Jason Fraser
207 statements · 10 topics · summaries given as host listed separately
Featured statements
if you try to just keep pushing and pushing pushing the baby kind of can squirm and stuff but if you go slow if you empty out the stomach if you kind of squish out the colon a little bit and you go slow you give the baby some sweeties the nurses are there to kind of relax the baby you have a couple people that that are there doing it you go slow you slowly kind of push things in you stretch out the belly a little bit
quote ·
Abdominal Wall Defects
Moreover, too, if you think about just the way that we close a sutured repair, you mobilize flaps from the skin and flaps from the fascia. So there's always, you know, redness around the incision, bruising around the incision. And so, you know, even that tissue manipulation is going to put you at higher risk for a potential infection or calling it erythema infection.
quote ·
Abdominal Wall Defects
the most important thing that kind of keeps showing up is the fact that we really need to define what your own institution has for tolerance and to kind of stay on the protocol and then really just look at the infant condition as you continue to go is the most important thing
our length of stay for gastroschisis and cincinnati was astronomically higher than like any other nick micu in the cooperative network that we worked with so we sat down we're like what is going on here so our average length of stay was 49 days
we instituted this uh a feeding protocol we spent a lot of time trying to get people to follow it and and making some adjustments and over two years we dropped the length of stay by 10 days and the mix of patients is not different
quote ·
Gastroschisis
we don't innovate our babies at all so we put the dressing plastic dressing on and as long as the kid's not you know has voluminous output we'll try to start start feedings on it
quote ·
Gastroschisis
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Jason's statements about Abdominal Wall Defects 34 statements
Open the Abdominal Wall Defects collection →
Gastroschisis and sutureless abdominal wall closure
Statement
Due to the heterogeneity of gastroschisis, patients able to undergo primary repair probably had more favorable bowel and theoretically would have less hospital stay and feed faster.
Open
Quotation
I think it was probably what we were expecting, I think, for a couple of reasons. One, due to the heterogeneity of this disease, you know, especially with gastroschisis, a lot of the patients that were able to undergo, you know, especially a primary repair, they probably had more favorable bowel. And then those patients, you know, theoretically would have less hospital stay and theoretically feed faster and things like that.
Open
Statement
Many patients who underwent sutureless repair were done in more recent cohorts and tended towards less interventions.
Open
Statement
In sutured repair, mobilizing flaps from the skin and fascia causes redness and bruising around the incision, which puts patients at higher risk for potential infection.
Open
Quotation
Moreover, too, if you think about just the way that we close a sutured repair, you mobilize flaps from the skin and flaps from the fascia. So there's always, you know, redness around the incision, bruising around the incision. And so, you know, even that tissue manipulation is going to put you at higher risk for a potential infection or calling it erythema infection.
Open
Statement
The finding of increased antibiotics needed after sutured repair was expected due to tissue manipulation.
Open
Statement
The next phase of the study is examining the same patients over several years of follow-up to assess growth and umbilical hernia repair rates.
Open
Statement
The consortium is working on operationalizing protocolization of gastroschisis closure across member institutions for a more prospective study with long-term follow-up.
Open
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
Quotation
we start feeding essentially you have to put the dressing on uh as long as the baby's not sick not having horrible output not puking or anything like that
Open
Statement
Jason Fraser's institution starts feeding immediately after dressing placement as long as the baby is not sick, not having horrible output, and not vomiting.
Open
Quotation
we don't innovate our babies at all so we put the dressing plastic dressing on and as long as the kid's not you know has voluminous output we'll try to start start feedings on it
Open
Statement
Awake reduction can be successful if performed slowly, with stomach emptying, colon decompression, oral sucrose, and gradual abdominal wall stretching.
Open
Quotation
if you try to just keep pushing and pushing pushing the baby kind of can squirm and stuff but if you go slow if you empty out the stomach if you kind of squish out the colon a little bit and you go slow you give the baby some sweeties the nurses are there to kind of relax the baby you have a couple people that that are there doing it you go slow you slowly kind of push things in you stretch out the belly a little bit
Open
Statement
Cincinnati Children's feeding protocol is based on patient tolerance and data from resource-limited settings where TPN is unavailable and feeding is mandatory.
Open
Quotation
it's really just based upon patient tolerance and it's kind of based upon some of the data that's out there from the rest of the world where they don't have tpn and so they just you have to feed the kid if the kid does okay then they keep going
Open
Statement
The reduction in surgical site infections with protocol feeding was likely due to decreased care variability rather than the feeding protocol itself.
Open
Quotation
a lot of the inconclusivity from the the study showed that you know most likely due to the fact that there was lots of different feeding protocols that were used uh across our member institutions
Open
Statement
The multi-institutional study showed inconclusive results due to significant variation in feeding protocols across institutions.
Open
Quotation
the ssi thing was probably just because patients that were fed via protocol were cared for via protocol and so that they actually had less variability and less uh less changes uh in the way that these these patients are not you know look for
Open
Statement
Cincinnati Children's average gastroschisis length of stay was 49 days before protocol implementation, which was astronomically higher than comparable NICUs in their cooperative network.
Open
Quotation
our length of stay for gastroschisis and cincinnati was astronomically higher than like any other nick micu in the cooperative network that we worked with so we sat down we're like what is going on here so our average length of stay was 49 days
Open
Statement
After implementing a feeding protocol, Cincinnati Children's reduced gastroschisis length of stay by 10 days over two years.
Open
Quotation
we instituted this uh a feeding protocol we spent a lot of time trying to get people to follow it and and making some adjustments and over two years we dropped the length of stay by 10 days and the mix of patients is not different
Open
Statement
Cincinnati Children's has seen a decrease in time from first feed to full feeds but has not yet reduced the time from admission to first feed (except in 2020).
Open
Statement
Cincinnati Children's gastroschisis protocol includes prenatal care coordination with obstetricians and neonatologists, with surgery continuing to follow patients throughout hospitalization.
Open
Quotation
the most important thing that kind of keeps showing up is the fact that we really need to define what your own institution has for tolerance and to kind of stay on the protocol and then really just look at the infant condition as you continue to go is the most important thing
Open
Statement
The most important aspects of gastroschisis feeding are defining institutional tolerance criteria, adhering to protocol, and continuously evaluating the infant's condition.
Open
Statement
For significant feeding intolerance, Cincinnati Children's protocol calls for stopping feeds for six hours, though this is not clearly evidence-based.
Open
Quotation
yes you can have a protocol yes you know you need to follow it but the most really you really need to continually evaluate the patient as they continue to go to make sure that you know yes your protocol is working but also to the patient does okay throughout
Open
Statement
One recent Cincinnati Children's gastroschisis patient who was primarily reduced on day of life zero was discharged at approximately two weeks and remained well at two-week follow-up, though this is an outlier on the faster end.
Open
Statement
Cincinnati Children's has not seen any aspirations with their early aggressive feeding approach, though they acknowledge they are still early in implementation and continue to monitor data.
Open
Statement
At Cincinnati Children's, approximately two-thirds of gastroschisis cases cannot be reduced immediately and are placed in a silo for gradual reduction followed by sutureless closure, with feeds started after closure.
Open
Jason's statements about Congenital Lung Lesions (CPAM) 7 statements
Open the Congenital Lung Lesions (CPAM) collection →
Complications and Beyond
Statement
CT angiography for congenital lung lesions is typically performed at 3-6 months in clinic rather than in NICU for asymptomatic patients
Open
Statement
When using energy devices for vessel control, leave enough remnant tissue so the vessel doesn't retract if seal fails, allowing purchase for clip or suture
Open
Statement
Obtain proximal control or partially cut across vessel with energy device to detect failure before complete division
Open
Statement
When using staplers, visualize the stapler end, use appropriate staple size for tissue, and leave extra tissue around stapler edge for adequate coaptation
Open
Statement
Newborn with esophageal atresia, dextrocardia, and respiratory instability at birth suggests complex anatomy beyond typical EA/TEF
Open
Statement
Echo findings of mesocardia, hypoplastic pulmonary arteries, persistent left SVC, and dilated right ventricle indicate significant cardiac anomalies
Open
Statement
Esophageal lung is rare congenital anomaly with approximately 30 reported cases where bronchus arises directly from esophagus rather than trachea
Open
Jason's statements about Congenital Pulmonary Airway Malformation 7 statements
Open the Congenital Pulmonary Airway Malformation collection →
Complications and Beyond
Statement
CT angiography for congenital lung lesions is typically performed at 3-6 months in clinic rather than in NICU for asymptomatic patients
Open
Statement
When using energy devices for vessel control, leave enough remnant tissue so the vessel doesn't retract if seal fails, allowing purchase for clip or suture
Open
Statement
Obtain proximal control or partially cut across vessel with energy device to detect failure before complete division
Open
Statement
When using staplers, visualize the stapler end, use appropriate staple size for tissue, and leave extra tissue around stapler edge for adequate coaptation
Open
Statement
Newborn with esophageal atresia, dextrocardia, and respiratory instability at birth suggests complex anatomy beyond typical EA/TEF
Open
Statement
Echo findings of mesocardia, hypoplastic pulmonary arteries, persistent left SVC, and dilated right ventricle indicate significant cardiac anomalies
Open
Statement
Esophageal lung is rare congenital anomaly with approximately 30 reported cases where bronchus arises directly from esophagus rather than trachea
Open
Jason's statements about Congenital Pulmonary Airway Malformation 7 statements
Open the Congenital Pulmonary Airway Malformation collection →
Complications and Beyond
Statement
CT angiography for congenital lung lesions is typically performed at 3-6 months in clinic rather than in NICU for asymptomatic patients
Open
Statement
When using energy devices for vessel control, leave enough remnant tissue so the vessel doesn't retract if seal fails, allowing purchase for clip or suture
Open
Statement
Obtain proximal control or partially cut across vessel with energy device to detect failure before complete division
Open
Statement
When using staplers, visualize the stapler end, use appropriate staple size for tissue, and leave extra tissue around stapler edge for adequate coaptation
Open
Statement
Newborn with esophageal atresia, dextrocardia, and respiratory instability at birth suggests complex anatomy beyond typical EA/TEF
Open
Statement
Echo findings of mesocardia, hypoplastic pulmonary arteries, persistent left SVC, and dilated right ventricle indicate significant cardiac anomalies
Open
Statement
Esophageal lung is rare congenital anomaly with approximately 30 reported cases where bronchus arises directly from esophagus rather than trachea
Open
Jason's statements about Etiologies (Gastroschisis/NEC/Atresia/Volvulus) 34 statements
Open the Etiologies (Gastroschisis/NEC/Atresia/Volvulus) collection →
Gastroschisis and sutureless abdominal wall closure
Statement
Due to the heterogeneity of gastroschisis, patients able to undergo primary repair probably had more favorable bowel and theoretically would have less hospital stay and feed faster.
Open
Quotation
I think it was probably what we were expecting, I think, for a couple of reasons. One, due to the heterogeneity of this disease, you know, especially with gastroschisis, a lot of the patients that were able to undergo, you know, especially a primary repair, they probably had more favorable bowel. And then those patients, you know, theoretically would have less hospital stay and theoretically feed faster and things like that.
Open
Statement
Many patients who underwent sutureless repair were done in more recent cohorts and tended towards less interventions.
Open
Statement
The finding of increased antibiotics needed after sutured repair was expected due to tissue manipulation.
Open
Quotation
Moreover, too, if you think about just the way that we close a sutured repair, you mobilize flaps from the skin and flaps from the fascia. So there's always, you know, redness around the incision, bruising around the incision. And so, you know, even that tissue manipulation is going to put you at higher risk for a potential infection or calling it erythema infection.
Open
Statement
In sutured repair, mobilizing flaps from the skin and fascia causes redness and bruising around the incision, which puts patients at higher risk for potential infection.
Open
Statement
The consortium is working on operationalizing protocolization of gastroschisis closure across member institutions for a more prospective study with long-term follow-up.
Open
Statement
The next phase of the study is examining the same patients over several years of follow-up to assess growth and umbilical hernia repair rates.
Open
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
Statement
Jason Fraser's institution starts feeding immediately after dressing placement as long as the baby is not sick, not having horrible output, and not vomiting.
Open
Quotation
we start feeding essentially you have to put the dressing on uh as long as the baby's not sick not having horrible output not puking or anything like that
Open
Quotation
we don't innovate our babies at all so we put the dressing plastic dressing on and as long as the kid's not you know has voluminous output we'll try to start start feedings on it
Open
Statement
Awake reduction can be successful if performed slowly, with stomach emptying, colon decompression, oral sucrose, and gradual abdominal wall stretching.
Open
Quotation
if you try to just keep pushing and pushing pushing the baby kind of can squirm and stuff but if you go slow if you empty out the stomach if you kind of squish out the colon a little bit and you go slow you give the baby some sweeties the nurses are there to kind of relax the baby you have a couple people that that are there doing it you go slow you slowly kind of push things in you stretch out the belly a little bit
Open
Statement
Cincinnati Children's feeding protocol is based on patient tolerance and data from resource-limited settings where TPN is unavailable and feeding is mandatory.
Open
Quotation
it's really just based upon patient tolerance and it's kind of based upon some of the data that's out there from the rest of the world where they don't have tpn and so they just you have to feed the kid if the kid does okay then they keep going
Open
Quotation
a lot of the inconclusivity from the the study showed that you know most likely due to the fact that there was lots of different feeding protocols that were used uh across our member institutions
Open
Statement
The reduction in surgical site infections with protocol feeding was likely due to decreased care variability rather than the feeding protocol itself.
Open
Statement
The multi-institutional study showed inconclusive results due to significant variation in feeding protocols across institutions.
Open
Quotation
the ssi thing was probably just because patients that were fed via protocol were cared for via protocol and so that they actually had less variability and less uh less changes uh in the way that these these patients are not you know look for
Open
Statement
Cincinnati Children's average gastroschisis length of stay was 49 days before protocol implementation, which was astronomically higher than comparable NICUs in their cooperative network.
Open
Quotation
our length of stay for gastroschisis and cincinnati was astronomically higher than like any other nick micu in the cooperative network that we worked with so we sat down we're like what is going on here so our average length of stay was 49 days
Open
Statement
After implementing a feeding protocol, Cincinnati Children's reduced gastroschisis length of stay by 10 days over two years.
Open
Quotation
we instituted this uh a feeding protocol we spent a lot of time trying to get people to follow it and and making some adjustments and over two years we dropped the length of stay by 10 days and the mix of patients is not different
Open
Statement
Cincinnati Children's has seen a decrease in time from first feed to full feeds but has not yet reduced the time from admission to first feed (except in 2020).
Open
Statement
Cincinnati Children's gastroschisis protocol includes prenatal care coordination with obstetricians and neonatologists, with surgery continuing to follow patients throughout hospitalization.
Open
Statement
The most important aspects of gastroschisis feeding are defining institutional tolerance criteria, adhering to protocol, and continuously evaluating the infant's condition.
Open
Quotation
the most important thing that kind of keeps showing up is the fact that we really need to define what your own institution has for tolerance and to kind of stay on the protocol and then really just look at the infant condition as you continue to go is the most important thing
Open
Quotation
yes you can have a protocol yes you know you need to follow it but the most really you really need to continually evaluate the patient as they continue to go to make sure that you know yes your protocol is working but also to the patient does okay throughout
Open
Statement
For significant feeding intolerance, Cincinnati Children's protocol calls for stopping feeds for six hours, though this is not clearly evidence-based.
Open
Statement
One recent Cincinnati Children's gastroschisis patient who was primarily reduced on day of life zero was discharged at approximately two weeks and remained well at two-week follow-up, though this is an outlier on the faster end.
Open
Statement
Cincinnati Children's has not seen any aspirations with their early aggressive feeding approach, though they acknowledge they are still early in implementation and continue to monitor data.
Open
Statement
At Cincinnati Children's, approximately two-thirds of gastroschisis cases cannot be reduced immediately and are placed in a silo for gradual reduction followed by sutureless closure, with feeds started after closure.
Open
Jason's statements about Gastroschisis 34 statements
Open the Gastroschisis collection →
Gastroschisis and sutureless abdominal wall closure
Quotation
I think it was probably what we were expecting, I think, for a couple of reasons. One, due to the heterogeneity of this disease, you know, especially with gastroschisis, a lot of the patients that were able to undergo, you know, especially a primary repair, they probably had more favorable bowel. And then those patients, you know, theoretically would have less hospital stay and theoretically feed faster and things like that.
Open
Statement
Due to the heterogeneity of gastroschisis, patients able to undergo primary repair probably had more favorable bowel and theoretically would have less hospital stay and feed faster.
Open
Statement
Many patients who underwent sutureless repair were done in more recent cohorts and tended towards less interventions.
Open
Quotation
Moreover, too, if you think about just the way that we close a sutured repair, you mobilize flaps from the skin and flaps from the fascia. So there's always, you know, redness around the incision, bruising around the incision. And so, you know, even that tissue manipulation is going to put you at higher risk for a potential infection or calling it erythema infection.
Open
Statement
In sutured repair, mobilizing flaps from the skin and fascia causes redness and bruising around the incision, which puts patients at higher risk for potential infection.
Open
Statement
The finding of increased antibiotics needed after sutured repair was expected due to tissue manipulation.
Open
Statement
The next phase of the study is examining the same patients over several years of follow-up to assess growth and umbilical hernia repair rates.
Open
Statement
The consortium is working on operationalizing protocolization of gastroschisis closure across member institutions for a more prospective study with long-term follow-up.
Open
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
Quotation
we start feeding essentially you have to put the dressing on uh as long as the baby's not sick not having horrible output not puking or anything like that
Open
Statement
Jason Fraser's institution starts feeding immediately after dressing placement as long as the baby is not sick, not having horrible output, and not vomiting.
Open
Quotation
we don't innovate our babies at all so we put the dressing plastic dressing on and as long as the kid's not you know has voluminous output we'll try to start start feedings on it
Open
Statement
Awake reduction can be successful if performed slowly, with stomach emptying, colon decompression, oral sucrose, and gradual abdominal wall stretching.
Open
Quotation
if you try to just keep pushing and pushing pushing the baby kind of can squirm and stuff but if you go slow if you empty out the stomach if you kind of squish out the colon a little bit and you go slow you give the baby some sweeties the nurses are there to kind of relax the baby you have a couple people that that are there doing it you go slow you slowly kind of push things in you stretch out the belly a little bit
Open
Quotation
it's really just based upon patient tolerance and it's kind of based upon some of the data that's out there from the rest of the world where they don't have tpn and so they just you have to feed the kid if the kid does okay then they keep going
Open
Statement
Cincinnati Children's feeding protocol is based on patient tolerance and data from resource-limited settings where TPN is unavailable and feeding is mandatory.
Open
Statement
The reduction in surgical site infections with protocol feeding was likely due to decreased care variability rather than the feeding protocol itself.
Open
Statement
The multi-institutional study showed inconclusive results due to significant variation in feeding protocols across institutions.
Open
Quotation
a lot of the inconclusivity from the the study showed that you know most likely due to the fact that there was lots of different feeding protocols that were used uh across our member institutions
Open
Quotation
the ssi thing was probably just because patients that were fed via protocol were cared for via protocol and so that they actually had less variability and less uh less changes uh in the way that these these patients are not you know look for
Open
Quotation
our length of stay for gastroschisis and cincinnati was astronomically higher than like any other nick micu in the cooperative network that we worked with so we sat down we're like what is going on here so our average length of stay was 49 days
Open
Statement
Cincinnati Children's average gastroschisis length of stay was 49 days before protocol implementation, which was astronomically higher than comparable NICUs in their cooperative network.
Open
Quotation
we instituted this uh a feeding protocol we spent a lot of time trying to get people to follow it and and making some adjustments and over two years we dropped the length of stay by 10 days and the mix of patients is not different
Open
Statement
After implementing a feeding protocol, Cincinnati Children's reduced gastroschisis length of stay by 10 days over two years.
Open
Statement
Cincinnati Children's has seen a decrease in time from first feed to full feeds but has not yet reduced the time from admission to first feed (except in 2020).
Open
Statement
Cincinnati Children's gastroschisis protocol includes prenatal care coordination with obstetricians and neonatologists, with surgery continuing to follow patients throughout hospitalization.
Open
Statement
The most important aspects of gastroschisis feeding are defining institutional tolerance criteria, adhering to protocol, and continuously evaluating the infant's condition.
Open
Quotation
the most important thing that kind of keeps showing up is the fact that we really need to define what your own institution has for tolerance and to kind of stay on the protocol and then really just look at the infant condition as you continue to go is the most important thing
Open
Quotation
yes you can have a protocol yes you know you need to follow it but the most really you really need to continually evaluate the patient as they continue to go to make sure that you know yes your protocol is working but also to the patient does okay throughout
Open
Statement
For significant feeding intolerance, Cincinnati Children's protocol calls for stopping feeds for six hours, though this is not clearly evidence-based.
Open
Statement
One recent Cincinnati Children's gastroschisis patient who was primarily reduced on day of life zero was discharged at approximately two weeks and remained well at two-week follow-up, though this is an outlier on the faster end.
Open
Statement
Cincinnati Children's has not seen any aspirations with their early aggressive feeding approach, though they acknowledge they are still early in implementation and continue to monitor data.
Open
Statement
At Cincinnati Children's, approximately two-thirds of gastroschisis cases cannot be reduced immediately and are placed in a silo for gradual reduction followed by sutureless closure, with feeds started after closure.
Open
Jason's statements about Gastroschisis 34 statements
Open the Gastroschisis collection →
Gastroschisis and sutureless abdominal wall closure
Statement
Due to the heterogeneity of gastroschisis, patients able to undergo primary repair probably had more favorable bowel and theoretically would have less hospital stay and feed faster.
Open
Quotation
I think it was probably what we were expecting, I think, for a couple of reasons. One, due to the heterogeneity of this disease, you know, especially with gastroschisis, a lot of the patients that were able to undergo, you know, especially a primary repair, they probably had more favorable bowel. And then those patients, you know, theoretically would have less hospital stay and theoretically feed faster and things like that.
Open
Statement
Many patients who underwent sutureless repair were done in more recent cohorts and tended towards less interventions.
Open
Quotation
Moreover, too, if you think about just the way that we close a sutured repair, you mobilize flaps from the skin and flaps from the fascia. So there's always, you know, redness around the incision, bruising around the incision. And so, you know, even that tissue manipulation is going to put you at higher risk for a potential infection or calling it erythema infection.
Open
Statement
In sutured repair, mobilizing flaps from the skin and fascia causes redness and bruising around the incision, which puts patients at higher risk for potential infection.
Open
Statement
The finding of increased antibiotics needed after sutured repair was expected due to tissue manipulation.
Open
Statement
The next phase of the study is examining the same patients over several years of follow-up to assess growth and umbilical hernia repair rates.
Open
Statement
The consortium is working on operationalizing protocolization of gastroschisis closure across member institutions for a more prospective study with long-term follow-up.
Open
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
Quotation
we start feeding essentially you have to put the dressing on uh as long as the baby's not sick not having horrible output not puking or anything like that
Open
Statement
Jason Fraser's institution starts feeding immediately after dressing placement as long as the baby is not sick, not having horrible output, and not vomiting.
Open
Quotation
we don't innovate our babies at all so we put the dressing plastic dressing on and as long as the kid's not you know has voluminous output we'll try to start start feedings on it
Open
Quotation
if you try to just keep pushing and pushing pushing the baby kind of can squirm and stuff but if you go slow if you empty out the stomach if you kind of squish out the colon a little bit and you go slow you give the baby some sweeties the nurses are there to kind of relax the baby you have a couple people that that are there doing it you go slow you slowly kind of push things in you stretch out the belly a little bit
Open
Statement
Awake reduction can be successful if performed slowly, with stomach emptying, colon decompression, oral sucrose, and gradual abdominal wall stretching.
Open
Quotation
it's really just based upon patient tolerance and it's kind of based upon some of the data that's out there from the rest of the world where they don't have tpn and so they just you have to feed the kid if the kid does okay then they keep going
Open
Statement
Cincinnati Children's feeding protocol is based on patient tolerance and data from resource-limited settings where TPN is unavailable and feeding is mandatory.
Open
Statement
The multi-institutional study showed inconclusive results due to significant variation in feeding protocols across institutions.
Open
Quotation
a lot of the inconclusivity from the the study showed that you know most likely due to the fact that there was lots of different feeding protocols that were used uh across our member institutions
Open
Statement
The reduction in surgical site infections with protocol feeding was likely due to decreased care variability rather than the feeding protocol itself.
Open
Quotation
the ssi thing was probably just because patients that were fed via protocol were cared for via protocol and so that they actually had less variability and less uh less changes uh in the way that these these patients are not you know look for
Open
Quotation
our length of stay for gastroschisis and cincinnati was astronomically higher than like any other nick micu in the cooperative network that we worked with so we sat down we're like what is going on here so our average length of stay was 49 days
Open
Statement
Cincinnati Children's average gastroschisis length of stay was 49 days before protocol implementation, which was astronomically higher than comparable NICUs in their cooperative network.
Open
Quotation
we instituted this uh a feeding protocol we spent a lot of time trying to get people to follow it and and making some adjustments and over two years we dropped the length of stay by 10 days and the mix of patients is not different
Open
Statement
After implementing a feeding protocol, Cincinnati Children's reduced gastroschisis length of stay by 10 days over two years.
Open
Statement
Cincinnati Children's has seen a decrease in time from first feed to full feeds but has not yet reduced the time from admission to first feed (except in 2020).
Open
Statement
Cincinnati Children's gastroschisis protocol includes prenatal care coordination with obstetricians and neonatologists, with surgery continuing to follow patients throughout hospitalization.
Open
Quotation
the most important thing that kind of keeps showing up is the fact that we really need to define what your own institution has for tolerance and to kind of stay on the protocol and then really just look at the infant condition as you continue to go is the most important thing
Open
Statement
The most important aspects of gastroschisis feeding are defining institutional tolerance criteria, adhering to protocol, and continuously evaluating the infant's condition.
Open
Quotation
yes you can have a protocol yes you know you need to follow it but the most really you really need to continually evaluate the patient as they continue to go to make sure that you know yes your protocol is working but also to the patient does okay throughout
Open
Statement
For significant feeding intolerance, Cincinnati Children's protocol calls for stopping feeds for six hours, though this is not clearly evidence-based.
Open
Statement
One recent Cincinnati Children's gastroschisis patient who was primarily reduced on day of life zero was discharged at approximately two weeks and remained well at two-week follow-up, though this is an outlier on the faster end.
Open
Statement
Cincinnati Children's has not seen any aspirations with their early aggressive feeding approach, though they acknowledge they are still early in implementation and continue to monitor data.
Open
Statement
At Cincinnati Children's, approximately two-thirds of gastroschisis cases cannot be reduced immediately and are placed in a silo for gradual reduction followed by sutureless closure, with feeds started after closure.
Open
Jason's statements about Intestinal Rehab 34 statements
Open the Intestinal Rehab collection →
Gastroschisis and sutureless abdominal wall closure
Quotation
I think it was probably what we were expecting, I think, for a couple of reasons. One, due to the heterogeneity of this disease, you know, especially with gastroschisis, a lot of the patients that were able to undergo, you know, especially a primary repair, they probably had more favorable bowel. And then those patients, you know, theoretically would have less hospital stay and theoretically feed faster and things like that.
Open
Statement
Due to the heterogeneity of gastroschisis, patients able to undergo primary repair probably had more favorable bowel and theoretically would have less hospital stay and feed faster.
Open
Statement
Many patients who underwent sutureless repair were done in more recent cohorts and tended towards less interventions.
Open
Statement
In sutured repair, mobilizing flaps from the skin and fascia causes redness and bruising around the incision, which puts patients at higher risk for potential infection.
Open
Statement
The finding of increased antibiotics needed after sutured repair was expected due to tissue manipulation.
Open
Quotation
Moreover, too, if you think about just the way that we close a sutured repair, you mobilize flaps from the skin and flaps from the fascia. So there's always, you know, redness around the incision, bruising around the incision. And so, you know, even that tissue manipulation is going to put you at higher risk for a potential infection or calling it erythema infection.
Open
Statement
The next phase of the study is examining the same patients over several years of follow-up to assess growth and umbilical hernia repair rates.
Open
Statement
The consortium is working on operationalizing protocolization of gastroschisis closure across member institutions for a more prospective study with long-term follow-up.
Open
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
Quotation
we start feeding essentially you have to put the dressing on uh as long as the baby's not sick not having horrible output not puking or anything like that
Open
Statement
Jason Fraser's institution starts feeding immediately after dressing placement as long as the baby is not sick, not having horrible output, and not vomiting.
Open
Quotation
we don't innovate our babies at all so we put the dressing plastic dressing on and as long as the kid's not you know has voluminous output we'll try to start start feedings on it
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Statement
Awake reduction can be successful if performed slowly, with stomach emptying, colon decompression, oral sucrose, and gradual abdominal wall stretching.
Open
Quotation
if you try to just keep pushing and pushing pushing the baby kind of can squirm and stuff but if you go slow if you empty out the stomach if you kind of squish out the colon a little bit and you go slow you give the baby some sweeties the nurses are there to kind of relax the baby you have a couple people that that are there doing it you go slow you slowly kind of push things in you stretch out the belly a little bit
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Statement
Cincinnati Children's feeding protocol is based on patient tolerance and data from resource-limited settings where TPN is unavailable and feeding is mandatory.
Open
Quotation
it's really just based upon patient tolerance and it's kind of based upon some of the data that's out there from the rest of the world where they don't have tpn and so they just you have to feed the kid if the kid does okay then they keep going
Open
Statement
The reduction in surgical site infections with protocol feeding was likely due to decreased care variability rather than the feeding protocol itself.
Open
Quotation
a lot of the inconclusivity from the the study showed that you know most likely due to the fact that there was lots of different feeding protocols that were used uh across our member institutions
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Statement
The multi-institutional study showed inconclusive results due to significant variation in feeding protocols across institutions.
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Quotation
the ssi thing was probably just because patients that were fed via protocol were cared for via protocol and so that they actually had less variability and less uh less changes uh in the way that these these patients are not you know look for
Open
Statement
Cincinnati Children's average gastroschisis length of stay was 49 days before protocol implementation, which was astronomically higher than comparable NICUs in their cooperative network.
Open
Quotation
our length of stay for gastroschisis and cincinnati was astronomically higher than like any other nick micu in the cooperative network that we worked with so we sat down we're like what is going on here so our average length of stay was 49 days
Open
Statement
Cincinnati Children's has seen a decrease in time from first feed to full feeds but has not yet reduced the time from admission to first feed (except in 2020).
Open
Statement
After implementing a feeding protocol, Cincinnati Children's reduced gastroschisis length of stay by 10 days over two years.
Open
Quotation
we instituted this uh a feeding protocol we spent a lot of time trying to get people to follow it and and making some adjustments and over two years we dropped the length of stay by 10 days and the mix of patients is not different
Open
Statement
Cincinnati Children's gastroschisis protocol includes prenatal care coordination with obstetricians and neonatologists, with surgery continuing to follow patients throughout hospitalization.
Open
Statement
The most important aspects of gastroschisis feeding are defining institutional tolerance criteria, adhering to protocol, and continuously evaluating the infant's condition.
Open
Quotation
the most important thing that kind of keeps showing up is the fact that we really need to define what your own institution has for tolerance and to kind of stay on the protocol and then really just look at the infant condition as you continue to go is the most important thing
Open
Quotation
yes you can have a protocol yes you know you need to follow it but the most really you really need to continually evaluate the patient as they continue to go to make sure that you know yes your protocol is working but also to the patient does okay throughout
Open
Statement
For significant feeding intolerance, Cincinnati Children's protocol calls for stopping feeds for six hours, though this is not clearly evidence-based.
Open
Statement
One recent Cincinnati Children's gastroschisis patient who was primarily reduced on day of life zero was discharged at approximately two weeks and remained well at two-week follow-up, though this is an outlier on the faster end.
Open
Statement
Cincinnati Children's has not seen any aspirations with their early aggressive feeding approach, though they acknowledge they are still early in implementation and continue to monitor data.
Open
Statement
At Cincinnati Children's, approximately two-thirds of gastroschisis cases cannot be reduced immediately and are placed in a silo for gradual reduction followed by sutureless closure, with feeds started after closure.
Open
Jason's statements about Umbilical Hernia 8 statements
Open the Umbilical Hernia collection →
Gastroschisis and sutureless abdominal wall closure
Statement
Due to the heterogeneity of gastroschisis, patients able to undergo primary repair probably had more favorable bowel and theoretically would have less hospital stay and feed faster.
Open
Quotation
I think it was probably what we were expecting, I think, for a couple of reasons. One, due to the heterogeneity of this disease, you know, especially with gastroschisis, a lot of the patients that were able to undergo, you know, especially a primary repair, they probably had more favorable bowel. And then those patients, you know, theoretically would have less hospital stay and theoretically feed faster and things like that.
Open
Statement
Many patients who underwent sutureless repair were done in more recent cohorts and tended towards less interventions.
Open
Quotation
Moreover, too, if you think about just the way that we close a sutured repair, you mobilize flaps from the skin and flaps from the fascia. So there's always, you know, redness around the incision, bruising around the incision. And so, you know, even that tissue manipulation is going to put you at higher risk for a potential infection or calling it erythema infection.
Open
Statement
In sutured repair, mobilizing flaps from the skin and fascia causes redness and bruising around the incision, which puts patients at higher risk for potential infection.
Open
Statement
The finding of increased antibiotics needed after sutured repair was expected due to tissue manipulation.
Open
Statement
The consortium is working on operationalizing protocolization of gastroschisis closure across member institutions for a more prospective study with long-term follow-up.
Open
Statement
The next phase of the study is examining the same patients over several years of follow-up to assess growth and umbilical hernia repair rates.
Open
Jason's statements about Umbilical Hernia 8 statements
Open the Umbilical Hernia collection →
Gastroschisis and sutureless abdominal wall closure
Statement
Many patients who underwent sutureless repair were done in more recent cohorts and tended towards less interventions.
Open
Statement
Due to the heterogeneity of gastroschisis, patients able to undergo primary repair probably had more favorable bowel and theoretically would have less hospital stay and feed faster.
Open
Quotation
I think it was probably what we were expecting, I think, for a couple of reasons. One, due to the heterogeneity of this disease, you know, especially with gastroschisis, a lot of the patients that were able to undergo, you know, especially a primary repair, they probably had more favorable bowel. And then those patients, you know, theoretically would have less hospital stay and theoretically feed faster and things like that.
Open
Statement
The finding of increased antibiotics needed after sutured repair was expected due to tissue manipulation.
Open
Quotation
Moreover, too, if you think about just the way that we close a sutured repair, you mobilize flaps from the skin and flaps from the fascia. So there's always, you know, redness around the incision, bruising around the incision. And so, you know, even that tissue manipulation is going to put you at higher risk for a potential infection or calling it erythema infection.
Open
Statement
In sutured repair, mobilizing flaps from the skin and fascia causes redness and bruising around the incision, which puts patients at higher risk for potential infection.
Open
Statement
The next phase of the study is examining the same patients over several years of follow-up to assess growth and umbilical hernia repair rates.
Open
Statement
The consortium is working on operationalizing protocolization of gastroschisis closure across member institutions for a more prospective study with long-term follow-up.
Open
Summaries Jason gave as host · 15 summaries
Recaps of other experts' statements, not Jason's own clinical position.
Summaries Jason gave as host · Abdominal Wall Defects 2 summaries
Open the Abdominal Wall Defects collection →
Gastroschisis and sutureless abdominal wall closure
Host summary
Jason Fraser summarizing a resource: Initial small studies showed that some sutureless patients had a high umbilical hernia repair rate, or at least a high umbilical hernia rate.
Open
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
Host summary
Jason Fraser summarizing the discussion: Some institutions ignore bilious emesis or bilious NG residuals completely during gastroschisis feeding advancement.
Open
Summaries Jason gave as host · Congenital Lung Lesions (CPAM) 1 summary
Open the Congenital Lung Lesions (CPAM) collection →
Complications and Beyond
Host summary
Jason Fraser summarizing the discussion: In asymptomatic newborns with prenatally diagnosed lung lesions, most US practitioners obtain chest X-ray initially in NICU
Open
Summaries Jason gave as host · Congenital Pulmonary Airway Malformation 1 summary
Open the Congenital Pulmonary Airway Malformation collection →
Complications and Beyond
Host summary
Jason Fraser summarizing the discussion: In asymptomatic newborns with prenatally diagnosed lung lesions, most US practitioners obtain chest X-ray initially in NICU
Open
Summaries Jason gave as host · Congenital Pulmonary Airway Malformation 1 summary
Open the Congenital Pulmonary Airway Malformation collection →
Complications and Beyond
Host summary
Jason Fraser summarizing the discussion: In asymptomatic newborns with prenatally diagnosed lung lesions, most US practitioners obtain chest X-ray initially in NICU
Open
Summaries Jason gave as host · Etiologies (Gastroschisis/NEC/Atresia/Volvulus) 2 summaries
Open the Etiologies (Gastroschisis/NEC/Atresia/Volvulus) collection →
Gastroschisis and sutureless abdominal wall closure
Host summary
Jason Fraser summarizing a resource: Initial small studies showed that some sutureless patients had a high umbilical hernia repair rate, or at least a high umbilical hernia rate.
Open
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
Host summary
Jason Fraser summarizing the discussion: Some institutions ignore bilious emesis or bilious NG residuals completely during gastroschisis feeding advancement.
Open
Summaries Jason gave as host · Gastroschisis 2 summaries
Open the Gastroschisis collection →
Gastroschisis and sutureless abdominal wall closure
Host summary
Jason Fraser summarizing a resource: Initial small studies showed that some sutureless patients had a high umbilical hernia repair rate, or at least a high umbilical hernia rate.
Open
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
Host summary
Jason Fraser summarizing the discussion: Some institutions ignore bilious emesis or bilious NG residuals completely during gastroschisis feeding advancement.
Open
Summaries Jason gave as host · Gastroschisis 2 summaries
Open the Gastroschisis collection →
Gastroschisis and sutureless abdominal wall closure
Host summary
Jason Fraser summarizing a resource: Initial small studies showed that some sutureless patients had a high umbilical hernia repair rate, or at least a high umbilical hernia rate.
Open
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
Host summary
Jason Fraser summarizing the discussion: Some institutions ignore bilious emesis or bilious NG residuals completely during gastroschisis feeding advancement.
Open
Summaries Jason gave as host · Intestinal Rehab 2 summaries
Open the Intestinal Rehab collection →
Gastroschisis and sutureless abdominal wall closure
Host summary
Jason Fraser summarizing a resource: Initial small studies showed that some sutureless patients had a high umbilical hernia repair rate, or at least a high umbilical hernia rate.
Open
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
Host summary
Jason Fraser summarizing the discussion: Some institutions ignore bilious emesis or bilious NG residuals completely during gastroschisis feeding advancement.
Open
Summaries Jason gave as host · Umbilical Hernia 1 summary
Open the Umbilical Hernia collection →
Gastroschisis and sutureless abdominal wall closure
Host summary
Jason Fraser summarizing a resource: Initial small studies showed that some sutureless patients had a high umbilical hernia repair rate, or at least a high umbilical hernia rate.
Open
Summaries Jason gave as host · Umbilical Hernia 1 summary
Open the Umbilical Hernia collection →
Gastroschisis and sutureless abdominal wall closure
Host summary
Jason Fraser summarizing a resource: Initial small studies showed that some sutureless patients had a high umbilical hernia repair rate, or at least a high umbilical hernia rate.
Open