Intestinal Transplant
Also covered as: intestinal failure · necrotizing enterocolitis · bladder outlet obstruction · posterior urethral valves · inguinal hernia · umbilical hernia · wound dehiscence
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Answers come only from this collection's statement ledger and cite the exact moment · not medical advice
Content of this collection
Surgical Management
2 items
Renal transplantation: Cincinnati Fetal Center
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Dr. Maria Alonso, Intestinal Transplant Surgeon, presents on renal transplantations. She discusses general surgical needs, gastrostomy tube, peritoneal dialysis catheter, hemodialysis catheter, extra peritoneal approach, extra vesicle re im
video · 13:51 · Nov 2018
Renal transplantation: Fetal Genitourinary Disease 2015
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Dr. Maria Alonso, Intestinal Transplant Surgeon, presents on renal transplantations. She discusses general surgical needs, gastrostomy tube, peritoneal dialysis catheter, hemodialysis catheter, extra peritoneal approach, extra vesicle re-im
video · 13:44 · Jan 2019
Evidence & Research
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Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
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Audio Journal with Dr. Von Allmen about using Corticosteroids After Hepatoportoenterostomy for Bile Drainage, Dr. Whit Holcomb about surgical site infections (SSI) are an important source of morbidity and mortality. and feasibility and safe
podcast · 44:19 · Dec 2020
In-Depth Reviews
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Intestinal Failure with Dr. Brad Warner
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Discussion with Dr. Brad W. Warner about intestinal failureWhat is intestinal failure?An umbrella term for when the small bowel is unable to digest and absorb an adequate amount of nutrients to sustain a patient through enteral means alone.
podcast · 52:46 · Dec 2020
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Every statement below comes from the recorded discussions, with its speaker and moment.
Intestinal Failure with Dr. Brad Warner
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
clinicalBrad Warner1:42 ↗
The intestine of a newborn or fetus doubles in length in the last trimester of gestation
clinicalBrad Warner3:03 ↗
For a neonate with ileocecal valve and entire colon, 10 to 15 centimeters of small intestine is a ballpark figure for salvageability
clinicalBrad Warner4:03 ↗
Without the colon and ileocecal valve, at least 15 to 20 centimeters would be a ballpark figure for salvageability
clinicalBrad Warner4:37 ↗
In adults with less than 50 centimeters of intestine, about 40% will not be alive after 5 to 10 years
epidemiologicalBrad Warner4:51 ↗
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
epidemiologicalBrad Warner5:56 ↗
Intestinal adaptation in humans probably takes place over about a year or two after small bowel resection
clinicalBrad Warner7:49 ↗
Stool outputs of up to 40 ccs per kilo per day are acceptable when advancing enteral feeding
guidelineBrad Warner8:30 ↗
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
guidelineBrad Warner10:22 ↗
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
guidelineBrad Warner10:45 ↗
A baby should gain about 20 to 30 g a day, which approximates in utero progression for a newborn
clinicalBrad Warner12:05 ↗
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
guidelineBrad Warner12:53 ↗
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
clinicalBrad Warner14:03 ↗
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
clinicalBrad Warner15:08 ↗
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
opinionBrad Warner18:11 ↗
Complex formulas fed enterally may stimulate adaptation better than elemental formulas by causing secretion of enterotrophic hormones to a greater extent
clinicalBrad Warner19:26 ↗
There is a threshold percentage of enteral calories that prevents onset of liver damage from TPN, though the exact number is unknown
clinicalBrad Warner21:19 ↗
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
guidelineBrad Warner22:33 ↗
Multiple episodes of sepsis along with abdominal distention and dilated bowel loops is an indication for surgical intervention
guidelineBrad Warner23:01 ↗
If child is starting to get jaundiced, there is a role to evaluate the gut for subclinical portal bacteremia arising from dilated bowel loops
clinicalBrad Warner23:18 ↗
Dilated bowel loops cause bacterial overgrowth leading to secretory diarrhea that is not related to digestion-absorption capacity but to enzyme dysfunction
clinicalBrad Warner23:53 ↗
More than 4 to 5 centimeters of bowel dilation with failure to advance enteral feeds or going backward is an indication for surgical intervention
guidelineBrad Warner25:43 ↗
In a child who is completely stable after 3 years but not progressing, would interrogate bowel and if dilated would proceed with lengthening
opinionBrad Warner26:07 ↗
If a child has over 100 centimeters of intestine, less than 5 or 10% should require TPN, suggesting possible underlying motility or mucosal problem
clinicalBrad Warner27:53 ↗
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
guidelineBrad Warner28:37 ↗
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
clinicalBrad Warner29:31 ↗
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
clinicalBrad Warner32:54 ↗
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
clinicalBrad Warner33:26 ↗
STEP procedures can cause dysmotility acting as a brake on intestinal transit
clinicalBrad Warner35:04 ↗
Would taper a child with dilated bowel who had at least 90 to 100 centimeters of intestinal length rather than performing a lengthening procedure
opinionBrad Warner38:21 ↗