# Intestinal Transplant — GCMD Library living collection

Also covered as: intestinal failure · necrotizing enterocolitis · bladder outlet obstruction · posterior urethral valves · inguinal hernia · umbilical hernia · wound dehiscence

Experts: Dr. Dr. Alonzo, Dr. Todd Ponsky, Dr. Ian Glenn, Dr. Brad Warner

Updated: n/a · 4 episodes · 116 cited statements

## Episodes
### 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)
- [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)

### Evidence & Research
- [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)

### In-Depth Reviews
- [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)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=0) Introduction and Definition of Intestinal Failure (Ep 3)
- [1:42](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=102) Prognostic Factors and Bowel Length Criteria (Ep 3)
- [7:07](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=427) Medical Management and TPN Strategy (Ep 3)
- [12:55](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=775) Lipid Formulations and Cholestasis Management (Ep 3)
- [17:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1071) Enteral Feeding Strategy and Adaptation (Ep 3)
- [26:01](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1561) Surgical Interventions: Lengthening Procedures (Ep 3)
- [38:10](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2290) Bacterial Overgrowth and Microbiome (Ep 3)
- [43:35](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2615) Growth Factors and Future Therapies (Ep 3)
- [46:32](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2792) Intestinal Transplantation and Multidisciplinary Care (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=0) Introduction and Biliary Atresia Corticosteroid Study (Ep 4)
- [10:48](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=648) Surgical Antiseptic Agents and Appendicitis Management (Ep 4)
- [20:20](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1220) Appendicitis Trial Discussion Continued (Ep 4)
- [30:35](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1835) Intestinal Failure and Enteral Autonomy (Ep 4)
- [36:44](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2204) Anesthetic Neurotoxicity in Children (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=0) Early surgical interventions: G-tubes and PD catheters (Ep 1)
- [3:46](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=226) Renal transplantation technique and complications (Ep 1)
- [6:47](https://library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=407) Discussion: G-tube placement strategy and anatomic considerations (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=0) Early surgical interventions: G-tubes and PD catheters (Ep 2)
- [3:28](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=208) Renal transplantation technique and complications (Ep 2)
- [6:40](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=400) Technical discussion: G-tube placement strategies (Ep 2)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 51:16](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=3076)
- "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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 11:43](https://library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=703)
- "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)
- "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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 43:17](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2597)

## Changelog
- Aug 31: 7 doctors auto-found from episode dossiers
- Aug 30: 7 doctors auto-found from episode dossiers
- Aug 30: 7 doctors auto-found from episode dossiers
- Aug 29: 7 doctors auto-found from episode dossiers
- Aug 29: 7 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 4 items, 4 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 4 items, 4 dossiers, summaries for 4 audience(s)

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