (clinical) [Ep 46 · 15:05](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=905)
- "Some people check residuals which will be bilious and some will completely ignore that" — Jason Frischer (clinical) [Ep 46 · 15:05](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=905)
- "A study from New Zealand discusses attitudes towards feeding in gastroschisis" — Jason Frischer (clinical) [Ep 46 · 15:05](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=905)
- "Institutions need to define their own tolerance thresholds and stay on protocol while continually evaluating patient condition" — Jason Frischer (opinion) [Ep 46 · 15:05](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=905)
- "If a patient has significant issues and complete intolerance, one approach is to stop feeds for six hours" — Jason Frischer (clinical) [Ep 46 · 15:05](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=905)
- "Cincinnati's written protocol states that emesis is expected to set family and nursing expectations" — Beth Rymeski (clinical) [Ep 46 · 16:58](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1018)
- "One recent patient who was primarily reduced on day of life zero was out of hospital in about two weeks" — Jason Frischer (clinical) [Ep 46 · 17:15](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1035)
- "Current gastroschisis length of stay is about 30 to 34 days at one institution" — Jason Frischer (epidemiological) [Ep 46 · 17:15](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1035)
- "The institution tries to push oral feeds quickly to avoid oral aversion" — Jason Frischer (clinical) [Ep 46 · 17:15](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1035)
- "One institution has not seen any aspirations with early aggressive feeding yet" — Jason Frischer (clinical) [Ep 46 · 18:00](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1080)
- "Much of the early feeding data came from low-resource countries without TPN access" — Justin (epidemiological) [Ep 46 · 18:28](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1108)
- "It is very hard for gastroschisis babies in Africa to tolerate early aggressive feeding" — Justin (clinical) [Ep 46 · 18:28](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1108)
- "At least two-thirds of gastroschisis cases at one institution cannot be reduced right away and are placed in a silo" — Jason Frischer (epidemiological) [Ep 46 · 18:56](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1136)
- "The study was retrospective and conducted in the Netherlands between 1998 and 2018" — Cecilia Gigena (epidemiological) [Ep 47 · 0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0)
- "The study included patients under three years old who underwent stoma reversal" — Cecilia Gigena (epidemiological) [Ep 47 · 0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0)
- "244 patients were included in the study" — Cecilia Gigena (epidemiological) [Ep 47 · 0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0)
- "10% of patients developed strictures" — Cecilia Gigena (epidemiological) [Ep 47 · 0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0)
- "95% of strictures occurred in patients with necrotizing enterocolitis" — Cecilia Gigena (clinical) [Ep 47 · 0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0)
- "68% of all patients had a contrast enema prior to stoma reversal" — Cecilia Gigena (epidemiological) [Ep 47 · 0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0)
- "Contrast enema was able to detect 92% of strictures" — Cecilia Gigena (clinical) [Ep 47 · 0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0)
- "Contrast enema prior to stoma reversal appears useful primarily in patients who had necrotizing enterocolitis" — Cecilia Gigena (opinion) [Ep 47 · 0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0)
- "Malrotation occurs in about 1 in 200 to 500 live births" — Em Tombash (epidemiological) [Ep 48 · 0:28](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=28)
- "In the fourth week of gestation, bowel development begins with the bowel herniating into the yolk sac and along the umbilical cord and SMA axis" — Meera Kotagal (clinical) [Ep 48 · 1:17](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=77)
- "Normal bowel rotation involves a 90 degree rotation of the duodenal-jejunal loop followed by a 270 degree rotation of the cecum and colon as the bowel returns to the abdominal cavity" — Meera Kotagal (clinical) [Ep 48 · 1:44](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=104)
- "Normal anatomy results in the duodenal-jejunal junction to the left of midline at the ligament of Treitz and the cecum in the right lower quadrant" — Meera Kotagal (clinical) [Ep 48 · 1:44](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=104)
- "Non-rotation results in the colon on the left and small bowel on the right without the problematic Ladd bands that cause obstruction in malrotation" — Meera Kotagal (clinical) [Ep 48 · 2:22](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=142)
- "Non-rotation anatomy looks similar to the anatomy of a malrotated patient post-Ladd procedure" — Meera Kotagal (clinical) [Ep 48 · 2:22](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=142)
- "Malrotation involves incomplete rotation preventing formation of a broad-based mesentery, which is important to reduce the risk of volvulus" — Meera Kotagal (clinical) [Ep 48 · 2:22](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=142)
- "Complications of malrotation fall into two categories: obstructive symptoms with feeding intolerance, and midgut volvulus resulting from narrow mesentery" — Meera Kotagal (clinical) [Ep 48 · 3:49](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=229)
- "About one in 200 children have a risk of malrotation, but only about one in 30 of those children with malrotation will develop a volvulus" — Meera Kotagal (epidemiological) [Ep 48 · 3:49](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=229)
- "About 70% of children who will have a midgut volvulus will present in the first year of life" — Meera Kotagal (epidemiological) [Ep 48 · 3:49](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=229)
- "As children with malrotation get older without having had a volvulus, their likelihood of having a significant clinical event related to malrotation decreases" — Meera Kotagal (clinical) [Ep 48 · 3:49](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=229)
- "Children with congenital cardiac disease and heterotaxy commonly have associated malrotation, but their likelihood of symptomatic events is much lower" — Meera Kotagal (clinical) [Ep 48 · 3:49](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=229)
- "Rotational abnormalities are associated with congenital diaphragmatic hernia, gastroschisis, and omphalocele due to the nature of the anatomy of these diagnoses" — Meera Kotagal (clinical) [Ep 48 · 3:49](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=229)
- "In the neonatal period, bilious emesis is the most critical symptom requiring evaluation for midgut volvulus even if the x-ray appears normal" — Meera Kotagal (clinical) [Ep 48 · 4:49](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=289)
- "Other symptoms of malrotation include feeding intolerance, abdominal pain, and abdominal distension" — Meera Kotagal (clinical) [Ep 48 · 4:49](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=289)
- "Late signs of volvulus include bloody stools, peritoneal signs on exam, and abdominal wall erythema, which are suggestive of intestinal ischemia" — Meera Kotagal (clinical) [Ep 48 · 4:49](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=289)
- "The differential diagnosis for bilious emesis includes atresia, Hirschsprung disease, meconium ileus, meconium plugs, incarcerated hernia, anorectal malformations, and necrotizing enterocolitis" — Meera Kotagal (clinical) [Ep 48 · 4:49](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=289)
- "Malrotation must be ruled out before pursuing other diagnoses in a child with bilious emesis" — Meera Kotagal (clinical) [Ep 48 · 4:49](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=289)
- "Upper GI is the most frequently used imaging for diagnosis of malrotation, looking at the position and course of the duodenum" — Meera Kotagal (clinical) [Ep 48 · 6:40](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=400)
- "On upper GI, normal anatomy shows the C loop of the duodenum coming back across the midline to the left, and on lateral view going posteriorly and cephalad" — Meera Kotagal (clinical) [Ep 48 · 6:40](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=400)
- "Contrast enema can sometimes determine cecal position but current sensitivity and specificity are not sufficient to rule out malrotation definitively" — Meera Kotagal (clinical) [Ep 48 · 7:30](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=450)
- "Upper GI remains the definitive test for malrotation because missing midgut volvulus is considered the number one surgical emergency in pediatric surgery" — Meera Kotagal (clinical) [Ep 48 · 7:30](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=450)
- "Surgical treatment of volvulus involves exploratory laparotomy with evisceration of the bowel and detorsion, usually requiring 270 degree counterclockwise rotation" — Meera Kotagal (clinical) [Ep 48 · 8:33](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=513)
- "After detorsion, the bowel is given time to rest to assess viability and determine if ischemia has been prolonged" — Meera Kotagal (clinical) [Ep 48 · 8:33](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=513)
- "You can have malrotation without midgut volvulus, but you cannot have midgut volvulus without malrotation" — Em Tombash (clinical) [Ep 48 · 8:33](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=513)
- "The Ladd procedure involves widening the mesentery by removing Ladd bands, straightening the duodenum to avoid obstruction, and often performing an appendectomy" — Meera Kotagal (clinical) [Ep 48 · 8:54](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=534)
- "Appendectomy during Ladd procedure is performed because the appendix will be in an abnormal anatomic position, and families need to be informed if it is left in place" — Meera Kotagal (clinical) [Ep 48 · 8:54](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=534)
- "After Ladd procedure, the bowel is placed in non-rotation configuration with small bowel on the right and large bowel on the left to keep the mesentery as broad as possible" — Meera Kotagal (clinical) [Ep 48 · 8:54](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=534)
- "Some believe that part of the benefit of Ladd procedure is causing scar tissue that helps the bowel adhere in a configuration preventing midgut volvulus" — Meera Kotagal (opinion) [Ep 48 · 10:01](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=601)
- "Laparoscopic Ladd procedure may have decreased adhesion rates, potentially reducing the adhesive benefit but also potentially reducing postoperative bowel obstruction" — Meera Kotagal (opinion) [Ep 48 · 10:01](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=601)
- "About a quarter of patients who undergo a Ladd procedure will have intestinal obstruction related to adhesive small bowel disease" — Meera Kotagal (epidemiological) [Ep 48 · 10:01](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=601)
- "In older children with symptomatic malrotation, laparoscopic approach may be started to assess mesentery width and duodenal anatomy before deciding on approach" — Meera Kotagal (opinion) [Ep 48 · 10:01](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=601)
- "There is controversy about whether laparoscopic approach can successfully broaden the mesentery as wide as it should be" — Meera Kotagal (opinion) [Ep 48 · 10:01](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=601)
- "There is controversy about whether prophylactic Ladd procedure should be performed in asymptomatic children with diagnosed malrotation or in conditions like congenital diaphragmatic hernia" — Meera Kotagal (opinion) [Ep 48 · 10:01](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=601)
- "In younger children with malrotation, the risk for volvulus or symptomatic malrotation is higher, so Ladd procedure is performed more commonly" — Meera Kotagal (clinical) [Ep 48 · 10:01](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=601)
- "Decisions about prophylactic Ladd procedure should involve informed consent discussions with families about risks of both doing and not doing the operation, considering factors like access to care" — Meera Kotagal (opinion) [Ep 48 · 10:01](https://library.globalcastmd.com/watch/malrotation-with-dr-meera-kotagal-6621?t=601)
- "Giant omphalocele is typically defined as five centimeters or greater or liver in the sac" (clinical) [Ep 73 · 0:36](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=36)
- "In a two-center retrospective study of 97 giant omphalocele survivors over 20 years, patients had greater time to full feeds, required more TPN, had more chromosomal anomalies, and higher incidence of respiratory insufficiency" (clinical) [Ep 73 · 0:36](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=36)
- "56 of 97 giant omphalocele patients were identified as having pulmonary hypertension, most diagnosed within the first week of life" (clinical) [Ep 73 · 1:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=74)
- "Five patients with giant omphalocele had no signs of pulmonary hypertension in first echo within seven days but subsequently developed severe pulmonary hypertension, all associated with sepsis episodes" (clinical) [Ep 73 · 1:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=74)
- "Two of the five patients who developed late pulmonary hypertension died, and one required pulmonary vasodilator for more than a year" (clinical) [Ep 73 · 1:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=74)
- "Treatment options for giant omphalocele include painting the sac, removing sac and placing silo with passive or active reduction, keeping sac with active reduction, or definitive immediate closure" — Ellen Encisco (clinical) [Ep 73 · 2:28](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=148)
- "Hydrocolloid dressing technique for giant omphalocele achieved closure in 97% of 40 patients within 30 days and 92% within 15 days" — Ellen Encisco (clinical) [Ep 73 · 3:54](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=234)
- "Hydrocolloid dressing should be placed within first 24 hours before the sac becomes stiff, and the dressing keeps the sac smooth and hydrated" (clinical) [Ep 73 · 4:26](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=266)
- "Patients with hydrocolloid dressing for omphalocele are kept in ICU, ventilated and completely paralyzed during reduction" (clinical) [Ep 73 · 4:20](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=260)
- "For ruptured omphalocele, the sac can be sutured and then hydrocolloid dressing applied" (clinical) [Ep 73 · 4:45](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=285)
- "Patients with omphalocele have increased risk of midgut volvulus compared to gastroschisis patients" (clinical) [Ep 73 · 5:17](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=317)
- "Patients with omphalocele have increased risk of adhesive bowel obstruction with gastroschisis, but higher risk of midgut volvulus" (clinical) [Ep 73 · 5:17](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=317)
- "Non-rotation does not exclude the possibility of anatomy with narrow base of mesentery and two ends being fairly close together" (clinical) [Ep 73 · 5:17](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=317)
- "If exposing intestines in omphalocele patient, Ladd procedure is worthwhile because patients have non-rotation or mal-rotation" (opinion) [Ep 73 · 5:17](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=317)
- "In gastroschisis, the liver is not expected to be eviscerated" (clinical) [Ep 73 · 7:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=434)
- "For massive abdominal wall defects with no amnion, options include leaving silo and squeezing down, creating separate silastic silo sewn to fascia or skin, creating silo with PTFE or biologic mesh sewn to fascial edges" (clinical) [Ep 73 · 7:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=434)
- "Proline mesh can be used for giant defects as it stays in place until closure, with bowel protected within a plastic bag" (clinical) [Ep 73 · 8:18](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=498)
- "Spring-loaded Bentec silo creates outward forces that can make the defect bigger over time in giant abdominal wall defects" (clinical) [Ep 73 · 8:49](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=529)
- "Biologic mesh creates a scaffold that sticks to bowel and allows skin to epithelialize" (clinical) [Ep 73 · 9:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=554)
- "Foreskin from circumcision can be used as a skin graft for abdominal wall coverage" (clinical) [Ep 73 · 9:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=554)
- "Component separation technique involves separating tissue at external oblique about one centimeter beyond rectus sheath on both sides, creating space by dissecting between external and internal oblique" — Ellen Encisco (clinical) [Ep 73 · 10:26](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=626)
- "Incision on anterior rectus sheath can provide additional centimeter of space for closure" — Ellen Encisco (clinical) [Ep 73 · 10:26](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=626)
- "Texas report of component separation in nine children aged 7 days to 10 years achieved fascial closure in vast majority, mostly for omphaloceles and giant defects" — Ellen Encisco (clinical) [Ep 73 · 10:26](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=626)
- "Complex gastroschisis has worse outcomes than simple variety in all measures: hospital length of stay, requirement for further operations, and sepsis rates" (clinical) [Ep 73 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "Sutureless gastroschisis closure involves placing silo or tucking bowel in with occlusive dressing, changed at five days, with defect mostly closed by next change" (clinical) [Ep 73 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "Sutured versus sutureless gastroschisis closure showed no difference in time to full feeds, TPN use, or hospital stay duration" (clinical) [Ep 73 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "Sutureless gastroschisis closure resulted in fewer anesthetics, less frequent antibiotic use, and fewer infections and septic events" (clinical) [Ep 73 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "Randomized trial of over 50 gastroschisis patients found no difference between immediate closure and silo placement" (clinical) [Ep 73 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)

## Changelog
- Aug 31: 88 doctors auto-found from episode dossiers
- Aug 30: 67 doctors auto-found from episode dossiers
- Aug 30: 56 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 68 doctors auto-found from episode dossiers
- Aug 29: 69 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 85 items, 53 dossiers, summaries for 3 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 52 items, 50 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 52 items, 50 dossiers, summaries for 3 audience(s)

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