# Intestinal Rehabilitation Fundamentals — GCMD Library living collection

Updated: n/a · 13 episodes · 70 cited statements

## Episodes
### Introduction & Overview
- [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)
- [Introduction to intestinal rehabilitation and intestinal failure in pediatric surgery](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526) — podcast · 14:33 · [machine version](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526.md)
- [Intestinal rehabilitation in pediatric short bowel syndrome: expert strategies for autonomy](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524) — podcast · 12:14 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524.md)

### Multidisciplinary Care Models
- [Impact of multidisciplinary teams for management of intestinal failure in children](https://library.globalcastmd.com/article/impact-of-multidisciplinary-teams-for-management-of-intestinal-failure-in-childr-16653) — article · [machine version](https://library.globalcastmd.com/article/impact-of-multidisciplinary-teams-for-management-of-intestinal-failure-in-childr-16653.md)
- [The impact of multi-disciplinary intestinal rehabilitation programs on the outcome of pediatric patients with intestinal failure: a systematic review and meta-analysis.](https://library.globalcastmd.com/article/the-impact-of-multi-disciplinary-intestinal-rehabilitation-programs-on-the-outco-16661) — article · [machine version](https://library.globalcastmd.com/article/the-impact-of-multi-disciplinary-intestinal-rehabilitation-programs-on-the-outco-16661.md)
- [Impact of Intestinal Rehabilitation Program and Its Innovative Therapies on the Outcome of Intestinal Transplant Candidates](https://library.globalcastmd.com/article/impact-of-intestinal-rehabilitation-program-and-its-innovative-therapies-on-the-16658) — article · [machine version](https://library.globalcastmd.com/article/impact-of-intestinal-rehabilitation-program-and-its-innovative-therapies-on-the-16658.md)
- [Neonatal short bowel syndrome outcomes after the establishment of the first Canadian multidisciplinary intestinal rehabilitation program: preliminary experience](https://library.globalcastmd.com/article/neonatal-short-bowel-syndrome-outcomes-after-the-establishment-of-the-first-cana-16663) — article · [machine version](https://library.globalcastmd.com/article/neonatal-short-bowel-syndrome-outcomes-after-the-establishment-of-the-first-cana-16663.md)

### Program Evolution & Outcomes
- [Change of Outcomes in Pediatric Intestinal Failure: Use of Time-Series Analysis to Assess the Evolution of an Intestinal Rehabilitation Program](https://library.globalcastmd.com/article/change-of-outcomes-in-pediatric-intestinal-failure-use-of-time-series-analysis-t-16655) — article · [machine version](https://library.globalcastmd.com/article/change-of-outcomes-in-pediatric-intestinal-failure-use-of-time-series-analysis-t-16655.md)
- [Researchers, Cincinnati Children's Hospital Medical Center](https://library.globalcastmd.com/article/researchers-cincinnati-children-s-hospital-medical-center-15232) — article · [machine version](https://library.globalcastmd.com/article/researchers-cincinnati-children-s-hospital-medical-center-15232.md)
- [Support Services | Cincinnati Children's Research Foundation](https://library.globalcastmd.com/article/support-services-cincinnati-children-s-research-foundation-15233) — article · [machine version](https://library.globalcastmd.com/article/support-services-cincinnati-children-s-research-foundation-15233.md)

### Educational Resources
- [Patient and Family Resources](https://library.globalcastmd.com/article/patient-and-family-resources-15230) — article · [machine version](https://library.globalcastmd.com/article/patient-and-family-resources-15230.md)
- [Resources for Healthcare Professionals](https://library.globalcastmd.com/article/resources-for-healthcare-professionals-15231) — article · [machine version](https://library.globalcastmd.com/article/resources-for-healthcare-professionals-15231.md)
- [Newsroom](https://library.globalcastmd.com/article/newsroom-15235) — article · [machine version](https://library.globalcastmd.com/article/newsroom-15235.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=0) Introduction and Program Context (Ep 1)
- [1:56](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=116) Defining Intestinal Failure and Intestinal Rehabilitation (Ep 1)
- [4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=290) Three Categories of Intestinal Failure (Ep 1)
- [8:20](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=500) Timing of Diagnosis and Referral (Ep 1)
- [10:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=605) Team Approach and Future Challenges (Ep 1)
- [13:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=795) Series Goals and Closing (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=0) Introduction and webinar context (Ep 3)
- [0:44](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=44) Principle 1: Infant gut growth potential and measurement (Ep 3)
- [2:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=138) Principle 2: Importance of distal ileum and functional bowel (Ep 3)
- [3:21](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=201) Principle 3: Surgical strategy for staged reconstruction (Ep 3)
- [4:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=295) Principle 4: Enteral nutrition strategies (Ep 3)
- [8:42](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=522) Principle 5: Parenteral nutrition management (Ep 3)
- [10:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=655) Summary and closing (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=0) Introduction to the intestinal rehabilitation series and guest experts (Ep 2)
- [1:56](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=116) Defining intestinal failure and intestinal rehabilitation programs (Ep 2)
- [3:34](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=214) Three categories of intestinal failure causes (Ep 2)
- [6:42](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=402) Complex presentations and older pediatric patients (Ep 2)
- [8:31](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=511) Three time points for diagnosis and referral (Ep 2)
- [10:05](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=605) Collaborative expertise and innovation at Cincinnati Children's (Ep 2)
- [11:38](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=698) Multidisciplinary team composition and long-term comorbidities (Ep 2)
- [13:15](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=795) Series goals and closing remarks (Ep 2)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Until recently, there was no standardized definition for intestinal failure. — Paul Wales (clinical) [Ep 1 · 1:56](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=116)
- Intestinal failure is when gut function is insufficient to absorb enough nutrients, fluids, and calories to support survival and, in children, growth. — Paul Wales (clinical) [Ep 1 · 2:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=123)
- Earlier recognition and taking advantage of the gut's biology to adapt are time dependent. — Michael Helmrath (clinical) [Ep 1 · 2:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=160)
- An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm that brings coordinated care for children with intestinal failure through comprehensive management of their specialized nutrition and other associated needs, as defined in recent ASPEN guidelines. — Paul Wales (guideline) [Ep 1 · 3:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=183)
- The intestinal rehabilitation approach streamlines care and improves communication with families and between care providers. — Paul Wales (clinical) [Ep 1 · 3:44](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=224)
- Intestinal rehabilitation depends on nutrition in the gut, nutrition in the body, and healing. — Michael Helmrath (clinical) [Ep 1 · 4:07](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=247)
- Pattern recognition from multiple experienced clinicians observing patients over time is essential in intestinal rehabilitation. — Michael Helmrath (clinical) [Ep 1 · 4:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=259)
- Causes of intestinal failure divide into three categories: short bowel syndrome, motility disorders, and congenital enteropathies. — Paul Wales (clinical) [Ep 1 · 4:39](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=279)
- Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients. — Paul Wales (epidemiological) [Ep 1 · 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 (intestinal atresia, malrotation, volvulus, gastroschisis, long segment Hirschsprung disease) and acquired neonatal diseases (necrotizing enterocolitis). — Paul Wales (clinical) [Ep 1 · 5:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=306)
- Motility disorders occur when abnormalities of intestinal muscle or the nerves controlling that muscle prevent coordinated propulsion of food and stool. — Paul Wales (clinical) [Ep 1 · 5:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=345)
- Congenital enteropathies are conditions where patients have all their bowel but the mucosal lining does not digest or absorb properly. — Paul Wales (clinical) [Ep 1 · 6:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=377)
- Some patients have elements of two or all three categories of intestinal failure in their presentation. — Paul Wales (clinical) [Ep 1 · 7:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=431)
- Most intestinal failure patients are infants or babies, but some older pediatric patients develop intestinal failure from inflammatory bowel disease, Crohn disease complications, trauma, malignancy, or vascular thrombosis. — Paul Wales (epidemiological) [Ep 1 · 7:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=465)
- Three time points exist for diagnosis and referral to intestinal rehab: prenatal diagnosis (atresia with cystic fibrosis, gastroschisis), postnatal acquired problems (volvulus, NEC), and later presentations after discharge when patients fail to progress. — Michael Helmrath (clinical) [Ep 1 · 8:53](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=533)
- Innovation in intestinal rehabilitation comes from multiple approaches to problems and different visions, with more expertise leading to better outcomes. — Michael Helmrath (opinion) [Ep 1 · 10:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=615)
- Transitioning older children with intestinal failure into their late teen years and beyond is a major obstacle currently not being adequately addressed. — Michael Helmrath (clinical) [Ep 1 · 10:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=651)
- The intestinal rehabilitation team includes dietitians (for nutritional needs), social workers, nurse practitioners, pharmacy, interventional radiology, pathology, endocrinology, and nephrology. — Michael Helmrath (clinical) [Ep 1 · 11:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=712)
- Long-term survivors now develop chronic comorbidities not previously seen to the same extent because patients did not live long enough, including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life problems. — Paul Wales (clinical) [Ep 1 · 12:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=766)
- Young infants, babies, infants, and young children have tremendous gut growth potential, with the gut growing for the first several years of life. — Paul Well (clinical) [Ep 3 · 0:49](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=49)
- A term baby will have 160 centimeters of small bowel, and by the time the child is 5 years old, it almost triples to about 425 to 450 centimeters. — Paul Well (clinical) [Ep 3 · 1:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=77)
- Residual bowel should be discussed as a percentage of what is normal for a child of that age, not in absolute centimeters. — Paul Well (clinical) [Ep 3 · 1:02](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=62)
- A patient can achieve enteral autonomy with as low as 10% expected gut length if they have the majority of their colon in continuity. — Paul Well (clinical) [Ep 3 · 1:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=111)
- The more important factor is the presence or absence of the distal small bowel or ileum and right colon that can act as a reclamation of bile and support the enterohepatic circulation. — Michael Helmrath (clinical) [Ep 3 · 2:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=150)
- The distal ileum produces hormones and incretins like GLP-2, GLP-1, and PYY. — Michael Helmrath (clinical) [Ep 3 · 2:43](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=163)
- The importance is not the ileocecal valve itself, but rather the distal ileum and proximal colon where bile recirculation occurs and hormones that help intestinal growth and absorption are produced. — Michael Helmrath (opinion) [Ep 3 · 2:43](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=163)
- The strategy at the first operation should provide a pathway forward that allows early enteral feeding, and it is sometimes better to stage reconstruction under more controlled conditions. — Michael Helmrath (clinical) [Ep 3 · 3:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=209)
- In situations of overwhelming intestinal loss, the strategy is to provide proximal control that allows feeding to occur without the enteral stream going through, and to leave questionable bowel with the understanding that many segments deemed non-usable have potential to heal. — Michael Helmrath (clinical) [Ep 3 · 3:53](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=233)
- As long as proximal diversion is achieved and the baby is stable, questionable bowel can be left for potential use in later secondary reconstructive procedures. (clinical) [Ep 3 · 4:26](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=266)
- The overarching principle is to deliver adequate nutrition to have normal growth within normal parameters, ideally enterally. — Paul Well (clinical) [Ep 3 · 5:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=308)
- As much as possible, the goal is to establish normal feeding behavior, recognizing that enteral nutrition is more than just nutrition. — Paul Well (clinical) [Ep 3 · 5:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=328)
- If a patient needs tube support from the beginning, bolus feeding should be tried rather than defaulting to continuous feeding. — Paul Well (clinical) [Ep 3 · 5:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=352)
- When motility issues or delayed gastric emptying prevent tolerance of food into the stomach, the strategy is to feed beyond the stomach and decompress the stomach through an NG tube if the child fails both bolus and continuous gastric feeding. — Paul Well (clinical) [Ep 3 · 6:02](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=362)
- Breast milk is the formula of choice, not only for its nutritional benefits but for all the other beneficial components within breast milk. — Michael Helmrath (clinical) [Ep 3 · 6:42](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=402)
- Formulas can be categorized as intact formulas or semi-elemental/elemental formulas, with protein and fat modules being particularly important. — Paul Well (clinical) [Ep 3 · 7:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=426)
- Single amino acid level protein is the generalized preference, ensuring patients are not having high stool output, high fluid losses, wound breakdown, rashes, or emesis. — Michael Helmrath (clinical) [Ep 3 · 7:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=448)
- Long chain fat is the preferred fat module rather than MCT fat, even though there is a feeling that MCT fat is better tolerated in short bowel syndrome. — Paul Well (opinion) [Ep 3 · 7:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=477)
- Long chain fat is a much stronger stimulus for GLP-2 release compared to MCT, which is important when trying to drive adaptation. — Paul Well (clinical) [Ep 3 · 8:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=495)
- Not every child needs to be on SMOFlipid for parenteral nutrition. — Paul Well (opinion) [Ep 3 · 9:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=540)
- For preterm babies, SMOFlipid is not the ideal lipid emulsion but is the best currently available option. — Paul Well (opinion) [Ep 3 · 9:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=543)
- SMOFlipid does not have enough arachidonic acid, which is important for brain development. — Paul Well (clinical) [Ep 3 · 9:16](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=556)
- There are two strategies to treat cholestasis: reduce the total amount of fat or change the composition to introduce SMOFlipid or omegaven. (clinical) [Ep 3 · 9:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=574)
- Reducing lipid dose to 1 g per kg per day can reverse cholestasis but results in reduced calorie delivery that can impair growth and potentially impact neurocognitive development. (clinical) [Ep 3 · 9:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=590)
- Omegaven is essentially pure fish oil with omega-3 and is dosed at 1 g/kg, so babies take a calorie deficit. (clinical) [Ep 3 · 10:07](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=607)
- SMOFlipid is a better choice than omegaven as it is a more well-balanced emulsion with an omega-3 to omega-6 ratio of 2.5 to 1, is less inflammatory than intralipid, and promotes bile flow. (opinion) [Ep 3 · 10:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=628)
- SMOFlipid should not be restricted and must be given at no less than 2 or 2.1 g per kg per day. (clinical) [Ep 3 · 10:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-in-pediatric-short-bowel-syndrome-expert-strategies-fo-16524?t=628)
- Until recently, there was no standardized definition for intestinal failure. — Paul Wales (clinical) [Ep 2 · 1:56](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=116)
- Intestinal failure is when someone's gut function is insufficient to absorb enough nutrients, fluids, and calories to support survival and, in children, growth. — Paul Wales (clinical) [Ep 2 · 2:05](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=125)
- Earlier recognition and taking advantage of the biology of the gut that wants to adapt and meet the needs of the child are time dependent. — Michael Helmrath (clinical) [Ep 2 · 2:40](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=160)
- An intestinal rehabilitation program is a multidisciplinary or interdisciplinary collaborative patient care paradigm that brings coordinated care for children with intestinal failure through comprehensive management of their specialized nutrition and other associated needs. — Paul Wales (clinical) [Ep 2 · 3:03](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=183)
- 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 2 · 4:07](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=247)
- The causes of intestinal failure can be divided into three categories: short bowel syndrome, motility disorders, and mucosal enteropathies or congenital diarrheas. — Paul Wales (clinical) [Ep 2 · 4:39](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=279)
- Short bowel syndrome is by far the most common category in pediatric patients with intestinal failure. — Paul Wales (epidemiological) [Ep 2 · 4:50](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=290)
- Causes of short bowel syndrome are usually related to congenital anomalies such as intestinal atresia, malrotation, volvulus, gastroschisis, or long segment Hirschsprung's disease, or acquired diseases of the newborn such as necrotizing enterocolitis. — Paul Wales (clinical) [Ep 2 · 4:50](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=290)
- In motility disorders, the bowel is unable to push things through in a coordinated way due to abnormalities of the muscle itself or of the nerves that control that muscle. — Paul Wales (clinical) [Ep 2 · 5:45](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=345)
- In mucosal enteropathies or congenital diarrheas, the patient has all of their bowel, but the mucosa (the inside lining that digests and absorbs) doesn't work. — Paul Wales (clinical) [Ep 2 · 6:17](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=377)
- Some patients will have elements of one, two, or all three categories of intestinal failure. — Paul Wales (clinical) [Ep 2 · 7:11](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=431)
- Although most patients referred to intestinal rehab programs are infants or babies, there are some older kids that develop intestinal failure. — Paul Wales (epidemiological) [Ep 2 · 7:45](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=465)
- Older pediatric patients can develop intestinal failure from inflammatory bowel disease or Crohn's disease (where they've lost gut as a result of complications), trauma, malignancy, or vascular thrombosis leading to gut loss. — Paul Wales (clinical) [Ep 2 · 7:56](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=476)
- Diagnoses like inflammatory bowel disease, trauma, malignancy, and vascular thrombosis are seen more in older patients or in adult series, and less so in pediatrics. — Paul Wales (epidemiological) [Ep 2 · 8:04](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=484)
- Prenatal diagnoses that lead to intestinal rehab referral typically include atresia (which could be with cystic fibrosis) and gastroschisis. — Michael Helmrath (clinical) [Ep 2 · 9:15](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=555)
- Innovation comes from multiple approaches to the problem and different visions of the problem; the more expertise you bring in, the better the outcome is. — Michael Helmrath (opinion) [Ep 2 · 10:25](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=625)
- How to take the older child who's had intestinal failure into their late teen years and later is a major obstacle that needs to be addressed and is currently not being met. — Michael Helmrath (opinion) [Ep 2 · 10:51](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=651)
- Dietitians and understanding the nutritional needs of a child are critical components of the intestinal rehabilitation team. — Michael Helmrath (clinical) [Ep 2 · 11:52](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=712)
- Social work is a really key part of the intestinal rehabilitation team. — Michael Helmrath (clinical) [Ep 2 · 12:01](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=721)
- Extended providers including nurse practitioners are fantastic and essential to the intestinal rehabilitation team. — Michael Helmrath (opinion) [Ep 2 · 12:03](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=723)
- Pharmacy, social work, interventional radiology, pathology, endocrinology, and nephrology are all important components of the intestinal rehabilitation team. — Paul Wales (clinical) [Ep 2 · 12:15](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=735)
- Kids with intestinal failure who survive long-term have developed chronic comorbidities that weren't seen to the same extent before because they didn't live long enough. — Paul Wales (epidemiological) [Ep 2 · 12:46](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=766)
- Long-term survivors of intestinal failure are now seeing diseases like renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life issues. — Paul Wales (clinical) [Ep 2 · 12:55](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=775)
- Having a coordinated team that can track chronic comorbidity problems long-term is vital for intestinal failure patients. — Paul Wales (opinion) [Ep 2 · 13:10](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=790)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- New guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function. — Rod Gerardo summarizing the discussion [Ep 1 · 2:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=144)
- Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth. — Rod Gerardo summarizing the discussion [Ep 1 · 3:33](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=213)
- Mucosal defects in enteropathies lead to hypersecretion and profuse fluid losses, preventing nutrient absorption. — Ellen Encisco summarizing the discussion [Ep 1 · 6:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=390)
- Gastroschisis can involve all three categories: short bowel from nonviable tissue, inflammation affecting absorption, and motility issues. — Ellen Encisco summarizing the discussion [Ep 1 · 7:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=442)
- Access and availability to intestinal rehabilitation programs is still very rare. — Rod Gerardo summarizing the discussion [Ep 1 · 8:41](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=521)
- Overall long-term survival in major intestinal rehabilitation programs is usually over 90%. — Rod Gerardo summarizing the discussion [Ep 1 · 12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=754)
- 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 summarizing the discussion [Ep 2 · 2:24](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=144)
- Mucosal defects lead to hypersecretion and profuse fluid losses, such that the bowel is unable to tolerate or absorb nutrients. — Ellen summarizing the discussion [Ep 2 · 6:30](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=390)
- A child with gastroschisis could have short bowel (because not all bowel was viable), inflamed bowel (so it doesn't absorb well), and motility issues. — Ellen summarizing the discussion [Ep 2 · 7:22](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=442)
- There are three general time points when families reach intestinal rehab programs: prenatal diagnosis, postnatal acquired problems, and later presentations after discharge when patients fail to progress. — Rod Gerardo summarizing the discussion [Ep 2 · 8:53](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=533)
- Postnatal acquired problems leading to intestinal rehab referral include volvulus and necrotizing enterocolitis. — Ellen summarizing the discussion [Ep 2 · 9:29](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=569)
- The survival overall in big intestinal rehabilitation programs is usually over 90% long-term survival. — Rod Gerardo summarizing the discussion [Ep 2 · 12:34](https://library.globalcastmd.com/watch/introduction-to-intestinal-rehabilitation-and-intestinal-failure-in-pediatric-su-16526?t=754)

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