# Intestinal Rehab — GCMD Library living collection

Also covered as: gastroschisis · necrotizing enterocolitis · intestinal failure · Hirschsprung disease · short bowel syndrome · intestinal atresia · cholestasis · malrotation

Experts: Dr. Todd Ponsky, Dr. Rod Gerardo, Dr. Ellen Encisco, Dr. Paul Wales

Updated: n/a · 109 episodes · 2720 cited statements

## Episodes
### Foundations
- [Multidisciplinary Approach: Intestinal Failure Innovations](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036) — video · 97:52 · [machine version](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036.md)
- [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 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)
- [Omphalocele & Gastroschisis](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255) — video · 9:32 · [machine version](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255.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)
- [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)

### Diagnosis & Workup
- [Overview of Prenatal Diagnosis: Cincinnati Fetal Center](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743) — video · 40:34 · [machine version](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743.md)
- [Prenatal diagnosis of fetal lower urinary tract obstruction: Fetal...](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919) — video · 40:14 · [machine version](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919.md)
- [The Colorectal Quiz Episode 8: Motility Disorders Part 1](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824) — podcast · 14:04 · [machine version](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824.md)
- [Colorectal Collaboration: Neurogastroenterology/Motility Disorders](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366) — video · 14:55 · [machine version](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366.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)

### 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)
- [Intestinal Rehabilitation, Episode 2: Overwhelming intestinal damage, Part 2](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993) — podcast · 17:21 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993.md)

### Medical Management
- [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)

### Nutritional Management
- [Intestinal Failure - Feeding Access and Nutrition](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740) — video · 118:06 · [machine version](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740.md)
- [Practical Approach: Intestinal Failure Innovations](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035) — video · 116:52 · [machine version](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035.md)
- [Intestinal Rehabilitation, Episode 3: Enteral Autonomy, Part 1](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141) — podcast · 16:18 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141.md)
- [Intestinal Rehabilitation, Episode 3: Enteral Autonomy, Part 2](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240) — podcast · 13:37 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240.md)
- [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)
- [Intestinal Rehabilitation, Episode 7: Refeeding in a neonatal patient](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209) — podcast · 16:09 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209.md)
- [Intestinal Rehabilitation Episode 8: Refeeding of an Older Patient](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227) — podcast · 12:05 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227.md)

### Surgical Management
- [Renal transplantation: Cincinnati Fetal Center](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623) — video · 13:51 · [machine version](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623.md)
- [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)
- [Renal transplantation: Fetal Genitourinary Disease 2015](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915) — video · 13:44 · [machine version](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915.md)
- [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)
- [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)
- [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)
- [Pediatric Vascular Access in Brief: Preoperative, Operative, and Postoperative Considerations](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870) — video · 13:54 · [machine version](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870.md)
- [Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909) — video · 19:07 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909.md)
- [Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913) — podcast · 19:07 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913.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)
- [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)

### Complications
- [Intestinal Rehabilitation, Episode 4: Surgical Management, Part 2](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099) — podcast · 12:24 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099.md)
- [Intestinal Rehabilitation, Episode 6: Cholestasis](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734) — podcast · 15:25 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734.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)
- [Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929) — podcast · 44:19 · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929.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)
- [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)
- [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 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)
- [CAPS - The use of urine sodium to creatinine ratio as a marker of total body sodium in infants with intestinal failure - Sara Choi](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432) — video · 8:40 · [machine version](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432.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)
- [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)
- [Journal of Pediatric Surgery Article Review: June 2022, AAP Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878) — video · 15:54 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878.md)
- [Journal of Pediatric Surgery Article Review: June 2022, AAP Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881) — podcast · 15:54 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881.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 7](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686) — video · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686.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)
- [Disruption of enterohepatic Circulation of Bile acids ameliorates small bowel resection associated hepatic injury](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050.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)
- [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)
- [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)
- [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)
- [Outcomes of Children With Short Bowel Syndrome: Experiences in a Multidisciplinary Intestinal Rehabilitation Unit Over Two Decades](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027) — video · 0:45 · [machine version](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027.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)
- [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)
- [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)
- [Impact of social determinants of health on outcomes in pediatric short bowel syndrome...](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896) — video · 0:43 · [machine version](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896.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)
- [The Colorectal Quiz Episode 9: Motility Disorders Part 2](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888) — podcast · 13:52 · [machine version](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888.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)
- [Colorectal Quiz: Episode 42 - HD Constipation](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506) — podcast · 14:48 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506.md)
- [Gastroschisis](https://library.globalcastmd.com/watch/gastroschisis-13502) — video · [machine version](https://library.globalcastmd.com/watch/gastroschisis-13502.md)

### In-Depth Reviews
- [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)
- [Intestinal Failure with Dr. Brad Warner](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927) — podcast · 52:46 · [machine version](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927.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)
- [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)
- [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)
- [Intestinal Rehabilitation Webinar 2023 - Top 5 Key Takeaways](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768) — video · 12:14 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768.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)
- [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)
- [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)
- [Advancements in Pediatric Intestinal Failure: Innovative Therapies and Improved Outcomes](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892) — video · 17:45 · [machine version](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892.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
- [Reliance on total parenteral nutrition (TPN) and travelling abroad](https://library.globalcastmd.com/watch/reliance-on-total-parenteral-nutrition-and-travelling-abroad-7804) — video · 1:42 · [machine version](https://library.globalcastmd.com/watch/reliance-on-total-parenteral-nutrition-and-travelling-abroad-7804.md)
- [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
- [Care transition from a pediatric intestinal rehabilitation program to adult care and the risk of all-cause mortality: A retrospective cohort study](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901) — video · 1:01 · [machine version](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901.md)

## Chapters
- [0:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=5) Introduction and Patient Population (Ep 80)
- [1:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=110) Dietary Strategy for Refeeding (Ep 80)
- [3:43](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=223) Fluid Management and Hydration (Ep 80)
- [5:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=351) Growth Through Puberty and Team Approach (Ep 80)
- [8:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=514) Growth Monitoring and Assessment (Ep 80)
- [0:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=4) Introduction and Program Context (Ep 47)
- [1:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=106) Defining Intestinal Failure (Ep 47)
- [4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=290) Three Categories of Intestinal Failure (Ep 47)
- [8:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=499) Timing of Diagnosis and Referral (Ep 47)
- [10:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=604) Multidisciplinary Team Approach (Ep 47)
- [12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=754) Outcomes and Future Challenges (Ep 47)
- [0:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=0) Introduction and Nutritional Fundamentals (Ep 53)
- [1:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=115) Feeding Protocols and Surgical Access Strategies (Ep 53)
- [4:21](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=261) Managing High Output and Gastric Losses (Ep 53)
- [6:42](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=402) Pharmacotherapy Considerations (Ep 53)
- [7:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=470) Surgical Interventions for Adaptation (Ep 53)
- [11:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=682) Decision-Making Principles and Conclusion (Ep 53)
- [0:07](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=7) STEP Procedure Indications and Expected Outcomes (Ep 68)
- [2:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=149) Postoperative Timeline and Staged Approach (Ep 68)
- [5:35](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=335) Staple-Line Ulcer Complications and Pathophysiology (Ep 68)
- [9:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=558) Surgical Management Philosophy and Long-term Care (Ep 68)
- [0:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=0) Historical Context and Preoperative Philosophy (Ep 67)
- [4:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=257) Surgical Decision-Making at Birth (Ep 67)
- [7:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=423) Diagnosis-Specific Considerations (Ep 67)
- [10:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=645) STEP Procedure Technical Details (Ep 67)
- [17:53](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=1073) Summary and Conclusion (Ep 67)
- [0:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=5) Defining Cholestasis (Ep 73)
- [1:37](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=97) Epidemiology and Risk Factors (Ep 73)
- [3:44](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=224) Prevention Strategies (Ep 73)
- [7:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=420) TPN Lipid Management (Ep 73)
- [9:13](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=553) Expected Post-Surgical Changes (Ep 73)
- [10:37](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=637) Surgical Considerations (Ep 73)
- [12:43](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=763) Long-Term Monitoring (Ep 73)
- [0:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=5) Introduction and Goals of Refeeding (Ep 79)
- [2:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=125) Initiating Feeds with High Stoma Output (Ep 79)
- [3:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=210) Formula Selection and Composition (Ep 79)
- [5:47](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=347) Volume Management and TPN Weaning (Ep 79)
- [7:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=437) Feeding Methods and Oral Skill Development (Ep 79)
- [9:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=562) Managing Gastric Dysmotility and Distal Refeeding (Ep 79)
- [11:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=710) G-tube Placement Strategy (Ep 79)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Older children (8-16 years) who experience volvulus can lose 90+% of their bowel" — Michael Helmrath (clinical) [Ep 80 · 1:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=71)
- "Older patients who have established eating behavior before bowel loss have both a benefit and curse in that they know how to eat" — Paul Wales (opinion) [Ep 80 · 1:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=84)
- "In older children, normal feeding behavior is important for social aspects of life beyond nutrition" — Cecilia Gigena (clinical) [Ep 80 · 1:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=90)
- "Even if a patient cannot be cured and weaned off TPN, compromises should be made to optimize quality of life" — Paul Wales (opinion) [Ep 80 · 1:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=110)
- "The general strategy is to push macronutrient modules of protein and fat which are well tolerated" — Paul Wales (clinical) [Ep 80 · 2:14](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=134)
- "Most short bowel patients don't tolerate simple sugars very well" — Paul Wales (clinical) [Ep 80 · 2:21](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=141)
- "Pushing solids and minimizing fluid intake helps reduce dumping" — Paul Wales (clinical) [Ep 80 · 2:25](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=145)
- "Smaller meals more frequently of solids separated from liquids and minimization of simple sugars is the recommended approach" — Paul Wales (clinical) [Ep 80 · 2:31](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=151)
- "Patients who have transitioned off TPN often come back with problems when diet history reveals they have gotten loose with diet choices" — Paul Wales (clinical) [Ep 80 · 2:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=172)
- "Increase in sugars can create problems with absorption and changes in stool output" — Cecilia Gigena (clinical) [Ep 80 · 3:12](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=192)
- "Minimizing sugars reduces symptoms related to bacterial overgrowth such as bloating and gas" — Paul Wales (clinical) [Ep 80 · 3:31](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=211)
- "Fluid losses whether by stoma or other source must be replaced" — Paul Wales (clinical) [Ep 80 · 3:48](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=228)
- "If patients are on IV support, some fluid can be replaced intravenously" — Paul Wales (clinical) [Ep 80 · 3:56](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=236)
- "When trying to wean off IV support, keeping patients hydrated through enteral replacements is important" — Paul Wales (clinical) [Ep 80 · 4:01](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=241)
- "Fluid transport requires sodium and glucose, so replacement solution must contain both" — Paul Wales (clinical) [Ep 80 · 4:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=251)
- "Gatorade doesn't work well for rehydration because it has too much sugar" — Paul Wales (clinical) [Ep 80 · 4:48](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=288)
- "Some patients can come off TPN but still need a central line for IV fluids" — Michael Helmrath (clinical) [Ep 80 · 4:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=295)
- "Without adequate IV fluids, patients end up sleeping most of the day and don't have energy" — Michael Helmrath (clinical) [Ep 80 · 4:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=295)
- "Being in a hydrated state is extremely important to making the bowel work well" — Michael Helmrath (clinical) [Ep 80 · 5:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=308)
- "Sometimes patients can't drink rehydration solution but the GI tract can use it via G-tube" — Michael Helmrath (clinical) [Ep 80 · 5:31](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=331)
- "Energy use goes up dramatically during puberty" — Michael Helmrath (clinical) [Ep 80 · 5:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=351)
- "Children doing well often hit the wall when they start puberty because energy needs overcome nutrient input" — Michael Helmrath (clinical) [Ep 80 · 5:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=351)
- "Some kids end up back on parenteral support to get through puberty" — Paul Wales (clinical) [Ep 80 · 6:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=388)
- "When not growing anymore as an adult, borderline or marginal gut function is often enough to sustain them" — Paul Wales (clinical) [Ep 80 · 6:33](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=393)
- "There are very few conditions with intestinal failure that have restricted growth" — Michael Helmrath (clinical) [Ep 80 · 6:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=417)
- "A 3rd percentile growth should not be accepted for most intestinal failure patients" — Michael Helmrath (opinion) [Ep 80 · 6:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=417)
- "After getting off TPN, patients often get into trouble with micronutrient deficiencies" — Paul Wales (clinical) [Ep 80 · 7:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=442)
- "Weight must be balanced with height as a growth metric" — Paul Wales (clinical) [Ep 80 · 8:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=531)
- "This population commonly shows round babies where weight for height is elevated" — Paul Wales (clinical) [Ep 80 · 8:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=537)
- "There is increasing data looking at quality of weight - how much is fat weight versus lean body mass" — Paul Wales (clinical) [Ep 80 · 9:01](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=541)
- "For any child not meeting growth potential, numerous other diagnoses must be considered including endocrine issues, pancreatic insufficiency, and micronutrient deficiencies" — Michael Helmrath (clinical) [Ep 80 · 9:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=574)
- "After addressing growth issues, improvements should be assessed on the order of weeks not months" — Michael Helmrath (clinical) [Ep 80 · 9:54](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=594)
- "Growth monitoring can be done remotely and should not wait until the next appointment" — Michael Helmrath (clinical) [Ep 80 · 10:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-8-refeeding-of-an-older-patient-7227?t=615)
- "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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 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 47 · 4:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=259)
- "A paper from Chris Duggan's group at Boston demonstrated that implementation of a feeding protocol is associated with achieving full autonomy in a shorter time period" — Wales (clinical) [Ep 53 · 1:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=115)
- "Bowel heals with adhesions that bring blood supply to the bowel and help it heal" — Helmuth (clinical) [Ep 53 · 2:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=165)
- "Very high outputs can occur initially in damaged bowel that requires luminal nutrition to start getting the bowel to learn how to reabsorb fluid" — Helmuth (clinical) [Ep 53 · 3:56](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=236)
- "High outputs without feeding are an indication to feed, as long as the child can be hydrated" — Helmuth (clinical) [Ep 53 · 4:10](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=250)
- "After massive resection and loss of distal bowel, patients can be hypergastrinemic and have elevated acid secretion for 6 to 12 months due to loss of hormonal feedback messaging" — Wales (clinical) [Ep 53 · 4:35](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=275)
- "Acid blockade with H2 blockers or PPIs can decrease gastric volume in the short term" — Wales (clinical) [Ep 53 · 4:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=297)
- "Acid blockade carries a counter risk of bacterial overgrowth by losing the acid barrier" — Wales (clinical) [Ep 53 · 5:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=311)
- "Increased secretions occur because of a thick, leaky mucosa, and the way to improve that is to heal the mucosa, which requires delivery of luminal nutrients" — Wales (clinical) [Ep 53 · 5:59](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=359)
- "If serum bicarbonate is kept above 20, feeding is generally safe even with high cc per kilo output" — Helmuth (clinical) [Ep 53 · 6:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=377)
- "Cycled antibiotics for bacterial overgrowth are often done very empiric and ad hoc" — Wales (clinical) [Ep 53 · 6:49](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=409)
- "Closing a stoma immediately recruits more bowel and restores continuity" — Wales (clinical) [Ep 53 · 7:58](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=478)
- "As bowel becomes increasingly dilated, its motility becomes impaired" — Wales (clinical) [Ep 53 · 8:36](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=516)
- "In dilated bowel with impaired motility, stool doesn't move, leading to mucosal inflammation, damage to the mucosal barrier allowing bacterial translocation, potential sepsis, and malabsorption" — Rod (clinical) [Ep 53 · 8:41](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=521)
- "Restoring bowel caliber to something more normal can improve motility, provide better stool clearance, decrease bacterial overgrowth, allow mucosa to heal, and improve absorptive function" — Wales (clinical) [Ep 53 · 9:01](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=541)
- "The Bianchi procedure (longitudinal intestinal lengthening) has been around since 1980" — Wales (clinical) [Ep 53 · 9:33](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=573)
- "One of the most important factors for efficacy of both Bianchi and STEP procedures is that you're tapering the bowel" — Wales (clinical) [Ep 53 · 9:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=585)
- "STEP differs from anti-mesenteric tapering or resection in that it preserves all available mucosa without removing any" — Wales (clinical) [Ep 53 · 9:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=591)
- "Bowel lengthening procedures primarily redistribute surface area rather than truly increasing it" — Rod (clinical) [Ep 53 · 10:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=655)
- "It takes about 6 months to see any changes in absorption after bowel lengthening procedures" — Ellen (clinical) [Ep 53 · 11:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=665)
- "Cincinnati published experience showing absorption changes over time using fecal fat, alpha-1 antitrypsin clearance, xylose as measures of macronutrient absorption, and citrulline rise" — Wales (clinical) [Ep 53 · 11:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=668)
- "An upper GI can only rule in a problem; it does not rule out a problem" — Ellen (clinical) [Ep 53 · 11:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=694)
- "A normal upper GI does not rule out an anatomical problem" — Helmuth (clinical) [Ep 53 · 11:48](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=708)
- "The new ASPEN guidelines define enteral autonomy as independence from parenteral support for 12 weeks" — Ellen (guideline) [Ep 53 · 12:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-2-5240?t=725)
- "The biggest benefit of the STEP procedure is tapering the bowel and reestablishing a more normal caliber to improve motility" — Paul Wales (clinical) [Ep 68 · 1:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=112)
- "The STEP procedure redistributes bowel rather than creating new bowel, helping to reestablish normal caliber which improves motility" — Ellen Encisco (clinical) [Ep 68 · 2:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=124)
- "It can take up to 6 months before significant improvement in absorptive capacity is seen after STEP" — Paul Wales (clinical) [Ep 68 · 3:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=184)
- "Absorptive capacity improvement is measured with fecal fat, alpha-1 antitrypsin clearance, xylose absorption, and citrulline levels" — Paul Wales (clinical) [Ep 68 · 3:12](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=192)
- "The delay in improvement is due to inflamed, sick, leaky mucosa in the setting of bacterial overgrowth needing time to heal" — Paul Wales (clinical) [Ep 68 · 3:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=204)
- "About 50% reduction in parental nutrition support can be expected after STEP" — Ellen Encisco (clinical) [Ep 68 · 3:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=214)
- "Half of patients who have a STEP will have progression of improved enteral tolerance, while half will have worsening" — Michael Helmrath (clinical) [Ep 68 · 3:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=220)
- "Before performing STEP, other anatomical problems must be ruled out by laying out the bowel and getting the mesentery completely oriented" — Michael Helmrath (clinical) [Ep 68 · 4:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=248)
- "There is nothing wrong with staging surgical procedures in intestinal failure patients" — Michael Helmrath (opinion) [Ep 68 · 5:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=300)
- "Ulcers at STEP staple lines are not uncommon and can cause recurrent bleeding requiring monthly transfusions for years" — Michael Helmrath (clinical) [Ep 68 · 5:39](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=339)
- "Chronic blood loss at the STEP line is an absolute indication to operate" — Michael Helmrath (clinical) [Ep 68 · 6:01](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=361)
- "Staple-line ulcer bleeding is an underreported complication that is difficult to manage" — Paul Wales (clinical) [Ep 68 · 6:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=384)
- "There is a spectrum of bleeding from staple-line ulcers ranging from specks of blood in stool to requiring transfusion every week and a half" — Ellen Encisco (clinical) [Ep 68 · 6:32](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=392)
- "Staple-line ulcers tend to occur in type 2 anatomy (small bowel to colonic remnant in the absence of an intact colon ileocecal valve)" — Paul Wales (clinical) [Ep 68 · 6:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=412)
- "Pathology of staple-line ulcers shows non-specific inflammation with no vasculitis, viral elements, or obvious ischemia" — Paul Wales (clinical) [Ep 68 · 7:12](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=432)
- "Medical management attempts for staple-line bleeding have included enteral omega 3 lipid supplements, cycled antibiotics, probiotics, 5ASA, budesonide, and immune modulators like Remicade, but none have been the perfect remedy" — Ellen Encisco (clinical) [Ep 68 · 7:21](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=441)
- "The underlying issue in staple-line bleeding is mesenteric inflammation and scarring that creates obstruction to venous outflow, not primary bowel pathology" — Michael Helmrath (clinical) [Ep 68 · 7:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=472)
- "Mesenteric inflammation causes venous hypertension along the staple lines" — Michael Helmrath (clinical) [Ep 68 · 8:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=483)
- "Mesenteric scarring causes enlarged veins, venous hypertension, and large lymph nodes from lymphatic obstruction visible on the bowel" — Ellen Encisco (clinical) [Ep 68 · 8:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=497)
- "During surgery for staple-line bleeding, vessels the size of your thumb and really big adenopathy can be seen due to lymphatic obstruction" — Michael Helmrath (clinical) [Ep 68 · 8:33](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=513)
- "Once mesenteric scar is freed up, the enlarged vessels come right back to normal" — Michael Helmrath (clinical) [Ep 68 · 8:42](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=522)
- "Venous hypertension is what leads to the bleeding from staple lines" — Michael Helmrath (clinical) [Ep 68 · 8:53](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=533)
- "Staple line revision is typically done with hand-sewn stitch to reconnect the bowel" — Michael Helmrath (clinical) [Ep 68 · 9:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=545)
- "The key to managing staple-line bleeding is to look at the mesentery and free up the mesentery, not just look at the bowel" — Michael Helmrath (clinical) [Ep 68 · 9:09](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=549)
- "Mesenteric pathology causing staple-line bleeding is obvious if you are looking for it" — Michael Helmrath (opinion) [Ep 68 · 9:27](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=567)
- "Most referrals for intestinal failure have had multiple operations before coming to a specialized center" — Paul Wales (clinical) [Ep 68 · 10:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=605)
- "Surgical planning may not be conducive to just one operation and may require setting up for the next case" — Paul Wales (opinion) [Ep 68 · 10:09](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=609)
- "Doing things in a staged fashion is typical for the intestinal failure patient population" — Ellen Encisco (clinical) [Ep 68 · 10:25](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=625)
- "Detailed operative notes documenting orientation, landmarks, and what was done are important for future operations" — Michael Helmrath (opinion) [Ep 68 · 10:33](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=633)
- "Surgeons should try not to be the hero and try not to do everything, especially in the first week of life" — Michael Helmrath (opinion) [Ep 68 · 10:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=652)
- "The surgeon plays a huge role in intestinal failure management even when patients are doing well, because progress must be monitored" — Michael Helmrath (opinion) [Ep 68 · 11:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=665)
- "Intestinal failure is a lifelong issue requiring long-term multidisciplinary follow-up" — Ellen Encisco (clinical) [Ep 68 · 11:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-2-6099?t=675)
- "Adrian Bianchi first reported the longitudinal intestinal lengthening procedure (Bianchi procedure) that divides bowel along its two leaves and tubularizes it" — Michael Helmrath (clinical) [Ep 67 · 1:23](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=83)
- "In the 1980s and 1990s, babies with intestinal failure had poor outcomes primarily due to liver progression to inflammation and fibrosis associated with parenteral nutrition, lipids, and phytosterols" — Ellen Encisco (epidemiological) [Ep 67 · 1:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=110)
- "Rising direct bilirubin was recognized as a sign that children with intestinal failure would not do well" — Michael Helmrath (clinical) [Ep 67 · 2:13](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=133)
- "The first 4 months of life is when care for intestinal failure patients is most uncoordinated and surgical decisions have the most profound effect on long-term outcome" — Em Tombash (clinical) [Ep 67 · 2:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=149)
- "The gut doubles in length during the last trimester and the first year of life" — Michael Helmrath (clinical) [Ep 67 · 2:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=175)
- "Intestinal maturation occurs when the baby is fed; healthy growth of the intestine requires nutrition" — Michael Helmrath (clinical) [Ep 67 · 2:58](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=178)
- "Disrupting the feeding and maturation process affects not only the intestine's ability to absorb and digest but also peristalsis and function" — Michael Helmrath (clinical) [Ep 67 · 3:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=186)
- "Absorptive surface area comes from the waves of peristalsis moving over the villi, not from the exposed length of bowel" — Em Tombash (clinical) [Ep 67 · 3:32](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=212)
- "Lengthening bowel that doesn't have peristalsis does not increase absorption; it's just more static water" — Michael Helmrath (clinical) [Ep 67 · 3:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=226)
- "Very short bowel children can sometimes come off TPN because their motility is so good" — Michael Helmrath (clinical) [Ep 67 · 3:59](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=239)
- "The majority of pediatric short bowel syndrome cases present at birth due to neonatal causes: congenital GI anomalies or acquired conditions like necrotizing enterocolitis" — Paul Wales (epidemiological) [Ep 67 · 4:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=258)
- "When reestablishing bowel continuity, size discrepancy between bowel ends must be addressed or a functional obstruction will result even if the anastomosis is patent" — Paul Wales (clinical) [Ep 67 · 5:42](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=342)
- "If adequate bowel length exists, size discrepancy can be managed by resection back to appropriate caliber or tapering enteroplasty" — Paul Wales (clinical) [Ep 67 · 6:02](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=362)
- "In short bowel cases, serial transverse enteroplasty (STEP) can address size discrepancy without resecting mucosa" — Paul Wales (clinical) [Ep 67 · 6:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=388)
- "Gastroschisis patients don't tend to do as well regardless of intervention; STEP procedures in gastroschisis patients consistently underperform" — Paul Wales (clinical) [Ep 67 · 7:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=428)
- "Gastroschisis patients have inherent dysmotility from enteric nervous system damage due to amniotic fluid exposure" — Em Tombash (clinical) [Ep 67 · 7:21](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=441)
- "The enteric nervous system in gastroschisis must go through a healing and recovery phase that is attenuated by dysmotility and stasis" — Michael Helmrath (clinical) [Ep 67 · 7:32](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=452)
- "Atresia patients may have good peristalsis from bowel working against obstruction, and longitudinal stapling procedures may benefit them" — Michael Helmrath (clinical) [Ep 67 · 7:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=475)
- "Children who undergo STEP procedures in the first year of life sometimes never progress and are labeled as poor motility patients unable to tolerate enteral feeds" — Michael Helmrath (clinical) [Ep 67 · 8:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=499)
- "Necrotizing enterocolitis patients do better than other intestinal failure etiologies because they have been fed before disease onset, initiating GI motility and maturation" — Michael Helmrath (opinion) [Ep 67 · 8:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=520)
- "STEP procedure requires bowel diameter of at least 5 centimeters to be worthwhile" — Paul Wales (clinical) [Ep 67 · 9:09](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=549)
- "At birth, neonatal bowel is usually not dilated enough to apply the STEP procedure" — Ellen Encisco (clinical) [Ep 67 · 9:36](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=576)
- "In scenarios where immediate anastomosis is not prudent, distal bowel can be accessed with a feeding tube to provide distal feeding and grow the bowel in caliber before a subsequent operation" — Paul Wales (clinical) [Ep 67 · 9:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=590)
- "Stepping the duodenum in non-rotated children is fraught with problems and causes significant issues later in life" — Michael Helmrath (opinion) [Ep 67 · 10:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=622)
- "The STEP procedure was originally described by HP Kim and Tom Jackson" — Paul Wales (clinical) [Ep 67 · 10:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=645)
- "Maintaining bowel alignment during STEP is critical; there is risk of longitudinal twisting if alignment is not maintained" — Paul Wales (clinical) [Ep 67 · 11:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=689)
- "An endo GIA stapler with vascular (white) load cartridge (2.5mm crimping to 1mm) is preferred over open GIA and prevents leaks better than the classic blue load" — Paul Wales (clinical) [Ep 67 · 12:26](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=746)
- "Target bowel caliber after STEP is 1.5 cm in babies and 2 to 2.5 cm in older infants or children" — Paul Wales (clinical) [Ep 67 · 13:23](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=803)
- "Making the bowel too narrow during STEP can cause obstruction, especially in patients with borderline motility" — Paul Wales (clinical) [Ep 67 · 13:36](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=816)
- "A U-stitch with 4-0 PDS should be placed in the crotch of each staple line to prevent potential leaks" — Paul Wales (clinical) [Ep 67 · 14:35](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=875)
- "Dog ears (blind loops) can form at the top and bottom of the STEP segment where bowel transitions in and out, and these can dilate over time" — Paul Wales (clinical) [Ep 67 · 15:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=908)
- "Dilated segments in STEP can allow the stepped segments to rotate away from each other and twist, forming a functional obstruction" — Ellen Encisco (clinical) [Ep 67 · 15:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=952)
- "STEP staple lines should be oriented perpendicular to the mesentery at 90 and 270 degrees (3 o'clock and 9 o'clock positions)" — Paul Wales (clinical) [Ep 67 · 12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=754)
- "The duodenum should not be stepped; STEP should start where the bowel begins to dilate, usually distal to the duodenum" — Paul Wales (clinical) [Ep 67 · 16:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=1011)
- "If duodenal narrowing is needed, a stapler should be used on the lateral side away from the bile duct and ampulla; plication sutures usually fail" — Paul Wales (clinical) [Ep 67 · 17:20](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=1040)
- "The duodenum has no mesentery, making it impossible to orient staple lines at 3 and 9 o'clock positions as in the jejunum" — Michael Helmrath (clinical) [Ep 67 · 17:32](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=1052)
- "Cholestasis is institutionally defined as conjugated bilirubin greater than 3 mg/dL or 50 micromoles/L sustained for 2 weeks and not associated with a septic event" — Paul Wales (guideline) [Ep 73 · 1:09](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=69)
- "A 2021 JPN publication defines cholestasis as conjugated bilirubin around 2 mg/dL or 34 micromoles/L for 2 weeks, not associated with a septic event" — Paul Wales (guideline) [Ep 73 · 1:20](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=80)
- "Advanced liver disease is defined as conjugated bilirubin above 5 or 6 mg/dL" — Cecilia Gigena (guideline) [Ep 73 · 1:48](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=108)
- "Cholestasis is now more an indicator of underlying diseases that need to be addressed rather than a direct morbidity/mortality factor" — Michael Helmrath (opinion) [Ep 73 · 1:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=117)
- "Historically 25-50% of intestinal failure patients died because of associated liver disease; now it is less than 2%" — Cecilia Gigena (epidemiological) [Ep 73 · 2:36](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=156)
- "In young children, intestinal failure causes cholestatic liver disease, whereas in adolescents and adults it tends to cause steatosis (fatty deposition)" — Paul Wales (clinical) [Ep 73 · 2:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=177)
- "Risk factors for intestinal failure-associated liver disease include prematurity, lack of enteral feeding, sepsis, and TPN components" — Cecilia Gigena (clinical) [Ep 73 · 3:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=199)
- "Prematurity is not modifiable by the clinical team, but other risk factors (enteral feeding, sepsis, TPN components) are modifiable" — Paul Wales (clinical) [Ep 73 · 3:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=210)
- "Prevention requires aggressive introduction of enteral feeding and surgical procedures to optimize anatomy for feed delivery" — Paul Wales (clinical) [Ep 73 · 4:09](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=249)
- "Limiting fat in TPN to 1 g/kg/day can help prevent cholestasis" — Michael Helmrath (clinical) [Ep 73 · 5:12](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=312)
- "New lipid emulsions (Omegaven first in US, then SMOF in Europe/Canada and now US over last 3-4 years) can reverse or prevent cholestasis" — Michael Helmrath (clinical) [Ep 73 · 5:20](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=320)
- "SMOF lipids allow provision of more calories from fat, as much as 2-2.5 g/kg" — Michael Helmrath (clinical) [Ep 73 · 6:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=375)
- "Conventional intralipid (soybean-based) when metabolized leads to production of prostaglandins and eicosanoids that are pro-inflammatory" — Paul Wales (clinical) [Ep 73 · 7:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=428)
- "SMOF lipid promotes bile flow, is hepatoprotective, and can be delivered at conventional dose while supporting somatic growth and neurologic development" — Paul Wales (clinical) [Ep 73 · 7:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=439)
- "SMOF lipid does not have enough arachidonic acid, so dose restriction can lead to essential fatty acid deficiency" — Paul Wales (clinical) [Ep 73 · 7:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=465)
- "When SMOF is delivered at conventional dosing, nobody develops essential fatty acid deficiency" — Paul Wales (clinical) [Ep 73 · 7:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=477)
- "Recommended lipid dosing is settling around 2.5 g/kg, but nutrition guidelines for preterms and babies state 3-4 g/kg/day" — Paul Wales (guideline) [Ep 73 · 8:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=486)
- "A bilirubin of 2 mg/dL is not advanced liver disease, is not dangerous, and is usually transient; approximately 90% of patients will improve with observation alone" — Paul Wales (opinion) [Ep 73 · 8:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=509)
- "When refeeding a cholestatic liver after jejunostomy takedown, direct bilirubin and liver enzymes (GGT, AST, ALT) will initially rise in the first 1-2 weeks as bile acid pool is reintroduced and liver becomes more active" — Michael Helmrath (clinical) [Ep 73 · 9:38](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=578)
- "It may take several weeks for bilirubin and liver enzyme levels to come back down after refeeding" — Ellen Encisco (clinical) [Ep 73 · 10:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=617)
- "Proximal blockage puts pressure in the biliary system at a much higher level and speeds up the cholestatic process" — Michael Helmrath (clinical) [Ep 73 · 11:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=678)
- "G-tubes do not decompress the duodenum" — Michael Helmrath (clinical) [Ep 73 · 11:31](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=691)
- "Liver biopsy is commonly performed during secondary surgical or autologous reconstruction procedures to provide an up-to-date microscopic snapshot" — Paul Wales (clinical) [Ep 73 · 12:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=731)
- "Prophylactic cholecystectomy is not recommended because the gallbladder helps with enterohepatic circulation and many patients will not need it" — Cecilia Gigena (guideline) [Ep 73 · 12:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=744)
- "Elastography or fibroscan is available for monitoring but is good for mild/no fibrosis or very advanced fibrosis; it is less sensitive for patients in the middle range" — Paul Wales (clinical) [Ep 73 · 13:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=780)
- "Outpatient follow-up frequency for children on TPN at home ranges from every 1-4 months depending on patient stability" — Paul Wales (clinical) [Ep 73 · 13:31](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=811)
- "Refeeding goals include establishing normal feeding habits to promote gut function and optimize quality of life and social aspects of eating" — Paul Wales (clinical) [Ep 79 · 0:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=57)
- "Damaged bowel is in a secretory phase even when not fed" — Michael Helmrath (clinical) [Ep 79 · 2:37](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=157)
- "Starting to feed the bowel transitions it to an absorptive state because luminal nutrition stimulates absorption, resulting in decreased stoma volume over time" — Michael Helmrath (clinical) [Ep 79 · 2:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=166)
- "Breast milk is the ideal first choice for feeding due to nutritional value, immunomodulatory effects, and growth healing effects not present in typical formulas" — Michael Helmrath (clinical) [Ep 79 · 3:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=220)
- "Donor breast milk is the second choice when maternal breast milk is unavailable" — Michael Helmrath (guideline) [Ep 79 · 4:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=248)
- "Breast milk has lower protein levels than desired and likely requires supplementation" — Cecilia Gigena (clinical) [Ep 79 · 4:21](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=261)
- "In short bowel syndrome, protein absorption is fairly well preserved, so the benefit of hydrolyzed or amino acid formulas is primarily from an allergy perspective" — Paul Wales (clinical) [Ep 79 · 4:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=274)
- "Long-chain fat is a stronger driver for intestinal adaptation than MCT" — Paul Wales (clinical) [Ep 79 · 5:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=304)
- "Long-chain fatty acids have developmental and immune properties" — Michael Helmrath (clinical) [Ep 79 · 5:21](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=321)
- "It is a common mistake to decrease TPN by the same volume that enteral feeds are increased, assuming the child will absorb all those calories, which results in stunted growth" — Michael Helmrath (clinical) [Ep 79 · 5:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=351)
- "One milliliter of parenteral nutrition is not isocaloric with one milliliter of formula" — Paul Wales (clinical) [Ep 79 · 6:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=366)
- "Advancing enteral feeds beyond 100-120 mL/kg can cause problems with sodium and calcium in addition to calorie and protein deficits, because milk composition differs from parenteral solution" — Paul Wales (clinical) [Ep 79 · 6:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=371)
- "If the child tolerates it and does not have lung issues, total daily volume can be expanded from 140 to 160, 170, or occasionally 180 mL/kg" — Michael Helmrath (clinical) [Ep 79 · 6:44](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=404)
- "Children with sick intestines will not absorb all the calories provided" — Cecilia Gigena (clinical) [Ep 79 · 7:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=420)
- "Bolus feeds are preferred as the default feeding method; patients should fail bolus feeds before transitioning to continuous feeds as the sole delivery mode" — Paul Wales (guideline) [Ep 79 · 8:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=485)
- "Continuous feeds can be used as a supplemental approach, with bolus feeds during the day and continuous feeds overnight" — Paul Wales (guideline) [Ep 79 · 8:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=485)
- "Oral feeding is important for skill development even when non-nutritive; children who never learn to suck, swallow, and process food by mouth will not eat solids later and will remain tube-dependent" — Paul Wales (clinical) [Ep 79 · 8:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=520)
- "The stomach is the most complicated part of the GI tract because it must coordinate both back-and-forth mixing and coordinated squeezing with pyloric relaxation several times per minute" — Michael Helmrath (clinical) [Ep 79 · 9:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=568)
- "When children have not been fed and have had an injury, gastric coordination is commonly disrupted" — Michael Helmrath (clinical) [Ep 79 · 9:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=568)
- "Gastric dysmotility after intestinal injury requires time and stimulation to resolve" — Michael Helmrath (clinical) [Ep 79 · 10:02](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=602)
- "Post-pyloric feeding with simultaneous gastric decompression allows distal bowel stimulation, which produces hormones that signal the stomach to start functioning and break the dysmotility cycle" — Michael Helmrath (clinical) [Ep 79 · 10:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=615)
- "Post-pyloric refeeding can be done as a bolus or over a pump; bolus is preferred, but running it over a pump for one hour works well at Cincinnati Children's" — Michael Helmrath (clinical) [Ep 79 · 11:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=663)
- "The Cincinnati Children's protocol typically starts post-pyloric feeds at 5 mL/kg, then 10 mL/kg, and advances based on tolerance" — Michael Helmrath (guideline) [Ep 79 · 11:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=663)
- "Feeding the distal colon reduces stoma output due to hormonal effects of the distal bowel, and often the stomach will start to work" — Michael Helmrath (clinical) [Ep 79 · 11:25](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=685)
- "Refeeding the distal intestine stimulates the proximal portion to absorb more" — Cecilia Gigena (clinical) [Ep 79 · 11:38](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=698)
- "When distal bowel has been functionally used through refeeding, the time to start feeding postoperatively after anastomosis is made easier" — Michael Helmrath (clinical) [Ep 79 · 11:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=710)
- "Distally fed bowel has improved size discrepancy at the time of anastomosis because the bowel has been used" — Paul Wales (clinical) [Ep 79 · 12:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=737)
- "Undigested formula in the colon is a trigger that can cause stress to the bowel and may not be the healthiest approach" — Michael Helmrath (opinion) [Ep 79 · 12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=754)
- "Placing a feeding tube into the stomach at the time of surgery does not commit the child to a lifelong G-tube or even for the first year" — Michael Helmrath (clinical) [Ep 79 · 12:53](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=773)
- "A gastric tube can be directed out of the pylorus into the proximal small bowel as a source of feeding to overcome unpredictable obstacles" — Michael Helmrath (clinical) [Ep 79 · 13:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=786)
- "When a gastric tube is no longer needed, it can be removed and the hole heals quickly like any other tube site" — Michael Helmrath (clinical) [Ep 79 · 13:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=804)
- "A gastric tube provides versatility for nutrition supplementation, medication delivery, and venting for gassy or bloated patients to improve enteral tolerance" — Paul Wales (clinical) [Ep 79 · 13:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=831)
- "The morbidity from a gastric tube is extremely low and the benefit can be very high" — Michael Helmrath (opinion) [Ep 79 · 14:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-7-refeeding-in-a-neonatal-patient-7209?t=845)
- "In Toronto, ultra-short gut is classified as less than 20% of expected bowel length for age" — Paul Wales (clinical) [Ep 49 · 1:37](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=97)
- "In a term baby, ultra-short gut corresponds to 20 to 30 centimeters of bowel" — Paul Wales (clinical) [Ep 49 · 1:42](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=102)
- "Overall survival in ultra-short gut patients in the current era is over 90%" — Paul Wales (clinical) [Ep 49 · 1:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=112)
- "Survival in ultra-short gut is actually 90 to 95%" — Ellen (clinical) [Ep 49 · 2:01](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=121)
- "Ultra-short gut patients don't die of liver failure anymore and rarely get transplanted" — Ellen (clinical) [Ep 49 · 2:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=123)
- "Ultra-short gut patients who reached autonomy required multiple nutritional supplements" — Paul Wales (clinical) [Ep 49 · 2:10](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=130)
- "Ultra-short gut patients with remnant ileum as part of residual bowel tended to do better" — Paul Wales (clinical) [Ep 49 · 2:26](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=146)
- "Ultra-short gut patients with longer colonic remnants tended to adapt and get off TPN" — Paul Wales (clinical) [Ep 49 · 2:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=170)
- "The ileum reclaims bile and tells the liver what to do" — Michael Helmrath (clinical) [Ep 49 · 2:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=175)
- "The ileum produces hormones like GLP-2, PYY and others that slow motility and tell the jejunum to reabsorb fluid" — Michael Helmrath (clinical) [Ep 49 · 2:58](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=178)
- "The colon can account for a third to half of the caloric needs of babies when exposed to undigested nutrients" — Michael Helmrath (clinical) [Ep 49 · 3:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=195)
- "Short bowel syndrome kids are largely neurologically fine, running and playing" — Michael Helmrath (clinical) [Ep 49 · 3:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=204)
- "Bowel removed is bowel never to be used" — Michael Helmrath (clinical) [Ep 49 · 4:26](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=266)
- "Most necrotizing enterocolitis kids don't have overwhelming totalis; NEC totalis is fairly rare" — Michael Helmrath (epidemiological) [Ep 49 · 4:48](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=288)
- "Cincinnati has a dozen or more NEC totalis kids that are off TPN and have done remarkably" — Michael Helmrath (clinical) [Ep 49 · 4:54](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=294)
- "If a baby grows well with protein growth, linear growth and head growth, that's brain growth" — Michael Helmrath (clinical) [Ep 49 · 6:49](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=409)
- "A baby will not grow well with an unhealthy liver" — Michael Helmrath (clinical) [Ep 49 · 6:59](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=419)
- "An unhealthy liver is not providing the protein for neurocognitive development" — Michael Helmrath (clinical) [Ep 49 · 6:59](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=419)
- "Lipid restriction was never a practice subscribed to by the Toronto program" — Paul Wales (opinion) [Ep 49 · 7:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=460)
- "Premature babies in the first year of life have caloric needs of 80, 100, 120 per kilo because they're growing and developing" — Michael Helmrath (clinical) [Ep 49 · 7:43](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=463)
- "When critically ill, babies no longer grow and develop; they can be fed 150 kcals per kilo but will not grow because their livers are catabolic" — Michael Helmrath (clinical) [Ep 49 · 7:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=472)
- "A transverse incision gives the least problems over time for patients requiring multiple operations" — Michael Helmrath (clinical) [Ep 49 · 8:25](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=505)
- "An 8 or 10 French Blake drain is placed through bowel just beyond what is expected to heal, advanced retrograde to the pylorus" — Michael Helmrath (clinical) [Ep 49 · 8:37](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=517)
- "A purse string is placed at the drain insertion site and secured to the skin, essentially creating a stoma to the abdominal wall" — Michael Helmrath (clinical) [Ep 49 · 9:10](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=550)
- "A 5 to 7 French feeding tube can be placed into the proximal bowel via the stomach using a purse string technique" — Michael Helmrath (clinical) [Ep 49 · 9:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=569)
- "Significant dissection of the distal ileum should be avoided to preserve blood supply and allow collateralization to recover proximal bowel" — Michael Helmrath (clinical) [Ep 49 · 10:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=608)
- "A refeeding tube can be placed in the distal bowel to allow intermediate bowel to heal" — Michael Helmrath (clinical) [Ep 49 · 10:53](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=653)
- "The volume of fluid output from injured bowel is very high initially; as bowel heals and regenerates reabsorptive capacity, output decreases" — Michael Helmrath (clinical) [Ep 49 · 11:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=679)
- "Intraoperative decisions in short bowel syndrome have a lifelong impact" — Paul Wales (opinion) [Ep 49 · 12:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=720)
- "Decisions made at the time of intraabdominal catastrophe can make the difference between staying on or getting off TPN or whether the child survives" — Paul Wales (opinion) [Ep 49 · 12:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=728)
- "Many kids who appear critically sick preoperatively are not as sick as believed once proximal bowel is controlled and decompressed" — Michael Helmrath (clinical) [Ep 49 · 13:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=802)
- "Kids may look worse over the first 24-36 hours postoperatively, then stop getting worse before they start improving" — Paul Wales (clinical) [Ep 49 · 14:21](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=861)
- "Blake tubes have linear cuts on the outside so they won't get obstructed when secretions accumulate" — Michael Helmrath (clinical) [Ep 49 · 14:49](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=889)
- "Blake tubes cannot be changed over a wire like JP drains with side holes" — Michael Helmrath (clinical) [Ep 49 · 14:58](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=898)
- "Blake tubes are soft and don't tend to put pressure on damaged bowel" — Michael Helmrath (clinical) [Ep 49 · 15:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=906)
- "Blake tubes can be connected to a bulb syringe and cut to size" — Michael Helmrath (clinical) [Ep 49 · 15:09](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-2-4993?t=909)
- "The inflection point of bowel loss requiring prolonged TPN is about 50%" — Michael Helmrath (clinical) [Ep 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 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 48 · 2:20](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-2-overwhelming-intestinal-damage-part-1-4954?t=140)
- "Adaptation is a natural process occurring in all infants during uterine development and the first few years of life, or as a regenerative response to damage in older children" — Michael Helmrath (clinical) [Ep 52 · 1:01](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=61)
- "Adaptation takes time measured in months and years, not weeks and days, and requires enteral nutrition in all situations" — Michael Helmrath (clinical) [Ep 52 · 1:25](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=85)
- "Adaptation is driven by intraluminal nutrients and their interaction with pancreatic biliary secretions and trophic gut peptides" — Paul Wales (clinical) [Ep 52 · 2:16](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=136)
- "Structural changes during adaptation include mucosal hypertrophy with increased villous length, increased blood supply through angiogenesis, bowel dilation, and gut lengthening in younger children, all increasing surface area for absorption" — Paul Wales (clinical) [Ep 52 · 2:42](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=162)
- "Functional changes during adaptation include slowed motility to allow more contact time and upregulation of enterocyte transporters" — Paul Wales (clinical) [Ep 52 · 3:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=184)
- "The duodenum is where caloric intake and sugars are sensed, hepatobiliary secretions occur, iron is absorbed, and it functions as an endocrine engine recognizing meal initiation" — Michael Helmrath (clinical) [Ep 52 · 3:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=214)
- "The jejunum is largely a source of secretion of large amounts of fluid needed for digestion, with random back-and-forth sloshing motion" — Michael Helmrath (clinical) [Ep 52 · 3:54](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=234)
- "The ileum secretes incretins GLP-2, GLP-1, and PYY that stop gastric emptying and slow motility when there is too much liquid in the distal bowel" — Michael Helmrath (clinical) [Ep 52 · 4:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=246)
- "Distal ileum bile uptake sends a signal to the liver, which regulates the whole metabolism of the patient" — Michael Helmrath (clinical) [Ep 52 · 4:31](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=271)
- "The colon, specifically the right colon, is a source of energy uptake from free fatty acids in short gut patients, which requires the presence of bacteria" — Michael Helmrath (clinical) [Ep 52 · 4:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=286)
- "Colonic adaptation does not occur in most patients because energy is reclaimed before reaching the colon" — Michael Helmrath (clinical) [Ep 52 · 5:01](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=301)
- "Until recently there was no standardized definition for enteral autonomy" — Paul Wales (clinical) [Ep 52 · 5:35](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=335)
- "TPN complications include line infections, liver disease, and vascular thrombosis" — Paul Wales (clinical) [Ep 52 · 6:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=364)
- "In the past, patients were lost to complications such as liver disease before they could reach their adaptive potential; management of these complications has improved significantly" — Paul Wales (clinical) [Ep 52 · 6:20](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=380)
- "Current ASPEN guidelines define enteral autonomy as independence of parenteral support for 12 weeks with maintenance of adequate growth and hydration" — Paul Wales (guideline) [Ep 52 · 6:39](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=399)
- "Healthy growth is the underlying driver of autonomy, not time off TPN" — Michael Helmrath (opinion) [Ep 52 · 7:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=426)
- "The last thing needed to come off TPN is fluid, and without hydration the baby will not grow or efficiently absorb nutrition" — Michael Helmrath (clinical) [Ep 52 · 7:13](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=433)
- "A 2012 PIFCO paper by Squires showed 50% of patients achieved enteral autonomy over 5-6 years, 25% died, and 25% got transplanted" — Paul Wales (epidemiological) [Ep 52 · 7:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=470)
- "Recent papers in the last 5-6 years show 60-80% of patients achieve enteral autonomy, with a higher proportion surviving to reach autonomy" — Paul Wales (epidemiological) [Ep 52 · 8:25](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=505)
- "Small bowel length is an independently significant variable for adaptation capacity" — Paul Wales (clinical) [Ep 52 · 9:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=595)
- "The ileum has a much greater capacity to adapt than the jejunum" — Paul Wales (clinical) [Ep 52 · 10:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=618)
- "A full-term baby is born with approximately 160 centimeters of small bowel" — Rod Gerardo (clinical) [Ep 52 · 10:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=634)
- "At 5 years old, a child has about 425 centimeters of small bowel, with the steepest growth rate between 35 weeks gestation to about 6 months postnatal" — Paul Wales (clinical) [Ep 52 · 10:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=640)
- "80 centimeters of small bowel represents about 50% of small intestine in a term baby but about 80% in a 30-week infant" — Ellen (clinical) [Ep 52 · 10:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=652)
- "The ileocecal valve itself is not the important factor; most people who lose their ileocecal valve also lose their terminal ileum, which is the bigger factor for adaptive potential" — Paul Wales (opinion) [Ep 52 · 11:25](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=685)
- "If a patient has the majority of their small bowel, it almost does not matter how much colon they have; probability of enteral autonomy is 85-100%" — Paul Wales (clinical) [Ep 52 · 11:53](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=713)
- "When small bowel remnant is less than 50% of expected length, the colon becomes vitally important for energy absorption from short-chain fatty acids and fluid/salt absorption" — Ellen (clinical) [Ep 52 · 12:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=726)
- "Lab data shows a shift in microbiota to one that is more acid-producing in an acidotic state, likely more full of bile because it is not being reclaimed" — Michael Helmrath (clinical) [Ep 52 · 12:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=760)
- "Bacterial colonization of the intestines is part of the adaptive response" — Rod Gerardo (clinical) [Ep 52 · 12:58](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=778)
- "NEC is an acquired condition; infants are born, start eating, often get up to full feeds, then have an incident usually at 2-3 weeks of life" — Michael Helmrath (clinical) [Ep 52 · 13:26](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=806)
- "NEC patients have not been using their gut in utero during the critical period of 35 weeks to 6 months, making them different from children who have been fed before" — Michael Helmrath (clinical) [Ep 52 · 13:38](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=818)
- "The sooner a child can be fed safely and bowel access obtained without exposing them to surgical risk, the more advantage can be taken of the adaptive process" — Michael Helmrath (opinion) [Ep 52 · 14:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=845)
- "Surgery puts kids in harm's way no matter how talented the surgeon, so balancing operative risk with the ability to optimize feeding has led to improved outcomes" — Michael Helmrath (opinion) [Ep 52 · 14:48](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-3-enteral-autonomy-part-1-5141?t=888)
- "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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 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 46 · 10:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=651)
- "The gut doubles in length in the last trimester and the first year of life" — Michael Helmrath (clinical) [Ep 66 · 2:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=175)
- "Maturation of the intestine occurs when you feed the baby" — Michael Helmrath (clinical) [Ep 66 · 2:58](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=178)
- "Healthy growth of the intestine requires nutrition" — Michael Helmrath (clinical) [Ep 66 · 3:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=183)
- "Anything done to disrupt feeding affects the maturation of the intestine's ability to absorb, digest, and peristalse" — Michael Helmrath (clinical) [Ep 66 · 3:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=186)
- "It's the waves of peristalsis going over the villi that give absorptive surface area, not the length of exposed bowel" — Em Tombash (clinical) [Ep 66 · 3:32](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=212)
- "Lengthening bowel that doesn't peristalse doesn't increase absorption - it's just more static water" — Michael Helmrath (clinical) [Ep 66 · 3:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=226)
- "Very short bowel kids sometimes come off TPN because their motility is so good" — Michael Helmrath (clinical) [Ep 66 · 3:59](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=239)
- "The point of intake for the majority of short bowel syndrome patients is at birth because etiologies are usually neonatal causes" — Paul Wales (epidemiological) [Ep 66 · 4:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=258)
- "Congenital anomalies of the GI tract or acquired conditions like necrotizing enterocolitis are the main causes" — Paul Wales (epidemiological) [Ep 66 · 4:36](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=276)
- "If reestablishing bowel continuity, you must deal with size discrepancy between the two ends" — Paul Wales (clinical) [Ep 66 · 5:42](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=342)
- "Even if an anastomosis is patent, disparate diameter will result in functional obstruction" — Ellen Encisco (clinical) [Ep 66 · 5:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=352)
- "Gastroschisis patients don't tend to do as well regardless of intervention" — Paul Wales (clinical) [Ep 66 · 7:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=428)
- "STEP procedures tend to not work as well in gastroschisis patients" — Paul Wales (clinical) [Ep 66 · 7:12](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=432)
- "Gastroschisis patients have inherent dysmotility" — Em Tombash (clinical) [Ep 66 · 7:21](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=441)
- "The enteric nervous system is damaged in gastroschisis from exposure to amniotic fluid" — Michael Helmrath (clinical) [Ep 66 · 7:32](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=452)
- "The enteric nervous system in gastroschisis has to go through a healing and recovery phase" — Michael Helmrath (clinical) [Ep 66 · 7:32](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=452)
- "When exposed to more dysmotility and stasis, regeneration and healing of the enteric nervous system is attenuated" — Michael Helmrath (clinical) [Ep 66 · 7:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=466)
- "A baby with atresia may have really good peristalsis that has been working against an obstruction" — Michael Helmrath (clinical) [Ep 66 · 7:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=475)
- "Children who have STEP procedures in the first year of life sometimes never progress and are labeled poor motility children" — Michael Helmrath (clinical) [Ep 66 · 8:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=499)
- "Babies with necrotizing enterocolitis do better when they heal because they've been fed before and already have GI motility starting" — Michael Helmrath (opinion) [Ep 66 · 8:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=520)
- "The STEP procedure requires bowel diameter of about 5 centimeters to be worthwhile" — Paul Wales (clinical) [Ep 66 · 9:09](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=549)
- "The length gained from STEP depends on the starting diameter of the bowel and the width of the stapler cuts" — Em Tombash (clinical) [Ep 66 · 9:21](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=561)
- "At birth, bowel is usually not dilated enough to apply the STEP procedure" — Ellen Encisco (clinical) [Ep 66 · 9:36](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=576)
- "It's critical to record bowel measurements before and after the procedure" — Em Tombash (guideline) [Ep 66 · 11:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=682)
- "There is a risk of bowel twisting in longitudinal orientation if alignment is not maintained during STEP" — Paul Wales (clinical) [Ep 66 · 11:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=689)
- "Target caliber for STEP in a baby is about 1.5 centimeters, and for older infant or child is 2 to 2.5 centimeters" — Paul Wales (guideline) [Ep 66 · 13:23](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=803)
- "Making the bowel too narrow during STEP can obstruct the patient, especially in someone with borderline motility" — Paul Wales (clinical) [Ep 66 · 13:36](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=816)
- "A proposed advantage of STEP is that the surgeon can maintain caliber all the way from top to bottom by careful measurements" — Paul Wales (clinical) [Ep 66 · 14:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=859)
- "There is potential for leak in the crotch of the staple line if not reinforced" — Paul Wales (clinical) [Ep 66 · 14:35](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=875)
- "Dog ears at the top and bottom of the STEP segment can dilate over time and form blind loops" — Paul Wales (clinical) [Ep 66 · 15:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=908)
- "If one part of the bowel becomes dilated, the STEP segments can rotate away from each other and form a functional obstruction" — Ellen Encisco (clinical) [Ep 66 · 15:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=957)
- "The duodenum doesn't have a mesentery, making it difficult to orient staple lines at 3 and 9 o'clock" — Michael Helmrath (clinical) [Ep 66 · 17:32](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5909?t=1052)
- "This was a retrospective cohort study of children with short bowel syndrome in an intestinal rehabilitation program, followed from 2006 to 2019." — Lizzie Lee (epidemiological) [Ep 109 · 0:07](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=7)
- "The study asked whether social determinants of health predict outcomes like bloodstream infections, liver disease, and achieving enteral autonomy." — Lizzie Lee (epidemiological) [Ep 109 · 0:16](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=16)
- "Social determinants of health do predict outcomes in pediatric short bowel syndrome." — Lizzie Lee (epidemiological) [Ep 109 · 0:24](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=24)
- "Distance from the hospital was associated with higher risks of serious complications in children with short bowel syndrome." — Lizzie Lee (epidemiological) [Ep 109 · 0:27](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=27)
- "Parental education was linked with fewer central line infections in children with short bowel syndrome." — Lizzie Lee (epidemiological) [Ep 109 · 0:33](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=33)
- "Clinicians need to consider social determinants of health to better support families of children with short bowel syndrome." — Lizzie Lee (opinion) [Ep 109 · 0:37](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=37)
- "Intestinal failure is defined as reduction of functioning intestinal mass below that which can sustain life, resulting in dependence on supplemental parenteral support for a minimum of 60 days within a 74 consecutive day interval" — Stephanie Oliveira (clinical) [Ep 108 · 0:26](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=26)
- "More than 50% of intestinal failure cases are related to short bowel syndrome, with some mucosal enteropathies and dysmotility disorders" — Stephanie Oliveira (epidemiological) [Ep 108 · 0:43](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=43)
- "Most causes of short bowel syndrome in pediatrics happen during the neonatal period, including gastroschisis, necrotizing enterocolitis, bowel atresia, and intestinal volvulus" — Stephanie Oliveira (clinical) [Ep 108 · 0:55](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=55)
- "The field is starting to focus on neurocognitive outcomes, quality of life, and caregiver burnout" — Stephanie Oliveira (opinion) [Ep 108 · 1:18](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=78)
- "Chronic intestinal inflammation resembling Crohn's disease is now seen in intestinal failure patients, requiring management with inflammatory bowel disease therapies like biologics" — Lizzie Lee (clinical) [Ep 108 · 1:24](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=84)
- "The cause of chronic intestinal inflammation in intestinal failure patients is not known" — Stephanie Oliveira (clinical) [Ep 108 · 1:37](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=97)
- "Intestinal adaptation is an active compensatory process that starts happening right after bowel resection" — Stephanie Oliveira (clinical) [Ep 108 · 2:30](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=150)
- "Food, bacteria, and hormones in the gut are important for enhancing intestinal adaptation" — Stephanie Oliveira (clinical) [Ep 108 · 2:42](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=162)
- "Enteral autonomy is achieved when a patient gets off TPN and has all nutrition going to the gut, either by mouth or by feeding tube" — Stephanie Oliveira (clinical) [Ep 108 · 3:11](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=191)
- "A 2012 Pediatric Intestinal Failure Consortium report showed 50% of intestinal failure patients achieved enteral autonomy, and 25% either passed away or had an intestinal transplant" — Lizzie Lee (epidemiological) [Ep 108 · 3:19](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=199)
- "From 2010 to 2015, a repeat study with double the number of patients showed about 50% reached enteral autonomy, but the number of transplants and deaths significantly decreased" — Stephanie Oliveira (epidemiological) [Ep 108 · 3:33](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=213)
- "The establishment of multidisciplinary teams changed outcomes in intestinal failure" — Stephanie Oliveira (clinical) [Ep 108 · 3:46](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=226)
- "Studies from Canada, Michigan, and Spain show that a multidisciplinary intestinal rehab team improves survival" — Lizzie Lee (epidemiological) [Ep 108 · 3:51](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=231)
- "Predictors of reaching enteral autonomy include greater residual bowel length, follow-up at an institution with an intestinal rehabilitation program, and no-step procedure" — Stephanie Oliveira (clinical) [Ep 108 · 4:03](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=243)
- "The number of intestinal transplants has significantly decreased over the last several decades" — Stephanie Oliveira (epidemiological) [Ep 108 · 4:56](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=296)
- "Liver disease in intestinal failure ranges from mild cholestasis to profound steatosis in older children or adolescents and adults, with ongoing inflammation, fibrosis, and ultimately cirrhosis" — Paul Wales (clinical) [Ep 108 · 5:23](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=323)
- "Risk factors for intestinal failure-associated liver disease include prematurity, lack of enteral feeding, inability to feed due to anatomy, recurrent infections, sepsis, and components of TPN" — Paul Wales (clinical) [Ep 108 · 5:41](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=341)
- "Intestinal rehab programs improve outcomes through integration of care, improved communication, and better continuity" — Paul Wales (clinical) [Ep 108 · 6:12](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=372)
- "Literature shows improvement of outcomes with intestinal rehab programs including improved survival related to liver dysfunction, decreased septic episodes, reduction in central line complications, reduced ICU admissions, and patients coming off transplant lists" — Paul Wales (epidemiological) [Ep 108 · 7:25](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=445)
- "Lipids are a source of essential fatty acids, a non-protein energy source important for growth, and fatty acids have a major role in cellular pathways" — Paul Wales (clinical) [Ep 108 · 8:02](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=482)
- "Soybean-based lipid emulsions have high phytosterol content, high omega-6 long chain polyunsaturated fatty acid content, and low antioxidant content" — Paul Wales (clinical) [Ep 108 · 8:15](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=495)
- "Prolonged soybean-based lipid exposure is associated with deterioration of liver dysfunction, specifically cholestasis" — Paul Wales (clinical) [Ep 108 · 8:31](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=511)
- "For every day an infant is exposed to soybean lipid dosed at greater than 2.5 g per kilo per day, there is a 3% increase in the odds ratio of developing advanced liver disease" — Paul Wales (clinical) [Ep 108 · 8:51](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=531)
- "Omega-6 lipids are metabolized to arachidonic acid, which produces leukotrienes and prostaglandins with a more pro-inflammatory profile" — Paul Wales (clinical) [Ep 108 · 9:51](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=591)
- "Omega-3 lipids are metabolized through EPA and DHA and lead to production of cytokines with a less inflammatory profile" — Paul Wales (clinical) [Ep 108 · 10:01](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=601)
- "Omega-3 lipids improve bile flow by decreasing lithogenicity of bile, decreasing steatosis, stimulating improved beta oxidation and clearance, lowering oxidative stress, and supporting immune function" — Paul Wales (clinical) [Ep 108 · 10:15](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=615)
- "Restricting soybean lipid exposure improves cholestasis when dosed at 1 g per kilo per day or less" — Paul Wales (clinical) [Ep 108 · 10:42](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=642)
- "In preterm babies, fat is important for growth, especially for neurocognitive development, and there is risk of essential fatty acid deficiency if lipid dosing is restricted too much" — Paul Wales (clinical) [Ep 108 · 11:00](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=660)
- "DHA and arachidonic acid are important for retinal and brain development" — Paul Wales (clinical) [Ep 108 · 11:22](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=682)
- "None of the current lipid emulsions were designed for premature babies; they were all designed for adults in a critical care setting" — Paul Wales (clinical) [Ep 108 · 11:26](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=686)
- "There are approximately 240,000 central line-associated bloodstream infections in the United States annually, with each costing about $30,000, totaling about $2 billion per year nationwide" — Paul Wales (epidemiological) [Ep 108 · 12:24](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=744)
- "4% tetrasodium EDTA (kite lock) is an antithrombotic, anti-fibrinolytic, and antimicrobial that satisfies all three criteria important for a good lock solution" — Paul Wales (clinical) [Ep 108 · 12:48](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=768)
- "Kite lock is licensed in Europe and Australia but not available in the United States" — Paul Wales (clinical) [Ep 108 · 13:23](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=803)
- "A multi-center randomized trial of kite lock versus heparin went live 4 weeks ago and is actively recruiting patients" — Paul Wales (clinical) [Ep 108 · 13:29](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=809)
- "In short bowel syndrome, there are 3 anatomical subtypes: Type 1 is high jejunostomy, Type 2 has lost distal small bowel and ileum with small bowel-colonic anastomosis, and Type 3 has lost mid-small bowel but retains some ileum and intact colon" — Paul Wales (clinical) [Ep 108 · 13:58](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=838)
- "Patients with Type 3 short bowel syndrome have the best prognosis because they still have residual ileum" — Lizzie Lee (clinical) [Ep 108 · 14:19](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=859)
- "The most common anatomical subtype of short bowel syndrome in pediatrics is Type 2" — Paul Wales (epidemiological) [Ep 108 · 14:26](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=866)
- "Type 1 and Type 2 short bowel syndrome patients struggle because they lack an ileum, which is where GLP-2 is naturally produced" — Paul Wales (clinical) [Ep 108 · 14:33](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=873)
- "Native GLP-2 hormone has a half-life of 7 minutes, making it impractical for clinical use" — Paul Wales (clinical) [Ep 108 · 14:53](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=893)
- "Teduglutide is a GLP-2 analog with one amino acid alteration that has a half-life of 2 hours and is given once daily by subcutaneous injection" — Paul Wales (clinical) [Ep 108 · 14:58](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=898)
- "Patients receiving teduglutide show a 40% reduction in TPN fluid and calorie requirements over a six-month period" — Paul Wales (clinical) [Ep 108 · 15:23](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=923)
- "70% of patients receiving teduglutide achieved the study endpoint of a 20% reduction in TPN requirements" — Paul Wales (clinical) [Ep 108 · 15:32](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=932)
- "Teduglutide is licensed for children greater than 1 year of age" — Paul Wales (clinical) [Ep 108 · 15:48](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=948)
- "Apraglutide is another GLP-2 analog with a longer half-life that can be given once a week and works even better than teduglutide, producing more bowel lengthening" — Paul Wales (clinical) [Ep 108 · 16:02](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=962)
- "These interventions have led to a decrease in transplantation since 2008, largely because of the successes of intestinal rehabilitation" — Paul Wales (epidemiological) [Ep 108 · 16:36](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=996)
- "Outcomes of intestinal transplant at 5 years are about 65%" — Paul Wales (epidemiological) [Ep 108 · 16:41](https://library.globalcastmd.com/watch/advancements-in-pediatric-intestinal-failure-innovative-therapies-and-improved-outcomes-13892?t=1001)
- "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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 33 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 34 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 38 · 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 100 · 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 100 · 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 100 · 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 100 · 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 100 · 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 100 · 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 100 · 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 100 · 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 100 · 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 100 · 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 100 · 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 100 · 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 100 · 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 100 · 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 100 · 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 100 · 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 100 · 3:53](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=233)
- "Advances in medicine have dramatically improved survival rates for children with intestinal failure" — Julian Goddard (clinical) [Ep 101 · 0:00](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=0)
- "The study tracked 46 patients who turned 20 to evaluate outcomes during care transition" — Julian Goddard (epidemiological) [Ep 101 · 0:13](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=13)
- "59% of patients transitioned to adult focused programs while the rest continued receiving care at Cincinnati Children's" — Julian Goddard (epidemiological) [Ep 101 · 0:23](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=23)
- "Patients who transitioned to adult care had a 33% mortality rate" — Julian Goddard (epidemiological) [Ep 101 · 0:29](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=29)
- "Patients who stayed in pediatric care had a 5% mortality rate" — Julian Goddard (epidemiological) [Ep 101 · 0:29](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=29)
- "The two groups showed no obvious differences in medical complexity or disease burden" — Julian Goddard (clinical) [Ep 101 · 0:29](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=29)
- "The median time from transition to death was approximately 12 months" — Julian Goddard (epidemiological) [Ep 101 · 0:42](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=42)
- "Young adults with a history of intestinal failure aging out of pediatric care remain a critically vulnerable population" — Julian Goddard (opinion) [Ep 101 · 0:46](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=46)
- "Structured transition programs need to be developed and widely implemented for this population" — Julian Goddard (opinion) [Ep 101 · 0:46](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=46)
- "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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 10 · 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 11 · 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 11 · 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 11 · 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 11 · 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 11 · 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 11 · 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 11 · 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 11 · 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 11 · 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 11 · 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 11 · 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 11 · 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 11 · 8:36](https://library.globalcastmd.com/watch/malrotation-rapid-fire-session-update-course-2015-879?t=516)
- "Babies that make urine are not likely to need peritoneal dialysis for a little while, but are likely to need it in the future" — Alonso (clinical) [Ep 12 · 0:25](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=25)
- "Peritoneal dialysis catheters should be left alone for a couple of weeks if at all possible after placement" — Alonso (clinical) [Ep 12 · 0:45](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=45)
- "Gastrostomy tube placement is focused along the lesser curvature to preserve the stomach for potential future bladder augmentation" — Alonso (clinical) [Ep 12 · 0:54](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=54)
- "Hemodialysis catheters need to be fairly large caliber and are preferentially placed in the right internal jugular site because it is a straight shot into the atrium" — Alonso (clinical) [Ep 12 · 2:11](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=131)
- "Inguinal and umbilical hernias can develop when babies are on peritoneal dialysis" — Alonso (clinical) [Ep 12 · 2:56](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=176)
- "Hernias are left alone if they are not affecting the mechanics of dialysis and are not particularly symptomatic" — Alonso (clinical) [Ep 12 · 2:56](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=176)
- "The ideal weight for transplantation is around 10 kg if babies are not on peritoneal dialysis" — Alonso (clinical) [Ep 12 · 4:01](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=241)
- "Babies on peritoneal dialysis have a more accommodating abdominal cavity and laxity in the abdominal wall, allowing transplantation closer to 8 kg" — Alonso (clinical) [Ep 12 · 4:01](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=241)
- "All infant recipients have been transplanted with adult donors" — Alonso (clinical) [Ep 12 · 4:17](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=257)
- "An extraperitoneal approach is used for infant renal transplantation with an incision extending to the upper edge close to the costal margin" — Alonso (clinical) [Ep 12 · 4:32](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=272)
- "The biggest complication from a general surgical perspective are wound complications as opposed to vascular complications" — Alonso (clinical) [Ep 12 · 4:59](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=299)
- "Some patients can only be closed at skin level and develop leaks or dehiscence requiring biologic mesh such as derma matrix for closure" — Alonso (clinical) [Ep 12 · 5:08](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=308)
- "In a 13-year follow-up of G tubes in babies, they all migrate up onto the chest" (clinical) [Ep 12 · 7:14](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=434)
- "Insufficient space between the G tube site and PD catheter site can lead to infection problems early on when drainage gets underneath the PD catheter dressing" — Alonso (clinical) [Ep 12 · 7:47](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=467)
- "The standard insertion site for gastrostomy tubes is 2 finger breadths below the costal margin" — Alonso (clinical) [Ep 12 · 8:24](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=504)
- "Gastrostomy tube location must be placed high on the stomach towards the lesser curvature to allow use of a gastric segment for gastric augmentation later in life" — Alonzo (clinical) [Ep 12 · 8:46](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=526)
- "Some babies with posterior urethral valves will need urinary diversion with a vesicostomy placed about 1-2 finger breadths below the umbilicus" — Alonzo (clinical) [Ep 12 · 9:06](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=546)
- "PD catheters can be placed to allow immediate use with lower volumes, though waiting for healing is preferable" — Alonso (clinical) [Ep 12 · 11:20](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=680)
- "Many babies with bladder outlet obstruction have small stomachs, possibly related to minimum amniotic fluid during development" (clinical) [Ep 12 · 11:43](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=703)
- "Disruption of the enterohepatic circulation of bile acids is beneficial for the liver" — Cecilia Gigena (clinical) [Ep 77 · 0:00](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=0)
- "The study was conducted at Saint Louis Children's Hospital" — Cecilia Gigena (clinical) [Ep 77 · 0:13](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=13)
- "The study aim was to elucidate the driving force behind hepatic injury" — Cecilia Gigena (clinical) [Ep 77 · 0:13](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=13)
- "Three groups of mice were studied: sham, 50% with proximal or duodenal resection, and 50% with distal resection or resection of the ileocecal valve" — Cecilia Gigena (clinical) [Ep 77 · 0:22](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=22)
- "Tissue samples were taken at the second and 10th postoperative weeks" — Cecilia Gigena (clinical) [Ep 77 · 0:34](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=34)
- "Mice with distal resection show less hepatic oxidative stress" — Cecilia Gigena (clinical) [Ep 77 · 0:41](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=41)
- "Mice with distal resection show more hydrophilic bile acid profile" — Cecilia Gigena (clinical) [Ep 77 · 0:41](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=41)
- "Ileal resection could lead to less hepatic injury" — Cecilia Gigena (clinical) [Ep 77 · 0:41](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=41)
- "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 78 · 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 78 · 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 78 · 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 78 · 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 78 · 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 78 · 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 78 · 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 78 · 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 78 · 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 78 · 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 106 · 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 106 · 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 106 · 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 106 · 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 106 · 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 106 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 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 107 · 9:48](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-nec-management-13612?t=588)
- "Young infants, babies, and young children have tremendous gut growth potential, with the gut growing for the first several years of life" — Paul Weil (clinical) [Ep 83 · 0:49](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=49)
- "A term baby will have 160 centimeters of small bowel, and by age 5 years it almost triples to about 425 to 450 centimeters" — Paul Weil (clinical) [Ep 83 · 1:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=77)
- "You can have as low as 10% expected gut length and still achieve enteral autonomy if you have the majority of your colon in continuity" — Paul Weil (clinical) [Ep 83 · 1:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?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 reclamation of bile and support enterohepatic circulation" — Michael Helmrath (clinical) [Ep 83 · 2:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=150)
- "GLP-2, GLP-1, and hormones like PYY are produced in the distal ileum, not because of the ileocecal valve but because of the distal ileum itself" — Michael Helmrath (clinical) [Ep 83 · 2:43](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=163)
- "Strategy at the first operation should provide a pathway forward that allows early interval feeding" — Michael Helmrath (clinical) [Ep 83 · 3:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=209)
- "It is sometimes better to stage reconstruction under more controlled conditions rather than attempt immediate continuity" — Michael Helmrath (opinion) [Ep 83 · 3:38](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=218)
- "Many segments of bowel deemed non-usable actually have potential to heal in this population and can make a huge difference in the lifetime of the child" — Michael Helmrath (clinical) [Ep 83 · 4:02](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=242)
- "As long as you can divert proximally and the baby is stable, you can leave questionable bowel for potential use at later secondary reconstructive procedures" (clinical) [Ep 83 · 4:26](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=266)
- "The overarching principle is to deliver adequate nutrition to have normal growth within normal parameters, ideally enterally" — Paul Weil (clinical) [Ep 83 · 5:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=308)
- "As much as possible, we should try to establish normal feeding behavior, realizing that enteral nutrition is more than just nutrition" — Paul Weil (clinical) [Ep 83 · 5:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=328)
- "If a patient needs tube support from the beginning, bolus feeding should be tried rather than defaulting to continuous feeding" — Paul Weil (clinical) [Ep 83 · 5:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=352)
- "If the child fails gastric approach (bolus then continuous), the strategy is to feed beyond the stomach and decompress the stomach through an NG tube" — Paul Weil (clinical) [Ep 83 · 6:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=375)
- "Breast milk is the formula of choice, not only for nutritional benefits but for all the other components within breast milk" — Michael Helmrath (clinical) [Ep 83 · 6:42](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=402)
- "Single amino acid level protein is the generalized preference to avoid high stool output, high fluid losses, wound breakdown, rashes, and emesis" — Michael Helmrath (clinical) [Ep 83 · 7:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=448)
- "Long chain fat is the preferred fat module rather than MCT, as long chain fat is a much stronger stimulus for GLP-2 release, which drives adaptation" — Paul Weil (clinical) [Ep 83 · 8:07](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=487)
- "Not every child needs to be on SMOF lipid emulsion" — Paul Weil (opinion) [Ep 83 · 9:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=540)
- "For preterm babies, SMOF is not the ideal lipid emulsion but is the best currently available" — Paul Weil (clinical) [Ep 83 · 9:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=543)
- "SMOF does not have enough arachidonic acid, which is really important for brain development" — Paul Weil (clinical) [Ep 83 · 9:16](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=556)
- "Two strategies to treat cholestasis are to reduce the total amount of fat or to change the composition to introduce SMOF lipids or omegaven" (clinical) [Ep 83 · 9:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=574)
- "Lipid restrictions that reduce dose to 1 g/kg/day can reverse cholestasis but result in reduced calorie delivery that can impair growth and potentially impact neurocognitive development" (clinical) [Ep 83 · 9:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=590)
- "Omegaven is essentially pure fish oil with omega-3 and is dosed at 1 g/kg, so babies take a calorie hit" (clinical) [Ep 83 · 10:07](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=607)
- "SMOF lipids are a more well-balanced emulsion with an omega-3 to omega-6 ratio of 2.5 to 1, being less inflammatory than intralipid and promoting bile flow" (clinical) [Ep 83 · 10:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=628)
- "SMOF lipids should not be restricted and must be given at no less than 2 or 2.5 g/kg/day" (clinical) [Ep 83 · 10:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=628)
- "McMaster University performed a retrospective review of infants born between 2014 and 2022 with uncomplicated gastroschisis" — Alex Halpern (epidemiological) [Ep 84 · 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 84 · 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 84 · 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 84 · 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 84 · 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 84 · 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 84 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 86 · 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 90 · 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 90 · 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 90 · 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 90 · 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 90 · 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 90 · 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 90 · 0:41](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=41)
- "Approximately one-third of Hirschsprung patients are constipated post-operatively and need proactive, aggressive management to avoid trouble" — Marc Levitt (epidemiological) [Ep 88 · 1:47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=107)
- "Hirschsprung disease is a very anatomically fixable problem and with a good operation you should get a good result" — Marc Levitt (clinical) [Ep 88 · 1:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=98)
- "Surgeons might leave behind the dilated segment right above the aganglionic segment as an anatomic reason for decompensation" — Marc Levitt (clinical) [Ep 88 · 2:11](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=131)
- "The most relevant reason for decompensation is that the patient never figured out how to successfully empty their sphincters and the pull-through decompensates" — Marc Levitt (clinical) [Ep 88 · 2:22](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=142)
- "Calretinin hangs out with ganglion cells, so normal calretinin staining provides double evidence of good ganglion cells" — Marc Levitt (clinical) [Ep 88 · 3:14](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=194)
- "In younger children age less than 3 or so, hypertrophic nerves are defined as greater than 40 microns in diameter" — Jason Frischer (clinical) [Ep 88 · 3:47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=227)
- "The definition of hypertrophic nerve is more gray in older patients and in patients who have chronic constipation issues" — Jason Frischer (clinical) [Ep 88 · 4:01](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=241)
- "If there are no ganglion cells and no calretinin staining, that is a retained Hirschsprung and the patient needs a redo to a higher level" — Marc Levitt (clinical) [Ep 88 · 4:27](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=267)
- "Nerve hypertrophy with good ganglion cells could represent transition zone or could represent that the bowel has decompensated over time because it hasn't emptied and gotten dilated" — Marc Levitt (clinical) [Ep 88 · 4:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=278)
- "An absent rectal anal inhibitory reflex means the internal anal sphincter doesn't relax when the rectum is distended, which can contribute to constipation" — Felipe Glu (clinical) [Ep 88 · 6:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=395)
- "Many patients are going to have an abnormal anorectal manometry but they're OK" — Marc Levitt (clinical) [Ep 88 · 6:47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=407)
- "Botox helps patients learn to overcome non-relaxing sphincters by other maneuvers like pushing on their abdominal wall" — Marc Levitt (clinical) [Ep 88 · 6:56](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=416)
- "Many patients are completely asymptomatic doing great with Hirschsprung's that have residual absent rectal anal inhibitory reflex" — Marc Levitt (clinical) [Ep 88 · 7:11](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=431)
- "In Hirschsprung patients with constipation, the colon is not the problem; the problem usually is the sphincters or the pelvic floor" — Marc Levitt (clinical) [Ep 88 · 7:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=459)
- "If you get an awake anorectal manometry in a cooperative patient with a normal rectal anal inhibitory reflex and can detect the resting pressure, the evaluation is complete without anesthesia or procedure" — Marc Levitt (clinical) [Ep 88 · 8:14](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=494)
- "If the rectal anal inhibitory reflex is absent, you're obligated to do a biopsy and give Botox" — Marc Levitt (guideline) [Ep 88 · 8:29](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=509)
- "Botox is given if the resting pressure of the external sphincter is also high" — Marc Levitt (clinical) [Ep 88 · 8:36](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=516)
- "Pelvic floor dysynergia can be detected on anorectal manometry and is a good indication that pelvic floor physical therapy will help the patient" — Marc Levitt (clinical) [Ep 88 · 8:41](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=521)
- "Colonic manometry should not be done in Hirschsprung patients with obstructive symptoms because it's not the colon but the distal pull-through that's the problem" — Marc Levitt (guideline) [Ep 88 · 9:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=595)
- "Anatomic and pathologic causes must be ruled out before any colonic manometry is considered" — Marc Levitt (guideline) [Ep 88 · 10:11](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=611)
- "Colonic manometry in a patient with a distal obstruction is the wrong test" — Marc Levitt (guideline) [Ep 88 · 10:18](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=618)
- "Once distal obstruction is ruled out or fixed and the colon is still not working, then you have a problem warranting colonic manometry" — Jason Frischer (clinical) [Ep 88 · 10:27](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=627)
- "If there's a segment less than 30 centimeters of inadequate high amplitude propagating contractions, the approach is not super aggressive; over 30 centimeters is definitely more of a red flag" — Jason Frischer (clinical) [Ep 88 · 11:01](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=661)
- "High amplitude propagating contractions aid in the transfer of colonic contents over long distance and often precede emptying" — Felipe Glu (clinical) [Ep 88 · 11:17](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=677)
- "In a PCPLC Consortium study of close to 100 patients with functional constipation and segmental dysmotility of the sigmoid, 97% successfully responded to Malone only without needing resection" — Marc Levitt (epidemiological) [Ep 88 · 11:54](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=714)
- "Five years ago, surgeons were taking sigmoids out of patients with segmental dysmotility, but this practice has changed based on new data" — Marc Levitt (clinical) [Ep 88 · 12:28](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=748)
- "A Malone procedure is a route for medical treatment, providing antegrade access to the colon for gastroenterologists to give better medical treatment" — Marc Levitt (clinical) [Ep 88 · 13:24](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=804)
- "While surgery can correct the underlying anatomical problem in Hirschsprung disease, many other factors can contribute to constipation including motility disorders, pelvic floor dysfunction, and behavioral issues" — Felipe Glu (clinical) [Ep 88 · 14:15](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=855)
- "The umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly" — Em Gootee (clinical) [Ep 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 89 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 30 · 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 30 · 0:37](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=37)
- "Pyloric stenosis is more common in males" — Bargave Muliudi (epidemiological) [Ep 30 · 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 30 · 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 30 · 1:12](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=72)
- "Emesis will progress until it is projectile" — Bargave Muliudi (clinical) [Ep 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 30 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 85 · 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 87 · 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 87 · 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 87 · 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 87 · 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 87 · 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 87 · 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 87 · 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 91 · 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 91 · 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 91 · 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 91 · 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 91 · 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 91 · 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 91 · 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 91 · 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 91 · 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 91 · 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 91 · 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 91 · 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 91 · 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 91 · 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 91 · 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 91 · 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 91 · 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 92 · 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 92 · 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 92 · 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 92 · 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 92 · 0:40](https://library.globalcastmd.com/watch/conservative-management-of-necrotizing-enterocolitis-in-newborns-incidence-and-management-of-intestinal-strictures-9738?t=40)
- "This is a retrospective study examining pediatric patients with short bowel syndrome" — Lizzie Lee (clinical) [Ep 93 · 0:10](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=10)
- "The study included 64 pediatric patients with short bowel syndrome" — Lizzie Lee (epidemiological) [Ep 93 · 0:10](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=10)
- "Patients were managed by a multidisciplinary intestinal rehab program" — Lizzie Lee (clinical) [Ep 93 · 0:10](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=10)
- "The study period was between 2001 and 2022" — Lizzie Lee (epidemiological) [Ep 93 · 0:10](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=10)
- "89% of patients survived" — Lizzie Lee (epidemiological) [Ep 93 · 0:22](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=22)
- "78% of patients were able to wean off parenteral nutrition" — Lizzie Lee (epidemiological) [Ep 93 · 0:22](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=22)
- "Survival rates improved over time" — Lizzie Lee (epidemiological) [Ep 93 · 0:22](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=22)
- "Fish oil-based parenteral nutrition was introduced in 2007" — Lizzie Lee (clinical) [Ep 93 · 0:31](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=31)
- "Introduction of fish oil-based parenteral nutrition improved survival" — Lizzie Lee (clinical) [Ep 93 · 0:31](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=31)
- "Intestinal failure associated liver disease was a factor that affected survival" — Lizzie Lee (clinical) [Ep 93 · 0:31](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=31)
- "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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 94 · 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 99 · 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 99 · 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 99 · 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 99 · 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 99 · 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 99 · 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 99 · 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 99 · 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 99 · 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 99 · 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 99 · 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 99 · 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 99 · 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 99 · 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 99 · 4:00](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=240)
- "Manometry is a catheter-based study of pressure changes within the lumen of the gut, involving visual pattern recognition of tracings to identify deviations from normal." — Ajay Hall (clinical) [Ep 44 · 1:24](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=84)
- "Colonic motility has four key components: diameter of the colon, tone, compliance of the colonic wall, and contraction pressures (how strong the contractions are), plus the length of the colon." — Ajay Hall (clinical) [Ep 44 · 1:34](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=94)
- "In megacolon, tone and compliance are usually abnormal, but colonic manometry may still show normal high-amplitude propagated contractions and transit may be normal." — Ajay Hall (clinical) [Ep 44 · 1:58](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=118)
- "There are three types of constipation: normal transit constipation, slow transit constipation (a problem with the neuromuscular integrity of the colonic wall), and outlet obstruction or withholding." — Ajay Hall (clinical) [Ep 44 · 2:35](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=155)
- "Outlet obstruction or withholding is the most common type of constipation in the pediatric population, including children with anorectal malformations." — Ajay Hall (epidemiological) [Ep 44 · 2:55](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=175)
- "In a Sitz marker study, a patient ingests radio-opaque markers and an X-ray is obtained after about 5 days; normally all markers should be evacuated, but remaining markers indicate abnormal transit." — Ajay Hall (clinical) [Ep 44 · 3:19](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=199)
- "When Sitz markers are collected in the dilated rectum at 5 days, this is indicative of outlet obstruction or withholding." — Ajay Hall (clinical) [Ep 44 · 3:48](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=228)
- "When Sitz markers are scattered all over the colon at 5 days, this is indicative of slow transit constipation." — Ajay Hall (clinical) [Ep 44 · 4:06](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=246)
- "Scintigraphy studies colonic transit by tracking the geometric center of an ingested radioisotope and can identify specific colonic locations with transit issues." — Ajay Hall (clinical) [Ep 44 · 4:15](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=255)
- "The smart pill is a large capsule that measures pH, temperature, and pressure; it is suitable for children around 10 or 12 years old and measures transit time from mouth to anus." — Ajay Hall (clinical) [Ep 44 · 4:51](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=291)
- "Colonic contractions include phasic (brief) or tonic (sustained) contractions, segmental non-propagated contractions (most common), and propagated contractions." — Ajay Hall (clinical) [Ep 44 · 6:05](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=365)
- "High-amplitude propagated contractions (HAPCs) move stool along the length of the colon and correspond to what radiologists see on contrast enema as mass movement." — Ajay Hall (clinical) [Ep 44 · 6:26](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=386)
- "The orthocolonic reflex (stimulus to colonic motility upon waking) and the gastrocolonic reflex (stimulus upon eating) affect colonic contractions." — Ajay Hall (clinical) [Ep 44 · 6:45](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=405)
- "Sennosides or bisacodyl can be used to induce high-amplitude propagated contractions." — Rod Gerardo (clinical) [Ep 44 · 6:54](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=414)
- "The majority of HAPCs originate in the proximal colon, most do not propagate beyond the midcolon, and fewer than 5% reach the rectum." — Ajay Hall (clinical) [Ep 44 · 7:05](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=425)
- "When an HAPC occurs, the internal anal sphincter should relax (choloanal reflex) to allow stool evacuation." — Rod Gerardo (clinical) [Ep 44 · 7:15](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=435)
- "Manometry catheters are typically placed during endoscopy, which allows evaluation of the colonic mucosa, though interventional radiologists can also place them under fluoroscopy." — Ajay Hall (clinical) [Ep 44 · 7:48](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=468)
- "The rectal motor complex appears as multiple small spikes on manometry tracings at the level of the rectum." — Ajay Hall (clinical) [Ep 44 · 8:33](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=513)
- "If more than 40 to 50 centimeters of colon does not have HAPCs, that segment is considered dysfunctional colon." — Ajay Hall (clinical) [Ep 44 · 10:16](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=616)
- "Management at Cincinnati Children's prioritizes maximizing medical therapy and understanding anatomic and functional issues before resorting to surgical resection." — Jason Frischer (guideline) [Ep 44 · 10:31](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=631)
- "The first step in management is to maximize stimulant laxatives to ensure evacuation; if that fails, irrigation or enemas are tried, and only then are other surgical interventions discussed." — Ajay Hall (guideline) [Ep 44 · 10:48](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=648)
- "Resection should not be performed immediately based on one abnormal finding; multiple factors must be considered." — Jason Frischer (opinion) [Ep 44 · 11:04](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=664)
- "The first step in evaluating a patient with suspected motility disorder is to ensure normal anatomy, which can be assessed with contrast studies." — Jason Frischer (guideline) [Ep 44 · 12:13](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=733)
- "In a child with gastroparesis, the stomach may appear enlarged on upper GI study." — Ajay Hall (clinical) [Ep 44 · 12:52](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=772)
- "Duodenal and colonic manometry can rule out more widespread dysmotility, which is invaluable information in a patient with an anorectal malformation." — Rod Gerardo (opinion) [Ep 44 · 14:03](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=843)
- "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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 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 37 · 57:57](https://library.globalcastmd.com/watch/hirschsprung-disease-part-i-with-marc-levitt-311?t=3477)
- "Babies that make urine are not likely to need peritoneal dialysis for a little while, but are likely to need it in the future" — Lanzo (clinical) [Ep 1 · 0:31](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=31)
- "Peritoneal dialysis catheters should be left alone for a couple of weeks if at all possible" — Lanzo (clinical) [Ep 1 · 0:49](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=49)
- "Gastrostomy tube placement is focused along the lesser curvature to preserve stomach tissue for potential bladder augmentation" — Lanzo (clinical) [Ep 1 · 0:49](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=49)
- "Hemodialysis catheters need to be fairly large caliber and are preferentially placed in the right internal jugular site because it provides a straight shot into the atrium" — Lanzo (clinical) [Ep 1 · 2:18](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=138)
- "Inguinal and umbilical hernias can develop when babies are on peritoneal dialysis" — Lanzo (clinical) [Ep 1 · 3:03](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=183)
- "Hernias are generally left alone if they are not affecting dialysis mechanics or particularly symptomatic" — Lanzo (clinical) [Ep 1 · 3:03](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=183)
- "Ideal weight for transplantation is around 10 kg if infants are not on peritoneal dialysis" — Lanzo (clinical) [Ep 1 · 4:08](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=248)
- "Infants on peritoneal dialysis have a more accommodating abdominal cavity and can be transplanted closer to 8 kg" — Lanzo (clinical) [Ep 1 · 4:08](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=248)
- "All infant recipients have been transplanted with adult donors" — Lanzo (clinical) [Ep 1 · 4:24](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=264)
- "An extraperitoneal approach is used for infant transplantation with an incision extending to the upper edge close to the costal margin" — Lanzo (clinical) [Ep 1 · 4:39](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=279)
- "The biggest complication from a general surgical perspective are wound complications rather than vascular complications" — Lanzo (clinical) [Ep 1 · 5:06](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=306)
- "Some infants can only be closed at the skin level and develop leaks or dehiscence requiring biologic mesh (derma matrix) for closure" — Lanzo (clinical) [Ep 1 · 5:15](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=315)
- "In a 13-year follow-up of G-tubes in babies, they all migrate up onto the chest" (clinical) [Ep 1 · 7:21](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=441)
- "Insufficient space between G-tube site and PD catheter site can lead to infection problems when drainage gets underneath the PD catheter dressing" — Lanzo (clinical) [Ep 1 · 7:54](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=474)
- "G-tube placement high on the stomach toward lesser curvature allows preservation of gastric tissue for potential gastric augmentation later in life" — Alonzo (clinical) [Ep 1 · 8:53](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=533)
- "Some babies will need urinary diversion with a vesicostomy placed about 1-2 finger breadths below the umbilicus" — Alonzo (clinical) [Ep 1 · 9:13](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=553)
- "PD catheters can be placed to allow immediate use with lower volumes, though waiting for healing is preferable" — Lanzo (clinical) [Ep 1 · 11:27](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=687)
- "Many babies with bladder outlet obstruction have small stomachs, possibly related to minimal amniotic fluid during development" (clinical) [Ep 1 · 11:50](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=710)
- "Amnio infusions are performed when patients present for first imaging to assess the baby's capacity to swallow and see if the stomach fills" (clinical) [Ep 1 · 12:30](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=750)
- "Infant presented with delayed passage of meconium of more than 48 hours" — Jafar (clinical) [Ep 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 18:36](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1116)
- "Breast milk provides significant benefit to time to wean off parenteral nutrition in gastroschisis and necrotizing enterocolitis patients compared to formula only" — Michael Helmrath (clinical) [Ep 8 · 59:57](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=3597)
- "Donor breast milk is less advantageous than maternal breast milk because it is typically from mothers 10-14 months postpartum with lower caloric density and protein levels" — Sam Kocoshis (clinical) [Ep 8 · 62:48](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=3768)
- "Continuous drip feeding improves absorption coefficient from 60% to 85% in adults with short bowel syndrome compared to ad lib feeding" — Sam Kocoshis (clinical) [Ep 8 · 17:44](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1064)
- "Combining daytime oral feeding with nighttime drip feeds achieves approximately 75% absorption, balancing benefits of both approaches" — Sam Kocoshis (clinical) [Ep 8 · 18:08](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1088)
- "Micronutrient deficiency occurs in approximately 60% of patients weaned off TPN" — Sam Kocoshis (epidemiological) [Ep 8 · 71:51](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=4311)
- "Patients with 50% of estimated bowel length are expected to come off parenteral nutrition" — Michael Helmrath (clinical) [Ep 8 · 28:11](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1691)
- "The one thing that makes the bowel adapt is feeding the bowel; procedures that cause problems in reinitiating feeds cause damage to the patient" — Michael Helmrath (clinical) [Ep 8 · 30:20](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1820)
- "STEP procedures done in the first year of life in patients who have not progressed with enteral feeds are not beneficial unless specifically avoiding line infections and bacterial overgrowth" — Michael Helmrath (opinion) [Ep 8 · 29:35](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1775)
- "In a neonatal STEP registry study, only 3 patients came off parenteral nutrition, whereas natural data shows 80-90% of similar patients come off TPN at 12 months without STEP" — Michael Helmrath (clinical) [Ep 8 · 31:32](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1892)
- "Dilated bowel does not become motile because you did a STEP procedure on it if the patient has never been able to advance feeds" — Michael Helmrath (clinical) [Ep 8 · 29:53](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1793)
- "Placing a balloon catheter directly into the jejunal lumen is obstructing; creating a chimney with a Roux limb allows easy family-managed tube changes" — Michael Helmrath (clinical) [Ep 8 · 4:36](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=276)
- "GJ tubes in small infants are very stiff, not durable long-term, and require families to return for radiographic exchange when displaced" — Michael Helmrath (clinical) [Ep 8 · 12:21](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=741)
- "In patients with mega duodenum and dysmotility, GJ tube tips invariably flip back into the stomach, requiring almost weekly replacement" — Sam Kocoshis (clinical) [Ep 8 · 13:16](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=796)
- "Patients with surgical jejunal feeding access have been successfully managed for 12-18 months with eventual return of gastric function" — Sam Kocoshis (clinical) [Ep 8 · 13:42](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=822)
- "Two-thirds of bloodstream infections occurred in patients on prophylactic Flagyl because it knocks out anaerobes and facilitates aerobic overgrowth" — Sam Kocoshis (clinical) [Ep 8 · 90:48](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=5448)
- "Metronidazole is the wrong choice for bacterial overgrowth because it has limited spectrum, knocks off anaerobes, and facilitates growth of aerobes" — Sam Kocoshis (opinion) [Ep 8 · 92:11](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=5531)
- "Breast milk contains non-nutrient oligosaccharides (2FL, 3FL) that affect microflora and dysbiosis, with 80% of donors having secretor status producing 2FL" — Michael Helmrath (clinical) [Ep 8 · 86:39](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=5199)
- "H2 blockers and antibiotics further dysbiosis in intestinal failure patients" — Michael Helmrath (clinical) [Ep 8 · 87:01](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=5221)
- "Elemental formulas at 20 kilocalories have osmolarity around 350-360; going higher increases osmolarity risk" — Sam Kocoshis (clinical) [Ep 8 · 64:35](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=3875)
- "In jejunum-only patients with no ileum, isotonic formulas at 15-17 calories per ounce are preferred because jejunum cannot absorb against concentration gradient" — Simon (clinical) [Ep 8 · 65:34](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=3934)
- "Patients handle volume much better than concentration when they don't have upper GI dysmotility" — Simon (clinical) [Ep 8 · 66:10](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=3970)
- "Introduction of baby foods, meats, and vegetables is remarkably helpful in the adaptation process once patients are older" — Simon (clinical) [Ep 8 · 66:18](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=3978)
- "Cholestyramine doses effective in firming stool will bind nutrients, fat-soluble vitamins, and fats, with risk of hyperchloremic acidosis and bezoars" — Sam Kocoshis (clinical) [Ep 8 · 106:00](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6360)
- "Pancreatic enzymes in distal areas of bowel, especially with stomas, can cause strictures or stoma problems when they sit in areas of stenosis and dysmotility" — Michael Helmrath (clinical) [Ep 8 · 109:07](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6547)
- "Physiologically, only pancreatic proteases are present in adult quantities in young infants; amylases appear at 6-12 months and lipase reaches adult levels by end of first year" — Sam Kocoshis (clinical) [Ep 8 · 109:38](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6578)
- "Short gut patients have very high trypsinogen levels because they lack sufficient enterokinase" — Sam Kocoshis (clinical) [Ep 8 · 110:07](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6607)
- "Pancreatic enzymes go through short gut before they've released, resulting in perianal excoriation" — Simon (clinical) [Ep 8 · 111:01](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6661)
- "GLP-2 analog reduces fecal output such that TPN can be reduced by 20% in 60-70% of adult patients, with 20% achieving complete TPN independence in extension studies" — Sam Kocoshis (clinical) [Ep 8 · 114:00](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6840)
- "Some patients regress when GLP-2 analog is discontinued" — Sam Kocoshis (clinical) [Ep 8 · 114:49](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6889)
- "Stoma output of 40-50 cc/kg is acceptable if electrolyte profile is maintained and patient is not acidotic with CO2 in the teens" — Michael Helmrath (clinical) [Ep 8 · 111:30](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6690)
- "Knee-jerk reactions to volume of output without considering overall pattern, acidosis, and electrolytes leads to variable feeding amounts over longer periods, which is detrimental" — Michael Helmrath (opinion) [Ep 8 · 112:26](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6746)
- "Stoma output is more relevant for guiding fluid and electrolyte replacement than for making decisions about stopping or decreasing feeds" — Michael Helmrath (clinical) [Ep 8 · 112:53](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6773)
- "Anti-inflammatory agents including 5-ASA products and steroid-based enemas can help manage hypermotility when inflammation is documented on endoscopy" — Michael Helmrath (clinical) [Ep 8 · 104:08](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6248)
- "In challenging Hirschsprung's patients with dysbiosis and high stool frequency not responding to antibiotics or formula changes, anti-inflammatories have been remarkably successful" — Michael Helmrath (clinical) [Ep 8 · 104:43](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6283)
- "Octreotide has not been found very useful for high output and raises concerns about growth hormone suppression in children trying to gain weight" — Simon (opinion) [Ep 8 · 102:49](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6169)
- "Proton pump inhibitors may decrease gastric secretion in patients with high gastric output" — Simon (clinical) [Ep 8 · 103:21](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6201)
- "First consideration in high output is whether the gut is being overtaxed and whether an osmotic diarrhea is occurring from pushing feeds too hard or fast" — Simon (clinical) [Ep 8 · 101:32](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6092)
- "Loperamide becomes helpful when colon is involved in managing high output" — Simon (clinical) [Ep 8 · 102:21](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6141)
- "Soluble fibers help decrease output" — Simon (clinical) [Ep 8 · 102:35](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6155)
- "Lactobacillus species from probiotics are extremely hard to clear when they infect central lines" — Simon (clinical) [Ep 8 · 100:01](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6001)
- "The frequency and incidence of abdominal wall defects appears to be increasing" (epidemiological) [Ep 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 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 39 · 50:16](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3016)
- "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 16 · 2:56](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 4:01](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 4:39](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 4:55](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=295)
- "Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia" — Daniel von Allmen (clinical) [Ep 16 · 5:10](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=310)
- "The study was powered to detect a 25% absolute treatment difference in outcomes" — Daniel von Allmen (clinical) [Ep 16 · 3:46](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 8:59](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 12:02](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 13:05](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=785)
- "No single antiseptic agent was associated with lower risk of surgical site infection than any other agent" — Whit Holcomb (clinical) [Ep 16 · 13:39](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=819)
- "Isopropyl alcohol provided no benefit: 4.5% SSI rate without alcohol versus 4.6% with alcohol" — Whit Holcomb (clinical) [Ep 16 · 13:49](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=829)
- "Registry data could not identify surgical site infections diagnosed after discharge, likely underestimating true SSI rate" — Whit Holcomb (clinical) [Ep 16 · 14:20](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=860)
- "Recent reports show 50% or more surgical site infections are diagnosed after discharge" — Whit Holcomb (epidemiological) [Ep 16 · 14:40](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=880)
- "Most surgical site infections occur 3 to 10 days after operation" — Whit Holcomb (clinical) [Ep 16 · 14:48](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=888)
- "Chlorhexidine prep dries faster than betadine, allowing cases to start sooner" — Whit Holcomb (clinical) [Ep 16 · 18:33](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 22:58](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 23:14](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 23:32](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 24:10](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 24:35](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1475)
- "Cost for initial inpatient stay was significantly lower in non-operative treatment group despite longer hospitalizations" — Whit Holcomb (clinical) [Ep 16 · 24:55](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1495)
- "Immunosuppressed cancer patients with typhlitis are sometimes treated non-operatively and most resolve with antibiotics" — Whit Holcomb (clinical) [Ep 16 · 27:00](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1620)
- "PIFCON study included 272 patients from 14 multidisciplinary intestinal rehab programs with median 33-month follow-up" — Aaron Lipskar (clinical) [Ep 16 · 32:32](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 32:40](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 32:58](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1978)
- "Residual small bowel length was a statistically significant but less impressive predictor of enteral autonomy" — Aaron Lipskar (clinical) [Ep 16 · 33:19](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1999)
- "The protective effect of necrotizing enterocolitis on enteral autonomy goes against understanding of that inflammatory illness" — Aaron Lipskar (opinion) [Ep 16 · 33:55](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 35:12](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2112)
- "FDA established SmartTots partnership with International Anesthesia Research Society in 2009 to study anesthesia-related neurotoxicity" — Aaron Lipskar (guideline) [Ep 16 · 37:19](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 37:34](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 38:09](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 38:43](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2323)
- "June 2014 SmartTots statement concluded animal data sufficiently convincing that large-scale clinical studies are warranted" — Aaron Lipskar (guideline) [Ep 16 · 39:06](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 39:14](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2354)
- "Regional anesthesia blocks can diminish amount of potentially neurotoxic medications in almost every laparoscopic, thoracoscopic, or open operation" — Aaron Lipskar (clinical) [Ep 16 · 42:00](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 42:16](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?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 16 · 43:17](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2597)
- "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 15 · 1:42](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=102)
- "The intestine of a newborn or fetus doubles in length in the last trimester of gestation" — Brad Warner (clinical) [Ep 15 · 3:03](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=183)
- "For a neonate with ileocecal valve and entire colon, 10 to 15 centimeters of small intestine would be a ballpark salvageable figure" — Brad Warner (clinical) [Ep 15 · 4:03](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=243)
- "Without the colon and ileocecal valve, at least 15 to 20 cm range would be a ballpark salvageable figure" — Brad Warner (clinical) [Ep 15 · 4:37](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=277)
- "In adult studies, adults with less than 50 centimeters of intestine, about 40% will not be alive after 5 to 10 years" — Brad Warner (epidemiological) [Ep 15 · 4:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=291)
- "Long term, 50% of kids with 15 cm intestinal length and entire colon should be able to wean from TPN, 25% would require intestinal and/or liver transplant, and 25% would probably die" — Brad Warner (epidemiological) [Ep 15 · 5:56](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=356)
- "Causes of death in short gut syndrome include liver failure, septic episodes from central line or bacterial overgrowth, variceal bleeding from liver disease, and loss of IV access" — Brad Warner (clinical) [Ep 15 · 7:11](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=431)
- "Intestinal adaptation in humans probably takes place over about a year or two" — Brad Warner (clinical) [Ep 15 · 7:49](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=469)
- "Would accept stool outputs of up to 40 ccs per kilo per day as the limit before backing off on enteral feeding" — Brad Warner (clinical) [Ep 15 · 8:30](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=510)
- "Top causes of short gut syndrome are necrotizing enterocolitis, gastroschisis, midgut volvulus, and atresias" — Brad Warner (epidemiological) [Ep 15 · 9:15](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=555)
- "For TPN, shoot for about 100 to 120 calories per kilo per day for total calories, about 50% glucose calories, with 2 to 3 g protein per kilo per day and 2 to 3 g fat per kilo per day" — Brad Warner (clinical) [Ep 15 · 10:22](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=622)
- "Want a baby to gain about 20 to 30 g a day, which approximates in utero aggression for a newborn" — Brad Warner (clinical) [Ep 15 · 12:05](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=725)
- "Lipid reduction strategy takes patients from 2 to 3 g per kilo per day of fat delivered every day down to about 1 g per kilo per day delivered twice or 3 times a week, which has been effective in reducing TPN-associated cholestasis" — Brad Warner (clinical) [Ep 15 · 12:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=773)
- "Omegaven is a fish oil-based fat primarily containing omega 3 fatty acids considered anti-inflammatory, versus intralipid which is soybean-based with omega 6 fatty acids considered pro-inflammatory" — Brad Warner (clinical) [Ep 15 · 13:46](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=826)
- "SMOF lipid contains soybean-based lipid (essential fatty acids), medium chain triglycerides (more easily digested), olive oil, and fish oil, and has become the most commonly used lipid in Canada with recent FDA approval in the United States" — Brad Warner (clinical) [Ep 15 · 15:08](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=908)
- "Breast milk is the best choice for neonates because it contains proper fat, growth factors like EGF and insulin-like growth factors that promote adaptation, and milk oligosaccharides that enhance adaptation" — Brad Warner (opinion) [Ep 15 · 18:11](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?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 (opinion) [Ep 15 · 19:26](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=1166)
- "There is a threshold percentage of enteral calories that prevents onset of liver damage from TPN, though the exact number is not known" — Brad Warner (clinical) [Ep 15 · 20:56](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=1256)
- "Would start thinking about surgical intervention if patient hits a point enterally and starts backing away, or if going backward rather than forward in enteral tolerance" — Brad Warner (opinion) [Ep 15 · 22:33](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=1353)
- "Multiple episodes of sepsis with abdominal distention and dilated bowel loops would be another reason to consider surgical intervention" — Brad Warner (clinical) [Ep 15 · 23:01](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=1381)
- "If child is starting to get jaundiced, should evaluate the gut because there could be subclinical portal bacteremia arising from dilated bowel loops" — Brad Warner (clinical) [Ep 15 · 23:18](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=1398)
- "Dilated bowel loops can cause bacterial overgrowth leading to secretory diarrhea that affects digestion and absorption capacity" — Brad Warner (clinical) [Ep 15 · 23:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=1433)
- "Would use more than 4 to 5 centimeters of bowel dilation as threshold for surgical intervention when patient is not advancing or going backward with enteral feeds" — Brad Warner (clinical) [Ep 15 · 25:43](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=1543)
- "If child has over 100 centimeters of intestine, less than 5 or 10% should require TPN, suggesting possible underlying motility or mucosal problem if still TPN-dependent" — Brad Warner (clinical) [Ep 15 · 27:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=1673)
- "With less than 50 cm intestine and bowel at least 4 to 5 cm dilated, have option of either Bianchi intestinal lengthening or STEP procedure" — Brad Warner (clinical) [Ep 15 · 28:37](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=1717)
- "The STEP procedure has emerged to be the most commonly performed lengthening operation" — Brad Warner (epidemiological) [Ep 15 · 29:31](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=1771)
- "Bianchi procedure takes advantage of bifurcating blood supply to bowel wall, creating two tubes of bowel each supplied by one arm of the V-shaped vessels" — Brad Warner (clinical) [Ep 15 · 30:00](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=1800)
- "STEP procedure cuts partially across bowel alternating from each side, creating channels that increase length of mucosal contact and reduce caliber" — Brad Warner (clinical) [Ep 15 · 31:45](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=1905)
- "STEP can redilate requiring redo procedures, and outcomes are not as good if you have to redo a STEP compared to never needing redo" — Brad Warner (clinical) [Ep 15 · 32:54](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=1974)
- "Can do a Bianchi and then go back and do a STEP on top of a Bianchi, but cannot do a Bianchi once a STEP has been done" — Brad Warner (clinical) [Ep 15 · 33:26](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2006)
- "STEP procedures can cause dysmotility and act as a brake on intestinal transit" — Brad Warner (clinical) [Ep 15 · 35:04](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2104)
- "Would taper a child with dilated bowel who had at least 90 to 100 centimeters of intestinal length" — Brad Warner (opinion) [Ep 15 · 38:21](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2301)
- "Strategies for TPN cholestasis include bile salts like chenodeoxycholic acid, changing lipid composition, and increasing enteral feeds" — Brad Warner (clinical) [Ep 15 · 39:00](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2340)
- "Cholecystokinin trial by Dan Teitelbaum to promote bile flow and mitigate TPN cholestasis did not work" — Brad Warner (clinical) [Ep 15 · 39:23](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2363)
- "Dilated bowel is a nidus for infection and encourages translocation of bacteria and endotoxin into portal circuit, damaging the liver" — Brad Warner (clinical) [Ep 15 · 39:38](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2378)
- "For bacterial overgrowth, people try oral antibiotics like Cipro and Flagyl, probiotics with lactobacilli, prebiotics, or fecal transplantation" — Brad Warner (clinical) [Ep 15 · 40:21](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2421)
- "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 15 · 41:32](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2492)
- "In mouse models, oral vancomycin to knock out gram positive organisms completely prevented hepatic steatosis after bowel resection" — Brad Warner (clinical) [Ep 15 · 42:19](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2539)
- "Mice with TLR-4 deficiency (endotoxin receptor knockout) also prevented hepatic steatosis after intestinal resection" — Brad Warner (clinical) [Ep 15 · 42:57](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2577)
- "Teduglutide, a GLP-2 analog, has been shown in randomized trials to reduce TPN requirements in adults by about 1-2 liters per week" — Brad Warner (clinical) [Ep 15 · 43:45](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2625)
- "Teduglutide is not yet approved for children in the United States, with concerns about malignancy risk from growth factor-induced proliferation" — Brad Warner (clinical) [Ep 15 · 44:29](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2669)
- "Growth hormone and glutamine combinations have shown primarily mixed results and are expensive" — Brad Warner (clinical) [Ep 15 · 45:40](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2740)
- "Survival for small bowel transplant is about 50 to 60% at 5 years, with one-year survivals above 70 to 80%" — Brad Warner (epidemiological) [Ep 15 · 46:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2811)
- "The intestine is highly immunogenic, filled with white cells and macrophages that mount a huge graft versus host response, requiring industrial strength immunosuppression" — Brad Warner (clinical) [Ep 15 · 47:11](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2831)
- "Ethanol locks for central lines have significantly reduced the number of sepsis episodes in patients with short gut syndrome" — Brad Warner (clinical) [Ep 15 · 49:22](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2962)
- "Should not go to transplant without trying everything possible to avoid it, including lengthening procedures and strategies to mitigate liver damage" — Brad Warner (opinion) [Ep 15 · 49:12](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=2952)
- "Multidisciplinary teams including pharmacists, nutritionists, surgeons, GI doctors, ID specialists, and interventional radiologists improve survival of short gut patients" — Brad Warner (clinical) [Ep 15 · 51:16](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-927?t=3076)
- "The frequency and incidence of abdominal wall defects appears to be increasing" (epidemiological) [Ep 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 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 19 · 26:46](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1606)
- "Team approach to intestinal failure reduced 1-year mortality from 30-40% to approximately 5% per year at University of Michigan" — Sam (clinical) [Ep 21 · 2:23](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=143)
- "Cincinnati's intestinal failure program was started in 1984" — Sam (clinical) [Ep 21 · 2:51](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=171)
- "Intestinal failure is defined by inadequate bowel length OR bowel that doesn't absorb nutrition and fluid adequately to maintain growth" — Monique (clinical) [Ep 21 · 3:47](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=227)
- "Almost 30% of patients leaving NICU without rotavirus vaccination were readmitted with rotavirus infection" (epidemiological) [Ep 21 · 16:56](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=1016)
- "Joint weekly rounds with surgeons, gastroenterologists, dietitians, and neonatologists help identify protocol deviations and build family rapport" — Sam (clinical) [Ep 21 · 18:11](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=1091)
- "Breast milk provides not just immunostimulatory benefits but motility effects through oligosaccharides and healing properties" (clinical) [Ep 21 · 30:13](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=1813)
- "PIFCON study data showing 25% mortality or transplant referral are now archaic; outcomes have improved dramatically in past 5 years" — Sam (opinion) [Ep 21 · 33:36](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=2016)
- "Cincinnati reduced catheter-related bloodstream infections from 12 per 1000 catheter-days to 2 per 1000, approaching <1 per 1000" (clinical) [Ep 21 · 37:31](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=2251)
- "Standardized central line bundles and multi-hospital communication networks have reduced line infections across pediatric populations" (clinical) [Ep 21 · 38:54](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=2334)
- "Intestinal failure patients have unique propensity for line infections and different infection types compared to general pediatric population" (clinical) [Ep 21 · 39:45](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=2385)
- "Toronto experience paper in JPGN examined PICC lines for TPN administration" (clinical) [Ep 21 · 41:13](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=2473)
- "Complication-free survival of PICC lines is approximately half that of broviacs according to IR literature" — Sam (clinical) [Ep 21 · 44:58](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=2698)
- "Subclavian approach for central lines carries higher risk of stenosis compared to jugular approach" — Valerie (clinical) [Ep 21 · 46:26](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=2786)
- "Lack of vascular access is no longer a common indication for intestinal transplant in past 3 years at some centers" (clinical) [Ep 21 · 50:04](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=3004)
- "Ethanol locks use 70% concentration with 2-6 hour dwell time, can be given 3 times weekly (Monday/Wednesday/Friday) with good results" — Sam (clinical) [Ep 21 · 60:20](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=3620)
- "Ethanol locks work better with 6.6 French catheters than smaller catheters; smaller PICC lines tend to occlude" — Sam (clinical) [Ep 21 · 61:04](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=3664)
- "Younger NPO infants often cannot tolerate TPN windows required for ethanol locks" — Sam (clinical) [Ep 21 · 61:28](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=3688)
- "UK predominantly uses taurolidine locks rather than ethanol locks for line infection prevention" — Girish (clinical) [Ep 21 · 63:55](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=3835)
- "Line care education is crucial; recurrent infections warrant revisiting line care practices before implementing locks" — Girish (clinical) [Ep 21 · 64:23](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=3863)
- "Fungal line infections are pulled more promptly, but some centers now treat through even fungal infections in patients with limited vascular access" (clinical) [Ep 21 · 65:32](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=3932)
- "Phytosterols in soy-based lipids are cleared poorly, share cholesterol transporter (down-regulated by endotoxemia), and reduce FXR receptor expression causing hepatocyte damage" — Sam (clinical) [Ep 21 · 68:34](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=4114)
- "Limiting lipid intake to 1 g/kg/day reduces cholestasis rate to less than 5% of patients" — Sam (clinical) [Ep 21 · 69:42](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=4182)
- "Fish oil-based lipid (Omegaven) may have anti-inflammatory advantage and benefit patients who don't respond to lipid restriction" — Sam (clinical) [Ep 21 · 70:43](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=4243)
- "Neonatologists often maintain higher lipid doses (2-3 g/kg/day) due to concern about depriving infants of linoleic acid and affecting brain development" — Sam (clinical) [Ep 21 · 71:50](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=4310)
- "With lipid restriction protocols, cholestasis rarely emerges from Cincinnati NICU" (clinical) [Ep 21 · 72:39](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=4359)
- "Standard metrics for essential fatty acid deficiency are based on malnourished children not on TPN, so altered triene:tetraene ratios may not apply the same way" (opinion) [Ep 21 · 74:14](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=4454)
- "Symptomatic essential fatty acid deficiency is not seen in practice with lipid restriction protocols" (clinical) [Ep 21 · 74:41](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=4481)
- "Higher glucose infusion rates become less efficient as caloric source and are pushed toward fatty acid and fat deposition" (clinical) [Ep 21 · 75:16](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=4516)
- "Age-based glucose infusion rate limits: generally 15-16 in premature/infants, gradually decreasing with age" (guideline) [Ep 21 · 75:41](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=4541)
- "Intestinal failure patients may not need to maintain 50th percentile growth; unclear what appropriate growth curve should be for this population" (opinion) [Ep 21 · 76:04](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=4564)
- "Neurodevelopmental outcomes in intestinal failure are multifactorial (prolonged hospitalization, recurrent admissions, neonatal insults), not solely attributable to lipid strategies" — Girish (clinical) [Ep 21 · 79:31](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=4771)
- "Babies with spontaneous intestinal perforation (no functional bowel removed) still require 2-3 months of parenteral nutrition" (clinical) [Ep 21 · 82:03](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=4923)
- "Feed absorption and ability to progress feeds are the best measures of bowel function, not absolute bowel length" — Girish (clinical) [Ep 21 · 85:29](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=5129)
- "Ability to wean TPN while maintaining good growth is the most important functional measure" (opinion) [Ep 21 · 86:18](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=5178)
- "Upper GI studies can identify problems but cannot rule them out; absence of findings does not exclude anastomotic issues" (clinical) [Ep 21 · 88:16](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=5296)
- "Delayed contrast films may reveal that barium flows into anastomosis but doesn't flow out well, suggesting functional problem" (clinical) [Ep 21 · 88:43](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=5323)
- "Some anastomoses are not strictured but kinked or twisted, creating functional rather than anatomic obstruction" (clinical) [Ep 21 · 88:43](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=5323)
- "Endoscopy is valuable for visualizing anastomosis diameter; sometimes can get scope on both sides but cannot see anastomosis itself" — Sam (clinical) [Ep 21 · 90:45](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=5445)
- "Motility abnormalities in short bowel syndrome are not well described; manometric assessment is less helpful in this population" — Sam (opinion) [Ep 21 · 94:28](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=5668)
- "Post-gastric tube feeding with gastric decompression can demonstrate distal bowel function and avoid unnecessary surgeries" (clinical) [Ep 21 · 95:24](https://library.globalcastmd.com/watch/multidisciplinary-approach-intestinal-failure-innovations-1036?t=5724)
- "Infant presented with delayed passage of meconium of more than 48 hours" — Jafar (clinical) [Ep 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 24 · 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 24 · 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 24 · 0:50](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=50)
- "Gastroschisis is more common than omphalocele" — Joyce (epidemiological) [Ep 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 24 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 33:52](https://library.globalcastmd.com/watch/nec-update-course-2013-1060?t=2032)
- "Failure of medical management is defined as appropriate treatment with no appropriate response, patient cannot take treatment, persistent symptoms or pain with treatment, or failure to grow" — Kahleb Graham (clinical) [Ep 41 · 2:51](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=171)
- "Failure of retrograde enemas is considered failure of medical management" — Kahleb Graham (clinical) [Ep 41 · 3:21](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=201)
- "Reliance on rectal therapy or retrograde enemas with continued soiling causing significant effect on functioning is considered failure of medical management" — Anil Darbari (clinical) [Ep 41 · 3:35](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=215)
- "General pediatricians typically prescribe osmotic laxatives like MiraLax or lactulose and stimulant laxatives such as Senna or bisacodyl, but there are other medications that pediatricians are not used to prescribing that GI doctors are" — Anil Darbari (clinical) [Ep 41 · 3:57](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=237)
- "Some children stool every day but do not completely evacuate" — Rod (clinical) [Ep 41 · 4:58](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=298)
- "Initial evaluation includes history of triggers, stooling frequency, timing, and sensation of complete emptying, plus physical exam looking for palpable stool and distension, rectal exam, and diagnostic imaging" — Anil Darbari (clinical) [Ep 41 · 4:46](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=286)
- "In patients with long-standing constipation where appropriate treatments have been tried and failed, the first step in management is diagnostic studies including contrast enema" — Kahleb Graham (clinical) [Ep 41 · 5:27](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=327)
- "Contrast enema is used to assess degree of colonic dilatation and redundancy and to ensure the ratio is normal" — Kahleb Graham (clinical) [Ep 41 · 5:56](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=356)
- "There are probably many people with redundant colons that stool perfectly normally without imaging documentation" — Jason Frischer (opinion) [Ep 41 · 6:53](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=413)
- "It is unclear whether colonic dilation and redundancy precedes constipation or results from outlet obstruction" — Rod (clinical) [Ep 41 · 6:59](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=419)
- "Contrast study is not a great predictor of how patients will respond to medical or surgical management" — Rod (clinical) [Ep 41 · 7:12](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=432)
- "Crazy looking colons can respond really nicely to treatment, and colons that look totally normal on contrast study may not respond at all to treatment" — Rod (clinical) [Ep 41 · 7:19](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=439)
- "Colons used to be resected based on appearance, but patients with motility disorders did not need resection" — Marc Levitt (clinical) [Ep 41 · 7:36](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=456)
- "Many dilated colons will respond to treatment" — Marc Levitt (clinical) [Ep 41 · 7:54](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=474)
- "Water-soluble contrast is used instead of barium because it helps empty the colon and acts as a cleanout for patients starting new medical therapy" — Jason Frischer (clinical) [Ep 41 · 8:06](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=486)
- "Reviewing diagnostic imaging with the family helps them understand anatomy and issues and builds rapport" — Rod (clinical) [Ep 41 · 8:37](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=517)
- "The rectoanal inhibitory reflex (RAIR) is when the rectum becomes distended with stool and the internal anal sphincter relaxes" — Rod (clinical) [Ep 41 · 9:11](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=551)
- "Anorectal manometry uses a catheter with sensors measuring pressure and a balloon to assess anal sphincter function and its relationship to the rectum" — Anil Darbari (clinical) [Ep 41 · 9:35](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=575)
- "High pressures on anorectal manometry may suggest underlying inability to relax causing functional obstruction" — Anil Darbari (clinical) [Ep 41 · 10:00](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=600)
- "Patients with Hirschsprung disease have an absent rectoanal inhibitory reflex (RAIR)" — Anil Darbari (clinical) [Ep 41 · 10:09](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=609)
- "Anorectal manometry provides information about defecation dynamics by having patients bear down, squeeze, and attempt to defecate while comparing sensation to defecate versus internal anal sphincter response" — Anil Darbari (clinical) [Ep 41 · 10:19](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=619)
- "Anorectal manometry is a functional test that provides baseline and functional information" — Anil Darbari (clinical) [Ep 41 · 10:36](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=636)
- "In the past, the sphincter and its major role in constipation patients was not well understood" — Jason Frischer (clinical) [Ep 41 · 10:51](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=651)
- "Anorectal manometry is critical for determining whether a patient needs surgery or resection, because patients with motility disorders do not need resection" — Rod (clinical) [Ep 41 · 12:03](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=723)
- "Water-soluble contrast enema showed a tortuous and redundant colon that was dilated and full of stool" (clinical) [Ep 42 · 0:53](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=53)
- "Anorectal manometry showed an absent rectoanal inhibitory reflex (RAIR)" — Rogerardo (clinical) [Ep 42 · 1:03](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=63)
- "The patient is showing massively dilated colon as a result of colonic dysfunction, although the dilatation is predominantly in the rectal sigmoid" — Anil Darbari (clinical) [Ep 42 · 2:04](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=124)
- "High resting pressure on manometry might indicate a patient amenable to anal Botox" — Kahleb Graham (clinical) [Ep 42 · 2:35](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=155)
- "Dyssynergia is when patients push from their belly but create a negative pressure at the bottom instead of relaxing the sphincter" — Kahleb Graham (clinical) [Ep 42 · 3:02](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=182)
- "Patients with dyssynergia might benefit from pelvic floor physical therapy or biofeedback" — Kahleb Graham (clinical) [Ep 42 · 3:15](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=195)
- "Sitz marker study is performed by taking markers and obtaining an X-ray at day 5" — Kahleb Graham (clinical) [Ep 42 · 3:39](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=219)
- "If Sitz markers are scattered throughout the colon or predominantly on the right side, it suggests colonic dysmotility and may warrant colonic manometry" — Kahleb Graham (clinical) [Ep 42 · 3:48](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=228)
- "If all markers are sitting at the bottom of the colon, it fits more with an outlet issue" — Rogerardo (clinical) [Ep 42 · 4:07](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=247)
- "If all markers have disappeared on day 5 X-ray, the patient did stool even if they reported not stooling" — Kahleb Graham (clinical) [Ep 42 · 4:13](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=253)
- "Sitz markers do not dissolve" — Kahleb Graham (clinical) [Ep 42 · 4:22](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=262)
- "Colonic manometry is not available everywhere, but Sitz marker study should be available pretty much anywhere" — Marc Levitt (epidemiological) [Ep 42 · 4:38](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=278)
- "Sitz marker study can be used as a colonic transit study by obtaining X-rays at day 0, 1, 2, and 4 to see transit of markers" — Anil Darbari (clinical) [Ep 42 · 4:51](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=291)
- "Sitz marker study is not a replacement for colonic manometry" — Amanda Jensen (opinion) [Ep 42 · 5:17](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=317)
- "Nuclear scintigraphy is available in most centers that have nuclear medicine capacity" — Marc Levitt (epidemiological) [Ep 42 · 5:32](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=332)
- "Three colonic motility scenarios: diffusely slow but functional, normal motility with segmental obstruction, and entire colon severely slow and amodal" — Marc Levitt (clinical) [Ep 42 · 5:40](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=340)
- "Anorectal manometry is the gold standard but is a sophisticated, expensive test not available everywhere" — Rogerardo (opinion) [Ep 42 · 6:40](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=400)
- "Colonic manometry provides information on peristaltic activity, which is the motion of the colon" — Anil Darbari (clinical) [Ep 42 · 7:07](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=427)
- "Throughout the day, you should have two really strong contractions throughout your colon called high amplitude propagating contractions (HAPCs)" — Rogerardo (clinical) [Ep 42 · 7:21](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=441)
- "HAPCs start on the right side of the colon in the cecum area and progress distally" — Anil Darbari (clinical) [Ep 42 · 7:32](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=452)
- "If a patient has two HAPCs during an 18 or 24 hour study period, they do not have colonic dysmotility" — Rogerardo (clinical) [Ep 42 · 7:45](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=465)
- "Many patients get colonic manometry but the results come back normal" — Jason Frischer (epidemiological) [Ep 42 · 8:02](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=482)
- "No one normal or typical gets a colonic motility test" — Marc Levitt (opinion) [Ep 42 · 8:10](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=490)
- "If the colon moves uniformly with HAPCs throughout, antegrade flush will work well and reliably" — Marc Levitt (clinical) [Ep 42 · 8:22](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=502)
- "Some patients have a truly outlet issue and their colon is actually normal on manometry" — Kahleb Graham (clinical) [Ep 42 · 8:38](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=518)
- "Manometry can characterize if contractions are well coordinated (neuropathic problem) or low amplitude (myopathic problem)" — Kahleb Graham (clinical) [Ep 42 · 8:47](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=527)
- "Contractions should go from the right side of the colon all the way down to the rectum, but the rectum does not have those same contractions" — Kahleb Graham (clinical) [Ep 42 · 9:03](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=543)
- "In Hirschsprung's patients post pull-through, the rectal sigmoid brake is removed and contractions may go all the way to the sphincters" — Kahleb Graham (clinical) [Ep 42 · 9:12](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=552)
- "If there is no response to stimulants on colonic manometry, the patient does not have normal colonic motility by definition" — Anil Darbari (clinical) [Ep 42 · 9:36](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=576)
- "The case was concluded to not be Hirschsprung's disease; the absent RAIR was a sampling error" — Marc Levitt (clinical) [Ep 42 · 10:11](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=611)
- "The surgeon did not re-biopsy because of calretinin positivity" — Marc Levitt (clinical) [Ep 42 · 10:20](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=620)
- "Anorectal manometry showed the colon was diffusely slow and the problem was the sphincter due to absent RAIR" — Rogerardo (clinical) [Ep 42 · 10:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=626)
- "The patient was offered a Malone for antegrade flushes in combination with Botox and biofeedback physiotherapy" — Rogerardo (clinical) [Ep 42 · 10:38](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=638)
- "Over time, the colon could probably rehab and the patient may eventually need just laxatives alone" — Rogerardo (opinion) [Ep 42 · 10:50](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=650)
- "A perfectly good endpoint is to have a mechanically emptying colon, not necessarily weaning to laxatives alone" — Marc Levitt (opinion) [Ep 42 · 11:00](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=660)
- "Enemas from below or from above (through a Malone or cecostomy) are acceptable long-term management; resection is reserved for failures of conservative therapy" — Marc Levitt (opinion) [Ep 42 · 11:11](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=671)
- "Patients who fail conservative management are those with slow transit throughout or segmental disease" — Rogerardo (clinical) [Ep 42 · 11:24](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=684)
- "The vast majority of patients with segmental disease respond to antegrade enema only and never need resection" — Marc Levitt (clinical) [Ep 42 · 11:32](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=692)
- "A collaborative model between surgery and gastroenterology should be promoted in every center providing colorectal care" — Anil Darbari (opinion) [Ep 42 · 12:17](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=737)
- "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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 45 · 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 51 · 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 51 · 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 51 · 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 51 · 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 51 · 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 51 · 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 51 · 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 51 · 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 51 · 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 51 · 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 51 · 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 51 · 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 51 · 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 51 · 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 51 · 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 51 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 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 56 · 20:49](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1249)
- "Infants with intestinal failure have compromised intestinal function, putting them at increased risk of malabsorption and electrolyte and fluid deficits" — Sarah Choi (clinical) [Ep 58 · 0:36](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=36)
- "Sodium depletion can go unrecognized, resulting in poor growth refractory to increased caloric intake" — Sarah Choi (clinical) [Ep 58 · 0:45](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=45)
- "Sodium supplementation has been shown to be associated with weight gain and overall growth in infants with intestinal failure" — Sarah Choi (clinical) [Ep 58 · 1:00](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=60)
- "Serum sodium does not reflect total sodium stores" — Sarah Choi (clinical) [Ep 58 · 1:04](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=64)
- "Fractional excretion of sodium is the optimum measure of total body sodium but is inconvenient in the pediatric population as it requires a paired urine and blood sample" — Sarah Choi (clinical) [Ep 58 · 1:14](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=74)
- "At BC Women's Hospital, urine sodium is used as a non-invasive marker to estimate total body sodium in infants with intestinal failure, with a value above 30 suggesting sodium sufficiency" — Sarah Choi (guideline) [Ep 58 · 1:29](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=89)
- "Urine sodium doesn't account for volume status, therefore can result in oversupplementation or under supplementation with sodium" — Sarah Choi (clinical) [Ep 58 · 1:44](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=104)
- "The urine sodium to urine creatinine ratio offers a non-invasive measure which accounts for variable urine flow and has shown to be strongly correlated with fractional excretion of sodium" — Sarah Choi (clinical) [Ep 58 · 1:57](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=117)
- "The use of the urine sodium to creatinine ratio has not yet been validated in the intestinal failure population" — Sarah Choi (clinical) [Ep 58 · 2:13](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=133)
- "The study included 22 infants with median gestational age of 31 weeks, median birth weight of 1.9 kg, and median age of enrollment at 8 days" — Sarah Choi (epidemiological) [Ep 58 · 3:18](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=198)
- "Gastroschisis was the most common etiology of intestinal failure in the study cohort" — Sarah Choi (epidemiological) [Ep 58 · 3:30](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=210)
- "There was no significant correlation between either urine sodium or the ratio with daily weight gain when evaluating the entire data set" — Sarah Choi (clinical) [Ep 58 · 3:41](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=221)
- "The ratio was more strongly associated with sodium intake when compared to urine sodium alone" — Sarah Choi (clinical) [Ep 58 · 4:04](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=244)
- "Urine sodium values above 29 and ratio values above 35 best predicted adequate weight gain" — Sarah Choi (clinical) [Ep 58 · 4:18](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=258)
- "It is generally accepted that urine sodium values above 30 is suggestive of sodium sufficiency" — Sarah Choi (guideline) [Ep 58 · 4:28](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=268)
- "In 19% of the time, urine sodium and ratio values were discordant" — Sarah Choi (clinical) [Ep 58 · 4:54](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=294)
- "Urine sodium to creatinine ratio significantly correlated with sodium intake" — Sarah Choi (clinical) [Ep 58 · 5:10](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=310)
- "Urine sodium to creatinine values above 35 best predicted adequate weight gain, therefore suggesting sufficient sodium stores" — Sarah Choi (clinical) [Ep 58 · 5:21](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=321)
- "Patients with stomas, even those without intestinal failure, run the risk of sodium depletion which has a significant impact on their growth" — Paul Wales (clinical) [Ep 58 · 6:08](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=368)
- "Stomas and high stool losses are a large source of sodium bicarb as well as magnesium loss" — Paul Wales (clinical) [Ep 58 · 6:19](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=379)
- "When we replace sodium, it does help restore growth, but it doesn't allow catch up growth" — Paul Wales (clinical) [Ep 58 · 6:38](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=398)
- "If potassium level is higher than sodium level in urine, that often will tell you that the aldosterone pathway is turned on" — Paul Wales (clinical) [Ep 58 · 7:41](https://library.globalcastmd.com/watch/caps-the-use-of-urine-sodium-to-creatinine-ratio-as-a-marker-of-total-body-sodium-in-infants-with-intestinal-failure-sara-choi-5432?t=461)
- "Gastric volvulus is associated with CDH about 17% of the time" — Rod Gerardo (epidemiological) [Ep 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 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 59 · 10:20](https://library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=620)
- "An estimated 5 million central venous catheter lines are placed in the United States annually, with several in pediatric surgical patients" — Rod (epidemiological) [Ep 63 · 0:13](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=13)
- "Cincinnati Children's Hospital handles the bulk of complex vascular access and all catheter-based access for dialysis" — Alex Bondoc (clinical) [Ep 63 · 0:26](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=26)
- "Central venous catheters are not tunneled and typically for temporary hospital use with 1 to 3 lumens" — Rod (clinical) [Ep 63 · 1:00](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=60)
- "Ports are for long-term access on the order of months to years, with tunneled catheters and totally implantable reservoirs, often used for chemotherapy" (clinical) [Ep 63 · 1:10](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=70)
- "Broviac catheters are tunneled lines with cuffs used for months to years for chemotherapy, parenteral nutrition, and frequent blood transfusions" — Rod (clinical) [Ep 63 · 1:25](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=85)
- "Hemodialysis or pheresis catheters can be temporary if uncuffed or permanent if cuffed" (clinical) [Ep 63 · 1:40](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=100)
- "Chest and neck central venous access is preferred from a purely logistical standpoint" — Alex Bondoc (opinion) [Ep 63 · 2:09](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=129)
- "There is fair evidence suggesting an increased rate of complications and infection with femoral access" (clinical) [Ep 63 · 2:17](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=137)
- "Indications for central access include need for total parenteral nutrition, resuscitation, or hemodialysis" (clinical) [Ep 63 · 2:29](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=149)
- "Contraindications for central access include thrombosis, collateralization, and central stenosis of the SVC" — Alex Bondoc (clinical) [Ep 63 · 2:39](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=159)
- "Routine ultrasound is not necessary unless the patient has a congenital anomaly, usually cardiovascular" — Alex Bondoc (opinion) [Ep 63 · 3:09](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=189)
- "For patients with multiple prior lines, Doppler venous ultrasound of the jugulars is the preferred first screening test" — Alex Bondoc (clinical) [Ep 63 · 3:20](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=200)
- "Imaging may escalate to contrast-enhanced MR or CT venogram, and sometimes intraoperative venography with fluoroscopy" — Alex Bondoc (clinical) [Ep 63 · 3:37](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=217)
- "Positioning over a vertically oriented shoulder roll is the most versatile approach for neonates and infants" — Alex Bondoc (clinical) [Ep 63 · 4:02](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=242)
- "A vertical shoulder roll provides hyperextension of the neck and allows shoulders to drop posteriorly, giving access to bilateral subclavians and jugulars" — Alex Bondoc (clinical) [Ep 63 · 4:12](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=252)
- "For really small babies, many surgeons prefer a cut-down approach" — Rod (opinion) [Ep 63 · 4:43](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=283)
- "A micropuncture kit with a 21 gauge finder needle is preferred over the 18 gauge needle in standard kits for small neonates" — Alex Bondoc (clinical) [Ep 63 · 4:55](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=295)
- "Using ultrasound for internal jugular central line placement is the number one preferred method, with lowest risk of pneumothorax and carotid injury" — Alex Bondoc (clinical) [Ep 63 · 5:25](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=325)
- "For large bore access like dialysis catheters, sticking the patient as low as possible on the neck is recommended" — Alex Bondoc (opinion) [Ep 63 · 5:52](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=352)
- "Levering the ultrasound probe (12mm diameter) against the clavicle provides a reasonable low puncture site" — Alex Bondoc (clinical) [Ep 63 · 6:00](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=360)
- "Sticking low on the neck leaves less catheter to curve in the neck, reducing problems with catheter displacement when patients turn their heads" — Alex Bondoc (opinion) [Ep 63 · 6:22](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=382)
- "Catheters have been observed to spit out of the SVC with excessive laxity in the neck" — Alex Bondoc (clinical) [Ep 63 · 6:36](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=396)
- "Subclavian line placement is more anatomic and considered when IJ access is lost or patient is in cervical collar" (clinical) [Ep 63 · 6:42](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=402)
- "For subclavian access, puncture at least 1 finger breadth (almost 1cm) inferior and lateral to the junction of median and medial aspects of the clavicle" — Alex Bondoc (clinical) [Ep 63 · 6:56](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=416)
- "When approaching the clavicle during subclavian access, keep the needle flat and push down on skin rather than angling at 30 degrees" — Alex Bondoc (clinical) [Ep 63 · 7:14](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=434)
- "For subclavian access, aim directly at the sternal notch, then angle wider toward the angle of mandible in a radial motion if unsuccessful" — Alex Bondoc (clinical) [Ep 63 · 7:34](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=454)
- "The catheter tip should be positioned at the junction between the right atrium and superior vena cava" (clinical) [Ep 63 · 7:46](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=466)
- "The right triangle technique uses the trachea as midline and the right mainstem bronchus as hypotenuse; catheter tip in this triangle will always be at the atrial-caval junction" — Alex Bondoc (clinical) [Ep 63 · 8:04](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=484)
- "Routine post-procedural X-rays are not ordered for single-stick, uncomplicated procedures using fluoroscopy" — Alex Bondoc (opinion) [Ep 63 · 8:38](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=518)
- "The practice of not routinely ordering X-rays is based on data from Children's Mercy Hospital Kansas City" — Rod (clinical) [Ep 63 · 8:45](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=525)
- "Post-procedural complications include pneumothorax, hemothorax, arterial injury (subclavian or carotid), and rarely chylothorax or thoracic duct injury" — Alex Bondoc (clinical) [Ep 63 · 9:06](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=546)
- "Long-term complications include thrombosis, catheter displacement, kinking, and eventual line degradation" — Rod (clinical) [Ep 63 · 9:21](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=561)
- "The first clinical decision for line infection is determining if the patient is septic from the line" — Alex Bondoc (clinical) [Ep 63 · 9:41](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=581)
- "If the patient is septic from the line, source control requires bedside removal under light sedation" — Alex Bondoc (clinical) [Ep 63 · 9:46](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=586)
- "For non-septic line-dependent patients with complex vascular access, treatment involves identifying the organism, assessing sensitivity, and performing serial blood cultures to achieve sustained culture negativity for line salvage" — Alex Bondoc (clinical) [Ep 63 · 10:04](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=604)
- "Antibiotic locking solutions have been around for a long time but predominantly develop resistance" — Paul Wales (clinical) [Ep 63 · 10:35](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=635)
- "Ethanol locks are antimicrobial without resistance and kill both planktonic bacteria (floating in lumen) and sessile bacteria (embedded in biofilm)" — Paul Wales (clinical) [Ep 63 · 10:56](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=656)
- "The price of ethanol in locking solutions skyrocketed, prompting search for alternatives" — Rod (clinical) [Ep 63 · 11:12](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=672)
- "Kite lock is a 4% tetrasodium EDTA chemical found in Canada" — Paul Wales (clinical) [Ep 63 · 11:24](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=684)
- "Kite lock is antimicrobial without resistance, antifibrinolytic, and antithrombotic" — Paul Wales (clinical) [Ep 63 · 11:36](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=696)
- "Kite lock has been licensed in Canada for pediatric use, and is now licensed in Europe and Australia" — Paul Wales (clinical) [Ep 63 · 11:59](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=719)
- "Translumbar line placement through back musculature into intrahepatic IVC is considered when femoral, IJ, and subclavian options are exhausted" — Alex Bondoc (clinical) [Ep 63 · 12:19](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=739)
- "Emergency facial vein cutdown involves horizontal incision lateral to sternocleidomastoid at angle of mandible with the head turned" — Alex Bondoc (clinical) [Ep 63 · 12:48](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=768)
- "For facial vein cutdown, beveling the catheter hard helps it follow a path when blindly passing without a wire" — Alex Bondoc (clinical) [Ep 63 · 13:04](https://library.globalcastmd.com/watch/pediatric-vascular-access-in-brief-preoperative-operative-and-postoperative-considerations-5870?t=784)
- "The Midwest Pediatric Surgery Research Consortium was established by departments of Pediatric Surgery from 11 children's hospitals" — Ellen Incisco and M. Tom Bash (epidemiological) [Ep 65 · 2:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=135)
- "Non-accidental trauma rates initially dropped during stay-at-home orders but subsequently increased above expected levels" — Nicole Chandler (epidemiological) [Ep 65 · 4:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=256)
- "Patients disproportionately affected by increased non-accidental trauma were older children (>5 years), minority children, and lower socioeconomic groups as determined by social vulnerability index" — Nicole Chandler (epidemiological) [Ep 65 · 4:31](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=271)
- "CDC Social Vulnerability Index was created to assess neighborhood vulnerability during times of crises" — Ellen Incisco and M. Tom Bash (guideline) [Ep 65 · 5:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=312)
- "During public health crises, it is important to maintain systems of protection for children who lose normal protections from school" — Nicole Chandler (opinion) [Ep 65 · 5:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=337)
- "Trauma registry data and ICD-10 codes have limitations that require caution in drawing strong conclusions" — Ellen Incisco and M. Tom Bash (clinical) [Ep 65 · 5:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=356)
- "Very few cell lines are available to study hepatoblastoma, and some cell lines labeled as hepatoblastoma are actually hepatocellular carcinoma" — Ellen Incisco and M. Tom Bash (clinical) [Ep 65 · 6:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=407)
- "Management of metastatic hepatoblastoma continues to pose significant treatment challenges" — Nicole Chandler (clinical) [Ep 65 · 7:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=433)
- "The new metastatic hepatoblastoma cell line was created by serial passage through mouse lungs, harvesting lung tissue, culturing surviving cells, and repeating the process" — Ellen Incisco and M. Tom Bash (clinical) [Ep 65 · 7:24](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=444)
- "The new hepatoblastoma cell line exhibited increased tumorigenicity, invasiveness, and increased resistance to chemotherapy compared to the original human cell line" — Nicole Chandler (clinical) [Ep 65 · 8:14](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=494)
- "PSORC (Pediatric Surgical Oncology Research Collaborative) is a multi-institutional consortium of North American pediatric surgeons focused on advancing care of children with cancer" — Marcus Malik (clinical) [Ep 65 · 9:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=586)
- "There has been no consistency in localization techniques for small pulmonary nodules across institutions" — Marcus Malik (clinical) [Ep 65 · 10:19](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=619)
- "The most common localization techniques for pulmonary nodules are wire and methylene blue dye, followed by methylene blue dye only" — Nicole Chandler (clinical) [Ep 65 · 10:49](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=649)
- "There was no difference in successful IR localization or successful resection of pulmonary nodules between different localization techniques" — Nicole Chandler (clinical) [Ep 65 · 10:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=656)
- "Time under anesthesia for nodule localization can be long and variable depending on institutional setup (hybrid OR vs separate IR suite)" — Marcus Malik (clinical) [Ep 65 · 11:10](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=670)
- "Experience is probably more important than the actual localization technique itself, given all techniques were wildly successful" — Nicole Chandler (opinion) [Ep 65 · 12:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=726)
- "Pediatric intestinal failure was defined as requirement of parenteral nutrition for 60 days or more at any time before 8 years of age" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 65 · 12:52](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=772)
- "Puberty is at least partially dependent on having good nutritional stores based on hormonal drivers" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 65 · 13:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=818)
- "The hypothesis was that chronic pediatric intestinal failure would delay puberty and potentially dull the sharp spike of peak height velocity" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 65 · 13:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=825)
- "Peak height velocity occurred at significantly younger ages for both males and females with intestinal failure" — Nicole Chandler (clinical) [Ep 65 · 14:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=840)
- "Puberty onset occurred significantly earlier compared to established norms for males with intestinal failure, reaching pubertal onset earlier than the CDC 50th percentile" — Nicole Chandler (clinical) [Ep 65 · 14:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=840)
- "There is a high incidence of short stature in chronic intestinal failure" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 65 · 14:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=877)
- "The finding that short stature is not due to missing pubertal timing suggests the need to do a better job at setting up intestinal failure patients for puberty by working on their height and linear growth beforehand" — Todd Ponsky and Dr. Biran Modi (opinion) [Ep 65 · 14:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=877)
- "The Midwest Pediatric Surgery Research Consortium was established by departments of Pediatric Surgery from 11 children's hospitals" — Ellen Incisco and M. Tom Bash (clinical) [Ep 64 · 2:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=135)
- "The study used historical patterns of NAT captured by trauma registries to predict what the volume should have been during the initial COVID time period and compared that to observed rates" — Ellen Incisco and M. Tom Bash (clinical) [Ep 64 · 3:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=222)
- "NAT rates initially dropped slightly but then increased above expected levels during stay-at-home orders" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 64 · 4:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=247)
- "Patients disproportionately affected were older children over 5 years who would commonly be in school, minority children, and lower socioeconomic groups as determined by social vulnerability index" — Nicole Chandler (epidemiological) [Ep 64 · 4:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=267)
- "The CDC Social Vulnerability Index was created to assess a neighborhood's vulnerability during times of crises" — Ellen Incisco and M. Tom Bash (clinical) [Ep 64 · 5:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=312)
- "During public health crises, it is important to maintain systems of protection for children, particularly when they are not afforded normal protections from school" — Nicole Chandler (opinion) [Ep 64 · 5:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=337)
- "One must be careful not to make too strong conclusions based on trauma registry data and ICD-10 codes, regardless of the number of institutions or evaluation period length" — Ellen Incisco and M. Tom Bash (opinion) [Ep 64 · 6:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=367)
- "Very few cell lines are available to study hepatoblastoma, and some cell lines touted as hepatoblastoma are actually hepatocellular carcinoma" — Ellen Incisco and M. Tom Bash (clinical) [Ep 64 · 6:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=407)
- "Management of metastatic hepatoblastoma continues to pose significant treatment challenges" — Nicole Chandler (clinical) [Ep 64 · 7:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=433)
- "The new metastatic hepatoblastoma cell line was created by labeling cells with luciferase, injecting them into mouse tail veins where they preferentially metastasized to lungs, harvesting and culturing surviving cells, and repeating the process until establishing a reliable metastatic cell line" — Ellen Incisco and M. Tom Bash (clinical) [Ep 64 · 7:24](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=444)
- "The new cell line exhibited increased tumorigenicity, invasiveness, and increased resistance to chemotherapy compared to the original human cell line" — Nicole Chandler (clinical) [Ep 64 · 8:14](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=494)
- "There was no hepatoblastoma cell line mouse model available before this study" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 64 · 8:29](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=509)
- "PSORC is the Pediatric Surgical Oncology Research Collaborative, a multi-institutional consortium of North American pediatric surgeons focused on advancing care of children with cancer" — Marcus Malik (clinical) [Ep 64 · 9:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=586)
- "PSORC was founded to amalgamate data from multiple institutions to better study surgical questions in pediatric cancer" — Marcus Malik (clinical) [Ep 64 · 10:05](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=605)
- "There has not been consistency in localization techniques for small pulmonary nodules across North American institutions" — Marcus Malik (clinical) [Ep 64 · 10:19](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=619)
- "The most common localization techniques were wire and methylene blue dye, followed by methylene blue dye only" — Nicole Chandler (clinical) [Ep 64 · 10:49](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=649)
- "There was no difference in successful IR localization or successful resection of pulmonary nodules between different localization techniques" — Nicole Chandler (clinical) [Ep 64 · 10:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=656)
- "Time under anesthesia for localization procedures can be long and variable depending on institutional setup, with some using hybrid ORs for immediate transition from localization to operation" — Marcus Malik (clinical) [Ep 64 · 11:10](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=670)
- "Experience is probably more important than the actual localization technique itself, given that all techniques were wildly successful despite significant variation" — Nicole Chandler (opinion) [Ep 64 · 12:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=726)
- "Pediatric intestinal failure was defined as requirement of parenteral nutrition for 60 days or more at any time, with diagnosis before 8 years of age" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 64 · 12:52](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=772)
- "Puberty is at least partially dependent on having good nutritional stores based on hormonal drivers of puberty" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 64 · 13:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=818)
- "The hypothesis was that chronic pediatric intestinal failure would delay puberty and potentially dull the sharp spike of peak height velocity" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 64 · 13:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=825)
- "Peak height velocity occurred at significantly younger ages for both males and females with intestinal failure" — Nicole Chandler (clinical) [Ep 64 · 14:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=840)
- "Puberty onset occurred significantly earlier compared to established norms for males, reaching pubertal onset earlier than the CDC 50th percentile" — Nicole Chandler (clinical) [Ep 64 · 14:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=840)
- "There is a high incidence of short stature in chronic intestinal failure" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 64 · 14:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=877)
- "The finding that short stature is not due to missing pubertal timing or peak height velocity suggests the need to better optimize height and linear growth before puberty" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 64 · 14:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=877)
- "Children reliant on TPN and their families may face challenges when traveling abroad" (clinical) [Ep 81 · 0:21](https://library.globalcastmd.com/watch/reliance-on-total-parenteral-nutrition-and-travelling-abroad-7804?t=21)
- "Medication and appropriate medical supplies must accompany the child on their travels" (guideline) [Ep 81 · 0:30](https://library.globalcastmd.com/watch/reliance-on-total-parenteral-nutrition-and-travelling-abroad-7804?t=30)
- "Parents and families may have concerns about not having access to specialist emergency care for their child whilst abroad" (clinical) [Ep 81 · 0:37](https://library.globalcastmd.com/watch/reliance-on-total-parenteral-nutrition-and-travelling-abroad-7804?t=37)
- "ERNICA has developed an online map tool to identify specialist centers across Europe that are able to administer TPN and meet particular criteria" (clinical) [Ep 81 · 0:46](https://library.globalcastmd.com/watch/reliance-on-total-parenteral-nutrition-and-travelling-abroad-7804?t=46)
- "The map tool can be accessed from the publicly available ERNICA website" (clinical) [Ep 81 · 0:58](https://library.globalcastmd.com/watch/reliance-on-total-parenteral-nutrition-and-travelling-abroad-7804?t=58)
- "Users can search for specialist centers per country and access detailed information on each center" (clinical) [Ep 81 · 1:04](https://library.globalcastmd.com/watch/reliance-on-total-parenteral-nutrition-and-travelling-abroad-7804?t=64)
- "A holiday checklist document is available for download on the ERNICA website" (clinical) [Ep 81 · 1:11](https://library.globalcastmd.com/watch/reliance-on-total-parenteral-nutrition-and-travelling-abroad-7804?t=71)
- "Templates are available for local healthcare providers to provide a written record of the child's medical history and clinical precautions" (clinical) [Ep 81 · 1:18](https://library.globalcastmd.com/watch/reliance-on-total-parenteral-nutrition-and-travelling-abroad-7804?t=78)
- "Medical documentation templates can accompany families on trips abroad in case emergency care is required" (guideline) [Ep 81 · 1:28](https://library.globalcastmd.com/watch/reliance-on-total-parenteral-nutrition-and-travelling-abroad-7804?t=88)
- "The front of a baby's belly does not form properly during early pregnancy in gastroschisis" (clinical) [Ep 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 82 · 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 95 · 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 95 · 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 95 · 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 95 · 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 95 · 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 95 · 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 95 · 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 95 · 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 95 · 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 96 · 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 96 · 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 96 · 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 96 · 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 96 · 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 96 · 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 96 · 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 97 · 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 97 · 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 97 · 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 97 · 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 97 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 98 · 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 103 · 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 103 · 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 103 · 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 103 · 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 103 · 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 103 · 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 103 · 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 103 · 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 103 · 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 103 · 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 103 · 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 103 · 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 103 · 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 103 · 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 103 · 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 103 · 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 103 · 7:58](https://library.globalcastmd.com/watch/malrotation-and-volvulus-with-trinity-11941?t=478)
- "The infant presented with repetitive bilious vomiting" (clinical) [Ep 102 · 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 102 · 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 102 · 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 102 · 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 102 · 0:36](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=36)
- "A very dilated proximal duodenum was visualized under the liver" (clinical) [Ep 102 · 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 102 · 1:00](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=60)
- "The first portion of the duodenum is extremely dilated" (clinical) [Ep 102 · 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 102 · 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 102 · 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 102 · 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 102 · 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 102 · 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 102 · 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 102 · 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 102 · 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 102 · 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 102 · 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 102 · 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 102 · 5:19](https://library.globalcastmd.com/watch/malrotation-infant-11940?t=319)
- "The duodenum was seen doubling back on itself" (clinical) [Ep 102 · 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 102 · 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 102 · 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 102 · 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 102 · 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 102 · 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 102 · 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 102 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 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 35 · 43:17](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2597)
- "The three major causes of LUTO are urethral atresia (complete obstruction with no communication from bladder neck through urethra), posterior urethral valves (flap of tissue in proximal urethra), and mid-urethral hypoplasia (significant tapering and narrowing that becomes progressive obstruction as pelvic anatomy matures)." — Mark (clinical) [Ep 13 · 0:32](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=32)
- "Incomplete urethral obstruction leads to progressive oligohydramnios until anhydramnios, resulting in physical deformations (joint contractures, flattened ears, Potter phenotype), pulmonary hypoplasia from inability to expand chest, and severe hydronephrosis with progressive renal fibrocystic dysplasia and renal failure." — Mark (clinical) [Ep 13 · 1:30](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=90)
- "In sheep model, early mid-gestational reversal of urethral obstruction prevented progressive dysplastic changes to kidneys and preserved kidney function, giving rise to the concept of vesico-amniotic shunting." — Mark (clinical) [Ep 13 · 2:58](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=178)
- "Early shunting had highly variable outcomes and success rates." — Mark (clinical) [Ep 13 · 4:32](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=272)
- "A stepwise approach to identifying fetuses for shunt therapy includes: high-resolution ultrasound to assess anatomy and rule out associated anomalies (myelomeningocele, cardiac disease, genetic syndromes), karyotype confirmation to rule out chromosomal abnormalities, and renal function evaluation by serial bladder drainage." — Mark (guideline) [Ep 13 · 4:50](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=290)
- "Amnioinfusion is sometimes necessary to expand amniotic fluid space and restore fluid interface for better ultrasound resolution when initial evaluation is difficult." — Mark (clinical) [Ep 13 · 5:19](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=319)
- "Not an insignificant portion of LUTO cases have chromosomal abnormalities such as major trisomies or Klinefelter syndrome." — Mark (epidemiological) [Ep 13 · 5:36](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=336)
- "It is important to confirm male fetus because female fetuses with large bladder-like structures are usually cloacal abnormalities that do not benefit from shunting due to different pathophysiology." — Mark (clinical) [Ep 13 · 5:53](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=353)
- "Renal function evaluation involves draining the bladder completely on several occasions and analyzing sodium, chloride, calcium, osmolarity, total proteins, and beta-2-microglobulin as reflections of proximal tubular injury and possible glomerular injury." — Mark (guideline) [Ep 13 · 6:17](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=377)
- "Increased kidney echogenicity is evidence of compression of renal parenchyma rather than a poor prognostic sign per se; following serial bladder drainages and allowing kidneys to drain, re-expansion of parenchyma occurs with more normal echogenicity." — Mark (clinical) [Ep 13 · 8:10](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=490)
- "Hydronephrosis pathophysiology: as collecting system (balloon) enlarges within kidney (sponge in fishbowl), it compresses parenchyma against serosa, impairing delicate vasculature and causing cell death, progressive fibrosis, and eventually cystic dysplasia." — Mark (clinical) [Ep 13 · 8:49](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=529)
- "Presence of cortical cysts indicates irreversibly damaged kidney not amenable to in utero therapy." — Mark (clinical) [Ep 13 · 10:18](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=618)
- "Patent urachus (tract from bladder dome to umbilical cord that reopens with high bladder pressure) is one etiology for LUTO with normal amniotic fluid volume." — Mark (clinical) [Ep 13 · 12:41](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=761)
- "Megacystis-microcolon-hypoperistalsis syndrome is a neurologic defect in bladder and ureteral muscles preventing contraction and emptying; these patients have massively distended bladder with normal amniotic fluid, thin bladder walls after drainage, and extremely poor survival (most do not survive more than a few years)." — Mark (clinical) [Ep 13 · 14:47](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=887)
- "The first urine specimen from bladder tap is not predictive or reliable because it is exposed to degradation products and osmotic gradients that change electrolyte composition; serial taps (second at 2 days, third at 4 days) sample urine from ureters/intrarenal collecting system and then freshly produced urine, which have much higher predictive value." — Mark (clinical) [Ep 13 · 19:05](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1145)
- "Prognostic urinary electrolyte cutoff thresholds (sodium <100, chloride <90, osmolarity <210, calcium <8, beta-2-microglobulin <6, total protein <40 mg/dL) predict potential for survival with successful shunt placement; values above these indicate significant renal injury." — Mark (guideline) [Ep 13 · 18:00](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1080)
- "All prognostic urinary electrolyte cutoff thresholds were based on urine analyzed between 18 to 22 weeks gestation; they cannot be used before 18 weeks or after 22 weeks without adjustment for gestational age." — Mark (guideline) [Ep 13 · 26:18](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1578)
- "Bladder morphology after drainage can suggest etiology: symmetric thick-walled bladder with difficult keyhole suggests urethral atresia; elongated bladder with more proximal thickening suggests posterior urethral valves; snowman appearance (head-chest-body shape) suggests mid-urethral hypoplasia/prune belly variant with smooth muscle deficiency in bladder dome." — Mark (clinical) [Ep 13 · 21:19](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1279)
- "In mid-urethral hypoplasia cases, histology shows abnormal smooth muscle from proximal ureters to renal pelvis and severe abnormalities in bladder dome smooth muscle development." — Mark (clinical) [Ep 13 · 25:13](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1513)
- "The Paris group (Francis Muller, Humberto Nicolini) emphasized importance of using gestational-age-specific cutoffs for urinary electrolytes." (guideline) [Ep 13 · 25:53](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1553)
- "Primary goal of fetal bladder shunting is to prevent pulmonary hypoplasia secondary to oligohydramnios; secondary goals are preservation of renal function and bladder function." (guideline) [Ep 13 · 28:41](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1721)
- "Vesico-amniotic shunt is a double-tailed silastic pigtail catheter (Rocket or Harrison shunt) with coils in different directions; flat end outside baby's abdomen prevents baby from grabbing and pulling it out, other end inside bladder." (clinical) [Ep 13 · 29:08](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1748)
- "Shunt placement is outpatient procedure with IV remifentanyl/propofol, local anesthetic, antibiotic, indomethacin, and possibly nifedipine; mother goes home couple hours later." (clinical) [Ep 13 · 29:43](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1783)
- "Amnioinfusion before shunt placement is critical because without good fluid volume around fetus, external end of shunt cannot be deposited properly (most difficult part of procedure)." (clinical) [Ep 13 · 30:06](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1806)
- "Shunt should ideally be inserted inferior to bladder because higher placement risks holes in shunt ending up in peritoneal cavity as bladder deflates, causing fetal urinary ascites." (clinical) [Ep 13 · 31:05](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1865)
- "Birmingham group meta-analysis showed in good-prognosis cases (by urinary electrolytes), there appeared to be some benefit to drainage; in poor-prognosis cases, drainage appeared to have even better result." (clinical) [Ep 13 · 31:37](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1897)
- "PLUTO trial was only randomized trial of bladder shunting; babies randomized when physician was uncertain whether to shunt; karyotype and urinalysis were not mandatory, amniotic fluid volume not used as prognostic evaluator." (clinical) [Ep 13 · 32:27](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1947)
- "PLUTO trial designed to collect 150 patients over 4 years but only 31 patients randomized; trial stopped early due to poor recruitment (only 20% of planned patients)." (epidemiological) [Ep 13 · 33:41](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2021)
- "PLUTO trial showed approximately 3-fold increase in survival in shunted fetuses compared to conservative management, but numbers very small and benefit unproven (confidence intervals crossed unity, results not significant)." (clinical) [Ep 13 · 33:55](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2035)
- "All 12 deaths in PLUTO trial were from pulmonary hypoplasia; improved survival inferred to be related to decrease in lung hypoplasia." (clinical) [Ep 13 · 34:36](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2076)
- "Only 7 of 12 live-born shunted babies in PLUTO trial were alive at age 2, and only 2 of shunted survivors had normal renal function; all 3 conservatively managed survivors had significant renal impairment." (epidemiological) [Ep 13 · 34:47](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2087)
- "Six studies reporting long-term outcomes of shunted babies show consistent results: approximately 40-50% have normal renal function, approximately one-third require dialysis or transplant." (epidemiological) [Ep 13 · 36:06](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2166)
- "In Canadian population, when parents review outcome studies, many opt for termination of pregnancy rather than shunting." (epidemiological) [Ep 13 · 37:13](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2233)
- "Some LUTO cases can resolve spontaneously, either by baby peeing and filling amniotic sac, spontaneous bladder decompression resulting in asymmetric hydronephrosis or urinary ascites, or development of perinephric urinoma." (clinical) [Ep 13 · 37:23](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2243)
- "Bladder rupture usually occurs after drainage (not spontaneously) and always resolves after a few days." (clinical) [Ep 13 · 38:06](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2286)
- "Megacystis-microcolon-hypoperistalsis syndrome and cloacal dysgenesis are cases where intervention by shunting is not indicated; clues include female fetus and normal amniotic fluid volume." (guideline) [Ep 13 · 38:26](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2306)
- "Despite 6 decades of research, the exact cause of NEC is unknown and there is no absolute cure" — Gail Besner (clinical) [Ep 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 45:06](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-930?t=2706)
- "Breast milk provides significant benefit to time to wean off parenteral nutrition in gastroschisis and necrotizing enterocolitis patients compared to formula-only feeding" — Mike (clinical) [Ep 20 · 59:42](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=3582)
- "Spontaneous intestinal perforation patients do not show the same benefit from breast milk as necrotizing enterocolitis patients" — Mike (clinical) [Ep 20 · 60:19](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=3619)
- "Patients with 50% of estimated bowel length are expected to come off parenteral nutrition" — Mike (clinical) [Ep 20 · 28:07](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1687)
- "STEP procedures done in the first year of life in patients who have not progressed with enteral feeds are not beneficial unless specifically avoiding line infections and bacterial overgrowth" — Mike (opinion) [Ep 20 · 29:20](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1760)
- "Only 3 of the neonates who had early STEP procedures in the registry study came off parenteral nutrition, whereas natural data shows 80-90% of similar patients come off TPN at 12 months without STEP" — Mike (clinical) [Ep 20 · 31:25](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1885)
- "Donor breast milk is less advantageous than maternal breast milk because it is usually from mothers 10-14 months postpartum with lower caloric density and protein levels" — Mike (clinical) [Ep 20 · 62:33](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=3753)
- "Continuous drip feeding improves absorption coefficient from 60% to 85% in adults with short bowel syndrome, while combined daytime eating plus overnight drip achieves 75% absorption" — Mike (clinical) [Ep 20 · 17:29](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1049)
- "Micronutrient deficiency is extremely common, occurring in about 60% of patients weaned off TPN" — Mike (clinical) [Ep 20 · 71:36](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=4296)
- "Human milk oligosaccharides (2FL, 3FL) are non-nutrient components that affect microflora and dysbiosis, with 80% of secretor mothers producing 2FL which is immunomodulatory" — Mike (clinical) [Ep 20 · 86:24](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5184)
- "Two-thirds of bloodstream infections occurred in patients on prophylactic Flagyl, suggesting it knocks out anaerobes and facilitates aerobic overgrowth" — Mike (clinical) [Ep 20 · 90:33](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5433)
- "Metronidazole has limited spectrum, knocks off anaerobes, and facilitates growth of aerobes, making it potentially the wrong choice for bacterial overgrowth" — Mike (opinion) [Ep 20 · 91:58](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5518)
- "GLP-2 analog can reduce fecal output allowing 20% reduction in TPN in 60-70% of adult patients, with 20% achieving complete TPN independence in extension studies" — Mike (clinical) [Ep 20 · 114:02](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6842)
- "Pancreatic enzymes are not physiologic in humans until 5-7 months of age; lipase doesn't reach adult levels until end of first year" — Mike (clinical) [Ep 20 · 109:36](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6576)
- "Cholestyramine doses effective for firming stool will bind nutrients, fat-soluble vitamins, and fats, with risk of hyperchloremic acidosis and bezoar formation" — Mike (clinical) [Ep 20 · 106:03](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6363)
- "There is no hard upper limit for acceptable stoma output; decisions should be based on electrolyte profile and acidosis rather than volume alone" — Mike (opinion) [Ep 20 · 111:19](https://library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6679)
- "The three major causes of LUTO are urethral atresia (complete obstruction with no communication from bladder neck through urethra), posterior urethral valves (flap of tissue in proximal urethra), and mid-urethral hypoplasia (significant tapering and narrowing that becomes progressive obstruction as pelvic anatomy matures)" — Mark (clinical) [Ep 9 · 0:44](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=44)
- "Complete urethral obstruction leads to progressive oligohydramnios until anhydramnios, physical deformations (joint contractures, ear flattening, Potter's phenotype), pulmonary hypoplasia due to inability to expand and contract chest, and severe hydronephrosis with progressive renal fibrocystic dysplasia resulting in renal failure after birth" — Mark (clinical) [Ep 9 · 1:41](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=101)
- "In sheep models, early mid-gestational reversal of obstruction prevented progressive dysplastic changes to kidneys and preserved kidney function, giving rise to the concept of in utero shunting" — Mark (clinical) [Ep 9 · 3:10](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=190)
- "A stepwise approach to identifying fetuses for shunt therapy involves: (1) high-resolution ultrasound to evaluate anatomy and rule out associated anomalies like myelomeningocele or cardiac disease, (2) karyotype confirmation to rule out chromosomal abnormalities, and (3) renal function evaluation by serial bladder drainage" — Mark (clinical) [Ep 9 · 4:44](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=284)
- "Amnioinfusions can be performed to expand the amniotic fluid space and restore fluid interface for better high-resolution ultrasound imaging when evaluation is difficult" — Mark (clinical) [Ep 9 · 5:31](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=331)
- "It is important to confirm male fetus because female fetuses with large bladder-like structures are usually cloacal abnormalities that do not benefit from shunting due to completely different pathophysiology" — Mark (clinical) [Ep 9 · 6:04](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=364)
- "The keyhole sign is the dilated proximal urethra down to the level of obstruction, characteristic of posterior urethral valves" — Mark (clinical) [Ep 9 · 7:42](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=462)
- "Increased echogenicity of kidneys is evidence of compression of renal parenchyma rather than a poor prognostic sign per se; following bladder drainage and allowing kidneys to drain, re-expansion of parenchyma occurs with more normal echogenicity" — Mark (clinical) [Ep 9 · 8:21](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=501)
- "The pathophysiology of hydronephrosis involves the collecting system (like a balloon) expanding within the kidney (like a sponge in a glass fishbowl), compressing parenchyma against the serosa, impairing delicate vasculature, resulting in cell death, progressive fibrosis, and eventually cystic dysplasia" — Mark (clinical) [Ep 9 · 9:01](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=541)
- "The presence of discrete cortical cysts indicates irreversible kidney damage and is not amenable to any in utero therapy due to severity of underlying injury" — Mark (clinical) [Ep 9 · 10:29](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=629)
- "Patent urachus (a tract from bladder dome to umbilical cord insertion that normally closes early in embryonic development) can reopen with early obstruction and high bladder pressure, draining urine into amniotic fluid space, explaining obstructive uropathy with normal amniotic fluid volume" — Mark (clinical) [Ep 9 · 12:53](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=773)
- "Megacystis-microcolon-hypoperistalsis syndrome is a neurologic defect in bladder and ureteral muscles preventing bladder contraction and emptying, more common in females but seen in males, with extremely poor survival (most do not survive more than a few years)" — Mark (clinical) [Ep 9 · 14:58](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=898)
- "In megacystis-microcolon-hypoperistalsis syndrome, after bladder drainage the entire bladder remains very thin-walled because it does not develop hyperplasia or thickening typically seen in complete obstruction, and amniotic fluid flows into amniotic cavity through a completely patent urethra" — Mark (clinical) [Ep 9 · 15:34](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=934)
- "Karyotype analysis can be obtained through amniocentesis (if possible), chorionic villus sampling, vesicocentesis (with FISH technology to screen and confirm male karyotype and rule out major aneuploidies), or cordocentesis for fetal blood" — Mark (clinical) [Ep 9 · 16:49](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1009)
- "Favorable prognostic urinary values for potential survival with shunt placement are: sodium <100 mEq/L, chloride <90 mEq/L, osmolarity <210 mOsm, calcium <8 mg/dL, beta-2 microglobulin <6 mg/L, and total protein <40 mg/dL" — Mark (clinical) [Ep 9 · 18:12](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1092)
- "Autopsy studies confirmed that fetuses with urinary values above the cutoff thresholds (not much higher) showed significant fibrotic injury to kidneys, while those with values below thresholds showed very little or very early changes potentially salvageable with in utero therapy" — Mark (clinical) [Ep 9 · 18:35](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1115)
- "Serial bladder drainage (first tap, second tap 2 days later, third tap 2 days after that) is necessary because the first urine specimen is not predictive or reliable; the third or fourth values have much higher predictive value for detecting significant underlying injury as they represent freshly produced urine" — Mark (clinical) [Ep 9 · 19:27](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1167)
- "Improving urinary electrolyte values across serial taps (e.g., sodium initially poor but dropping with second and third taps) indicates an excellent candidate for shunting with reasonably good prognosis, while worsening values indicate ongoing irreversible damage that shunting won't benefit" — Mark (clinical) [Ep 9 · 20:29](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1229)
- "After bladder drainage, urethral atresia cases show symmetric, very thick, universal bladder wall thickening with a typical keyhole; posterior urethral valve cases show elongated bladder shape with more proximal than distal thickening; mid-urethral hypoplasia (prune belly/triad) cases show a 'snowman appearance' with typical hypertrophy in lower bladder but significant smooth muscle deficiency in upper bladder" — Mark (clinical) [Ep 9 · 21:31](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1291)
- "All urinary electrolyte cutoff thresholds are based on urine analyzed between 18 to 22 weeks of gestation; these cutoffs cannot be used before 18 weeks or after 22 weeks without adjustment" — Mark (clinical) [Ep 9 · 26:30](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1590)
- "Urinary electrolyte cutoff values change with gestational age due to maturation and increasing kidney function; at 17 weeks the cutoff would be higher, and at 24-26 weeks the cutoffs would be much lower" — Mark (clinical) [Ep 9 · 27:00](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1620)
- "The primary goal of fetal bladder shunting is to prevent pulmonary hypoplasia secondary to oligohydramnios; secondary goals are preservation of renal function and bladder function" (clinical) [Ep 9 · 28:52](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1732)
- "Vesicoamniotic shunting uses a double-tailed silastic pigtail catheter (Rocket shunt) with coils in different directions so the flat end outside the baby's abdomen cannot be grabbed and pulled out, and the other end is inside the bladder" (clinical) [Ep 9 · 29:27](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1767)
- "Shunt placement is done as an outpatient procedure with IV remifentanyl and if necessary propofol, local anesthetic, antibiotic, indomethacin, and possibly nifedipine, with mother going home a couple hours later" (clinical) [Ep 9 · 29:54](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1794)
- "Amnioinfusion before shunt placement is the most important step because without good fluid volume around the fetus, the external end of the shunt (the trickiest part) cannot be deposited properly" (clinical) [Ep 9 · 30:18](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1818)
- "Shunt should ideally be inserted inferior to the bladder because the higher the placement, the greater the risk that when the bladder deflates, some shunt holes will be in the peritoneal cavity, potentially causing fetal urinary ascites" (clinical) [Ep 9 · 31:16](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1876)
- "The Birmingham group's meta-analysis showed that in cases with good prognosis from urinary electrolytes, there appeared to be some benefit to drainage, and in the poor prognosis group, drainage appeared to have an even better result" (epidemiological) [Ep 9 · 31:48](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1908)
- "The PLUTO trial randomized patients only when the physician was uncertain whether to shunt; if they knew whether shunting worked, patients were not randomized; karyotype and urinalysis were not mandatory, and amniotic fluid volume was not used as a prognostic evaluator" (clinical) [Ep 9 · 32:59](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1979)
- "The PLUTO trial was designed to collect 150 patients over 4 years but only 31 patients were randomized by the end, representing only 20% of planned recruitment" (epidemiological) [Ep 9 · 33:53](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2033)
- "In the PLUTO trial, shunted fetuses showed about a 3-fold increase in survival compared to those not shunted, but numbers were very small and the benefit is unproven; all 12 deaths were from pulmonary hypoplasia" (epidemiological) [Ep 9 · 34:33](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2073)
- "In the PLUTO trial, only 7 of 12 live-born shunted babies were alive at age 2, and only 2 of the shunted survivors had normal renal function; all 3 conservatively managed survivors had significant renal impairment" (epidemiological) [Ep 9 · 34:59](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2099)
- "Difficulties in fetal therapy trials include: conditions are rare, many go undetected prenatally, many parents choose termination when faced with outcome realities, delay in accepting new therapy reflects clinician and patient bias based on small heterogeneous observational studies, and loss of clinical equipoise" (opinion) [Ep 9 · 35:18](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2118)
- "Long-term outcome data from 6 studies show consistent results: among shunted fetuses with good electrolytes (the best of the best), only 40-50% have normal renal function and approximately one-third require dialysis or transplant" (epidemiological) [Ep 9 · 36:17](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2177)
- "Some LUTO cases can resolve spontaneously, either by the baby starting to void and refill its bladder naturally, or by spontaneous bladder decompression resulting in asymmetrical hydronephrosis or urinary ascites" (clinical) [Ep 9 · 37:40](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2260)
- "Bladder rupture usually occurs after bladder drainage rather than spontaneously, and always resolves after a few days" (clinical) [Ep 9 · 38:17](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2297)
- "Megacystis-microcolon-hypoperistalsis syndrome and cloacal dysgenesis are cases where there is no role whatsoever for shunting intervention" (clinical) [Ep 9 · 38:38](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2318)
- "70% of volvulus cases occur in the first two months of life" (epidemiological) [Ep 4 · 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 4 · 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 4 · 19:27](https://library.globalcastmd.com/watch/malrotation-629?t=1167)
- "A normal ultrasound does not rule out volvulus" (clinical) [Ep 4 · 19:55](https://library.globalcastmd.com/watch/malrotation-629?t=1195)
- "Ladd bands do not cause midgut volvulus" — Jack (opinion) [Ep 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 11:53](https://library.globalcastmd.com/watch/malrotation-629?t=713)
- "Laparoscopic Ladd procedure can be performed effectively even in newborns" — Tim (opinion) [Ep 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 30:55](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-636?t=1855)
- "Decompressing distended bowel may reduce ischemia and salvage additional segments" (clinical) [Ep 2 · 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 2 · 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 2 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 32 · 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 71 · 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 71 · 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 71 · 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 71 · 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 71 · 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 71 · 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 71 · 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 71 · 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 71 · 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 71 · 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 71 · 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 71 · 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 71 · 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 71 · 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 71 · 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 71 · 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 71 · 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 71 · 3:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "The study examined 277 children with Hirschsprung's disease, with about half receiving Soave procedure, a third Duhamel, and the rest Swenson" — Britney Levy (clinical) [Ep 72 · 0:47](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=47)
- "217 of the 277 children had long-term outcome data available" — Britney Levy (clinical) [Ep 72 · 1:10](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=70)
- "Duhamel procedure has the lowest risk of incontinence but the highest risk of constipation in school age children with Hirschsprung's disease" — Britney Levy (clinical) [Ep 72 · 1:15](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=75)
- "The Peters et al. study examined 55 pediatric patients with short bowel syndrome" — Rod Gerardo (clinical) [Ep 72 · 1:35](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=95)
- "Infants with an ileocecal valve had significantly shorter duration on parenteral nutrition" — Rod Gerardo (clinical) [Ep 72 · 1:50](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=110)
- "Patients with less than 50% of their colon had significantly less time on parenteral nutrition as long as they had their ileocecal valve" — Rod Gerardo (clinical) [Ep 72 · 2:05](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=125)
- "The Olsen et al. systematic review analyzed 10 studies with 6,430 patients" — Cecilia Gigena (epidemiological) [Ep 72 · 2:43](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=163)
- "The definition of a high volume surgeon varies widely from 9 thyroidectomies per year to over 200 thyroidectomies with at least 30 being in pediatric patients" — Cecilia Gigena (clinical) [Ep 72 · 3:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=180)
- "Thyroidectomies performed by high volume surgeons show shorter length of stays" — Cecilia Gigena (clinical) [Ep 72 · 3:20](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=200)
- "The Tendon et al. study was a prospective randomized control trial conducted between 2017 and 2018" — Ellen Encisco (clinical) [Ep 72 · 3:35](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=215)
- "The study compared three skin closure groups: sutures with tissue adhesive, sutures with adhesive tape, and sutures alone" — Ellen Encisco (clinical) [Ep 72 · 3:55](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=235)
- "Wounds were assessed at two weeks, six weeks, and more than six months after operation by surveying clinicians and parents" — Ellen Encisco (clinical) [Ep 72 · 4:10](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=250)
- "Wounds with tissue adhesive had poorer cosmesis at six weeks" — Em Tombash (clinical) [Ep 72 · 4:17](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=257)
- "The cosmesis difference between tissue adhesive and other closure methods was gone by six months" — Em Tombash (clinical) [Ep 72 · 4:25](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=265)
- "There was no difference between the three closure groups at six months for clinicians or for parents" — Em Tombash (clinical) [Ep 72 · 4:35](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=275)
- "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 75 · 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 75 · 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 75 · 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 75 · 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 75 · 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 75 · 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 75 · 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 75 · 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 75 · 2:39](https://library.globalcastmd.com/watch/quick-literature-updates-episode-10-6801?t=159)
- "The contrast enema study gathered 244 patients" (clinical) [Ep 75 · 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 75 · 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 75 · 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 75 · 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 75 · 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 75 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 74 · 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 76 · 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 76 · 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 76 · 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 76 · 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 76 · 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 76 · 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 76 · 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 76 · 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 76 · 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 76 · 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 76 · 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 76 · 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 76 · 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 76 · 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 76 · 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 76 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 27 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 29 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 31 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 40 · 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 43 · 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 43 · 0:20](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=20)
- "Duodenal atresia type III is present" (clinical) [Ep 43 · 1:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=60)
- "Malrotation is identified intraoperatively" (clinical) [Ep 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 43 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 50 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Nearly 60% of gastroschisis cases are premature" — Fung Lim (epidemiological) [Ep 54 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 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 54 · 7:54](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=474)
- "The Update Course has approximately 2000 people signed up" (epidemiological) [Ep 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 57 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 55 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 61 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 60 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 62 · 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 69 · 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 69 · 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 69 · 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 69 · 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 69 · 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 69 · 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 69 · 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 69 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 70 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 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 105 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)

## Changelog
- Aug 31: 112 doctors auto-found from episode dossiers
- Aug 30: 92 doctors auto-found from episode dossiers
- Aug 30: 82 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 96 doctors auto-found from episode dossiers
- Aug 29: 98 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 132 items, 96 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 86 items, 83 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 86 items, 83 dossiers, summaries for 2 audience(s)
- Aug 29: Collection generated from campaign corpus: 86 items, 83 dossiers, summaries for 1 audience(s)

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Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://library.globalcastmd.com/ai