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Educational Webinars & Interactive Learning
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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SMOF lipids are a better choice as they are a more well-balanced emulsion with an omega-3 and omega-6 ratio of 2.5 to 1, are less inflammatory than Intralipid, and promote bile flow. Intestinal Rehabilitation Webinar 2023 - Top 5 Key Takeaways · 10:28
Intestinal Rehabilitation Webinar 2023 - Top 5 Key Takeaways
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In November 2023 we held the first Intestinal Rehabilitation webinar with Dr. Paul Wales & Dr. Michael Helmrath, 2 experts from the Intestinal Rehab center at Cincinnati Children's.
These are the top 5 key takeaways from this webinar!!
video12:14 · Jun 2024
Pediatric Intestinal Failure Quiz | Intestinal Rehab Clinic Showdown w/ Dr. Paul Wales & Dr. Michael Helmrath
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Test your knowledge on pediatric intestinal failure with this interactive quiz from the Intestinal Rehab Clinic Showdown. Learn about categories like Short Bowel Syndrome and Mucosal Enteropathies, intestinal adaptation, and specific condit
video1:43 · Oct 2026
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article · Oct 2026
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Intestinal Rehabilitation Webinar 2023 - Top 5 Key Takeaways
Young infants, babies, and young children have tremendous gut growth potential, with the gut growing for the first several years of life.
clinicalPaul Well0:49 ↗
A term baby will have 160 centimeters of small bowel, and by age 5 years it almost triples to about 425 to 450 centimeters.
clinicalPaul Well1:17 ↗
Residual bowel should be discussed as a percentage of what is normal for a child of that age, not in absolute centimeters.
clinicalPaul Well1:02 ↗
You can have as low as 10% expected gut length and still achieve enteral autonomy if you have the majority of your colon in continuity.
clinicalPaul Well1:51 ↗
The more important factor than the ileocecal valve is the presence or absence of the distal small bowel (ileum) and right colon that can act as a site for bile reclamation and enterohepatic circulation.
clinicalMichael Helmrath2:30 ↗
The distal ileum produces hormones and incretins including GLP-2, GLP-1, and PYY.
clinicalMichael Helmrath2:43 ↗
The importance is not the ileocecal valve itself but the distal ileum and proximal colon where bilioenteric circulation occurs and where hormones and peptides that help intestinal growth and absorption are produced.
Host summaryThe host summarizing the discussion — not the host's own clinical position3:01 ↗
The surgical strategy at the first operation should provide a pathway forward that allows early interval feeding.
clinicalMichael Helmrath3:29 ↗
It is sometimes better to stage reconstruction with the plan to restore bowel continuity under more controlled conditions.
opinionMichael Helmrath3:38 ↗
In situations of overwhelming intestinal loss, the strategy is to provide proximal control that allows feeding to occur without the enteral stream going through, and to leave questionable bowel segments that have potential to heal and can make a huge difference in the child's lifetime.
clinicalMichael Helmrath3:53 ↗
As long as you can divert proximally and the baby is stable, you can leave questionable bowel for potential use at later secondary reconstructive procedures.
clinical4:26 ↗
The overarching principle is to deliver adequate nutrition to have normal growth within normal parameters, ideally enterally.
clinicalPaul Well5:08 ↗
As much as possible, the goal is to establish normal feeding behavior, recognizing that enteral nutrition is more than just nutrition.
clinicalPaul Well5:28 ↗
If a patient needs tube support from the beginning, bolus feeding should be tried rather than defaulting to continuous feeding.
clinicalPaul Well5:52 ↗
If the child fails a gastric approach (both bolus and continuous), the strategy is to feed beyond the stomach and decompress the stomach through an NG tube.
clinicalPaul Well6:15 ↗
Breast milk is the formula of choice, not only for its nutritional benefits but for all the other beneficial components within breast milk.
clinicalPaul Well6:42 ↗
Starting at the single amino acid level for protein is the generalized preference, ensuring patients are not having high stool output, high fluid losses, wound breakdown, rashes, or emesis.
clinicalMichael Helmrath7:28 ↗
Long-chain fat is the preferred fat module rather than MCT fat, especially in the setting of short bowel syndrome.
clinicalPaul Well7:57 ↗
Long-chain fat is a much stronger stimulus for GLP-2 release compared to MCT, which is important when trying to drive intestinal adaptation.
clinicalPaul Well8:15 ↗
Not every child needs to be on SMOF lipids.
opinionPaul Well9:00 ↗
For preterm babies, SMOF is not the ideal lipid emulsion but is the best currently available.
clinicalPaul Well9:03 ↗
SMOF lipids do not have enough arachidonic acid, which is important for brain development.
clinicalPaul Well9:16 ↗
Two strategies exist to treat cholestasis: reduce the total amount of fat, or change the composition to introduce SMOF lipids or Omegaven.
clinical9:34 ↗
Lipid restrictions that reduce lipid dose to 1 g per kg per day can reverse cholestasis but result in reduced calorie delivery that can impair growth and potentially impact neurocognitive development.
clinical9:50 ↗
Omegaven is essentially pure fish oil with omega-3 and is dosed at 1 g/kg, so babies take a calorie hit.
clinical10:07 ↗
SMOF lipids are a better choice as they are a more well-balanced emulsion with an omega-3 and omega-6 ratio of 2.5 to 1, are less inflammatory than Intralipid, and promote bile flow.
clinical10:28 ↗
SMOF lipids should not be restricted and can be given at no less than 2 or 2.5 g per kg per day.
clinical10:28 ↗
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