Intestinal Failure
Also covered as: necrotizing enterocolitis · short bowel syndrome · gastroschisis · cholestasis · Hirschsprung disease · bacterial overgrowth · midgut volvulus · intestinal atresia
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Answers come only from this collection's statement ledger and cite the exact moment · not medical advice
Content of this collection
Foundations
4 items
Multidisciplinary Approach: Intestinal Failure Innovations
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Dr. Michael Helmrath leads a discussion amongst the panel including topics of intestinal failure, a team approach to intestinal patients, nutritional administration, complication rates, central line vs. PICC line use for total parenteral nu
video · 97:52 · Jan 2019
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
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We’re starting a new series about intestinal rehabilitation and all of its intricacies. We’re joined by Drs. Michael Helmrath and Paul Wales, leaders of the Intestinal Rehabilitation Program at Cincinnati Children’s. Hosted by: Todd Ponsky,
video · 14:33 · Dec 2021
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
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We’re starting a new series about intestinal rehabilitation and all of its intricacies. We’re joined by Drs. Michael Helmrath and Paul Wales, leaders of the Intestinal Rehabilitation Program at Cincinnati Children’s. Hosted by: Todd Ponsky,
podcast · 14:33 · Dec 2021
Intestinal Rehabilitation, Episode 3: Enteral Autonomy, Part 1
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We're back with a new episode from the Intestinal Rehabilitation Center at Cincinnati Children's Hospital. This time we're talking about enteral autonomy with Drs. Helmrath and Wales. This is the first of two parts on this topic, stay tuned
podcast · 16:18 · Mar 2022
Acute Management
1 item
Intestinal Rehabilitation, Episode 2: Overwhelming intestinal damage, Part 1
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We're back with a new episode from the Intestinal Rehabilitation Center at Cincinnati Children's Hospital. This time we're talking about the management of overwhelming intestinal damage in conditions such as necrotizing enterocolitis and vo
podcast · 13:27 · Feb 2022
Nutritional Management
4 items
Intestinal Failure - Feeding Access and Nutrition
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Dr. Michael Helmrath discusses alternative feeding techniques for intestinal failure, distal feeding, button insertion illustration, anastomosis, dilated bowel segments, small bowel length significance, liver disease, international patient
video · 118:06 · Nov 2018
Intestinal Rehabilitation, Episode 3: Enteral Autonomy, Part 2
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We're back with the second part of episode 3, enteral autonomy along with Drs. Michael Helmrath and Paul Wales from Intestinal Rehabilitation Center at Cincinnati Children's Hospital. Hosts: Ellen Encisco & Rod GerardoRegister for Best of t
podcast · 13:37 · Mar 2022
Intestinal Rehabilitation, Episode 7: Refeeding in a neonatal patient
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We’re back with a new episode from the intestinal rehabilitation center at Cincinnati Children’s Hospital.
This time we’re talking about How to refeed a neonatal patient with a damage bowel, as always with the experts Drs. Helmrath and W
podcast · 16:09 · Sep 2023
Intestinal Rehabilitation Episode 8: Refeeding of an Older Patient
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We’re back with a new episode from the intestinal rehabilitation center at Cincinnati Children’s Hospital.
This time we’re talking about Refeeding in older patients with Drs. Helmrath and Wales.
If you are looking for refeeding a Neon
podcast · 12:05 · Oct 2023
Surgical Management
4 items
Practical Approach: Intestinal Failure Innovations
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Dr. Michael Helmrath leads a discussion in alternative feeding techniques for intestinal failure, distal feeding, button insertion, the significant of small bowel length, liver disease, international patient management, breast milk therapy,
video · 116:52 · Jan 2019
Intestinal Rehabilitation, Episode 2: Overwhelming intestinal damage, Part 2
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We're back with the second part of episode 2, management of overwhelming intestinal damage along with Drs. Michael Helmrath and Paul Wales from Intestinal Rehabilitation Center at Cincinnati Children's Hospital. Article for further reading:
podcast · 17:21 · Feb 2022
Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1
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We're back with a new topic, discussing surgical management with Drs. Michael Helmrath and Paul Wales from Intestinal Rehabilitation Center at Cincinnati Children's Hospital.
Hosts: Ellen Encisco & Em Tombash
Don't forget to like and
video · 19:07 · Oct 2022
Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1
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We're back with a new topic, discussing surgical management with Drs. Michael Helmrath and Paul Wales from Intestinal Rehabilitation Center at Cincinnati Children's Hospital.
Hosts: Ellen Encisco & Em Tombash
Resources:
Bianchi A.
podcast · 19:07 · Oct 2022
Complications
3 items
Pediatric Vascular Access in Brief: Preoperative, Operative, and Postoperative Considerations
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All surgeons need to know about vascular access. Here we review some preoperative, operative, and postoperative considerations of pediatric vascular access with Dr. Alex Bondoc from Cincinnati Children's Hospital, including indications, con
video · 13:54 · Sep 2022
Intestinal Rehabilitation, Episode 4: Surgical Management, Part 2
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We're back with the second part of discussing surgical management with Drs. Michael Helmrath and Paul Wales from Intestinal Rehabilitation Center at Cincinnati Children's Hospital.
Hosts: Ellen Encisco & Em Tombash
Don't forget to lik
podcast · 12:24 · Oct 2022
Intestinal Rehabilitation, Episode 6: Cholestasis
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We’re back with a new episode from the intestinal rehabilitation center at Cincinnati Children’s Hospital.
This time we’re talking about Cholestasis with Drs. Helmrath and Wales.
Hosts: Cecilia Gigena & Ellen Encisco.
podcast · 15:25 · Jun 2023
Evidence & Research
7 items
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
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Audio Journal with Dr. Von Allmen about usingCorticosteroids After Hepatoportoenterostomy for Bile Drainage, Dr. Whit Holcomb aboutsurgical site infections (SSI) are an important source of morbidity and mortality.andfeasibility and safety o
podcast · 44:19 · Jan 2019
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
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Audio Journal with Dr. Von Allmen about using Corticosteroids After Hepatoportoenterostomy for Bile Drainage, Dr. Whit Holcomb about surgical site infections (SSI) are an important source of morbidity and mortality. and feasibility and safe
podcast · 44:19 · Dec 2020
CAPS - The use of urine sodium to creatinine ratio as a marker of total body sodium in infants with intestinal failure - Sara Choi
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Listen to Sara Choi gave her presentation of "The use of urine sodium to creatinine ratio as a marker of total body sodium in infants with intestinal failure" at the first ever Best of the Best in Pediatric Surgery event.Controlar el sodio
video · 8:40 · May 2022
Journal of Pediatric Surgery Article Review: June 2022, AAP Issue
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Here's the June 2022 issue of JPS article highlights. This time we're talking to Dr. Nicole Chandler and authors Drs. Elizabeth Beierle, Marcus Malek, Biren Modi, Amelia Collings and Katherine Flynn O'Brien.
Hosts: Ellen Encisco, Em Tomb
video · 15:54 · Sep 2022
Journal of Pediatric Surgery Article Review: June 2022, AAP Issue
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Here's the June 2022 issue of JPS article highlights. This time we're talking to Dr. Nicole Chandler and authors Drs. Elizabeth Beierle, Marcus Malek, Biren Modi, Amelia Collings and Katherine Flynn O'Brien.
Hosts: Ellen Encisco, Em Tomb
podcast · 15:54 · Sep 2022
Outcomes of Children With Short Bowel Syndrome: Experiences in a Multidisciplinary Intestinal Rehabilitation Unit Over Two Decades
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Jaime Tsz-wing Tsang, Adrian Chi-heng Fung , Stephen Cheuk-lam Lau,Kenneth Kak-yuen Wong
Background: Short bowel syndrome (SBS) is a rare but serious form of organ failure, and patients with SBS depend on total parenteral nutrition (PN)
video · 0:45 · Mar 2025
Impact of social determinants of health on outcomes in pediatric short bowel syndrome...
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This video discusses a retrospective cohort study from Cincinnati Children's, presented by Lizzy Lee, examining the impact of social determinants of health on outcomes for children with pediatric short bowel syndrome. The study found that f
video · 0:43 · Aug 2026
In-Depth Reviews
4 items
Intestinal Failure with Dr. Brad Warner
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Dr. Brad Warner discusses intestinal failure management in pediatric patients, covering diagnostic criteria, bowel length thresholds for survival, and long-term outcomes. Key topics include short bowel syndrome following necrotizing enteroc
podcast · 52:46 · Jan 2019
Intestinal Failure with Dr. Brad Warner
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Discussion with Dr. Brad W. Warner about intestinal failureWhat is intestinal failure?An umbrella term for when the small bowel is unable to digest and absorb an adequate amount of nutrients to sustain a patient through enteral means alone.
podcast · 52:46 · Dec 2020
Intestinal Rehabilitation Webinar 2023 - Top 5 Key Takeaways
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In November 2023 we held the first Intestinal Rehabilitation webinar with Dr. Paul Wales & Dr. Michael Helmrath, 2 experts from the Intestinal Rehab center at Cincinnati Children's.
These are the top 5 key takeaways from this webinar!!
video · 12:14 · Jun 2024
Advancements in Pediatric Intestinal Failure: Innovative Therapies and Improved Outcomes
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This podcast from Cincinnati Children's Hospital Medical Center explores the definition, causes, and management of pediatric intestinal failure, emphasizing advancements in treatment. Dr. Stephanie Bachi de Castro Oliveira and Dr. Paul W. W
video · 17:45 · Aug 2026
Patient & Family Education
1 item
Reliance on total parenteral nutrition (TPN) and travelling abroad
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Intestinal failure in children: Reliance on total parenteral nutrition (TPN) and travelling abroad - An ERNICA animation for patients and families
Click here to access the tool and find out more information: https://www.ern-ernica.eu/int
video · 1:42 · Dec 2023
Long-Term Care
1 item
Care transition from a pediatric intestinal rehabilitation program to adult care and the risk of all-cause mortality: A retrospective cohort study
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Gillian R Goddard, Stephanie Oliveira, Crystal Slaughter, Kim Klotz, Marilyn Stoops, Julie Schletker, Jackie Wessel, Michael Helmrath, Samuel Kocoshis, Monique Goldschmidt, Paul W WalesBackground: As patients with intestinal failure reach a
video · 1:01 · May 2026
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Every statement below comes from the recorded discussions, with its speaker and moment.
Intestinal Rehabilitation Episode 8: Refeeding of an Older Patient
Older children (8-16 years) who experience volvulus can lose 90+% of their bowel
clinicalMichael Helmrath1:11 ↗
Older patients who have established eating behavior before bowel loss have both a benefit and curse in that they know how to eat
opinionPaul Wales1:24 ↗
In older children, normal feeding behavior is important for social aspects of life beyond nutrition
clinicalCecilia Gigena1:30 ↗
Even if a patient cannot be cured and weaned off TPN, compromises should be made to optimize quality of life
opinionPaul Wales1:50 ↗
The general strategy is to push macronutrient modules of protein and fat which are well tolerated
clinicalPaul Wales2:14 ↗
Most short bowel patients don't tolerate simple sugars very well
clinicalPaul Wales2:21 ↗
Pushing solids and minimizing fluid intake helps reduce dumping
clinicalPaul Wales2:25 ↗
Smaller meals more frequently of solids separated from liquids and minimization of simple sugars is the recommended approach
clinicalPaul Wales2:31 ↗
Patients who have transitioned off TPN often come back with problems when diet history reveals they have gotten loose with diet choices
clinicalPaul Wales2:52 ↗
Increase in sugars can create problems with absorption and changes in stool output
clinicalCecilia Gigena3:12 ↗
Minimizing sugars reduces symptoms related to bacterial overgrowth such as bloating and gas
clinicalPaul Wales3:31 ↗
Fluid losses whether by stoma or other source must be replaced
clinicalPaul Wales3:48 ↗
If patients are on IV support, some fluid can be replaced intravenously
clinicalPaul Wales3:56 ↗
When trying to wean off IV support, keeping patients hydrated through enteral replacements is important
clinicalPaul Wales4:01 ↗
Fluid transport requires sodium and glucose, so replacement solution must contain both
clinicalPaul Wales4:11 ↗
Gatorade doesn't work well for rehydration because it has too much sugar
clinicalPaul Wales4:48 ↗
Some patients can come off TPN but still need a central line for IV fluids
clinicalMichael Helmrath4:55 ↗
Without adequate IV fluids, patients end up sleeping most of the day and don't have energy
clinicalMichael Helmrath4:55 ↗
Being in a hydrated state is extremely important to making the bowel work well
clinicalMichael Helmrath5:08 ↗
Sometimes patients can't drink rehydration solution but the GI tract can use it via G-tube
clinicalMichael Helmrath5:31 ↗
Energy use goes up dramatically during puberty
clinicalMichael Helmrath5:51 ↗
Children doing well often hit the wall when they start puberty because energy needs overcome nutrient input
clinicalMichael Helmrath5:51 ↗
Some kids end up back on parenteral support to get through puberty
clinicalPaul Wales6:28 ↗
When not growing anymore as an adult, borderline or marginal gut function is often enough to sustain them
clinicalPaul Wales6:33 ↗
There are very few conditions with intestinal failure that have restricted growth
clinicalMichael Helmrath6:57 ↗
A 3rd percentile growth should not be accepted for most intestinal failure patients
opinionMichael Helmrath6:57 ↗
After getting off TPN, patients often get into trouble with micronutrient deficiencies
clinicalPaul Wales7:22 ↗
Weight must be balanced with height as a growth metric
clinicalPaul Wales8:51 ↗
This population commonly shows round babies where weight for height is elevated
clinicalPaul Wales8:57 ↗
There is increasing data looking at quality of weight - how much is fat weight versus lean body mass
clinicalPaul Wales9:01 ↗