Multidisciplinary Approach: Intestinal Failure Innovations
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Practical Approach: Intestinal Failure Innovations
116 min · Published Dec 2014
Video
Intestinal Failure - Feeding Access and Nutrition
118 min · Published Nov 2018
Video
Advancements in Pediatric Intestinal Failure: Innovative Therapies and Improved Outcomes
17 min · Published Aug 2026
Podcast
Intestinal Rehabilitation, Episode 3: Enteral Autonomy, Part 1
16 min · Published Mar 2022
Podcast
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
44 min · Published May 2017
Podcast
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
44 min · Published May 2017
Video
Pediatric Surgical Oncology Research Collaborative (PSORC): Studying Rare Pediatric Tumors
56 s · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Pooling Patients to Study Rare Pediatric Tumors: An Introduction to PSORC
56 s · Published May 2026
Video
The fetal frontier: A review of current and emerging fetal therapies for genetic diseases
44 s · Published May 2026
Video
Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients
1 min · Published May 2026
What the experts said
Team approach to intestinal failure reduced 1-year mortality from 30-40% to approximately 5% per year at University of Michigan
Cincinnati's intestinal failure program was started in 1984
Intestinal failure is defined by inadequate bowel length OR bowel that doesn't absorb nutrition and fluid adequately to maintain growth
Almost 30% of patients leaving NICU without rotavirus vaccination were readmitted with rotavirus infection
Joint weekly rounds with surgeons, gastroenterologists, dietitians, and neonatologists help identify protocol deviations and build family rapport
Breast milk provides not just immunostimulatory benefits but motility effects through oligosaccharides and healing properties
PIFCON study data showing 25% mortality or transplant referral are now archaic; outcomes have improved dramatically in past 5 years
Cincinnati reduced catheter-related bloodstream infections from 12 per 1000 catheter-days to 2 per 1000, approaching <1 per 1000
Standardized central line bundles and multi-hospital communication networks have reduced line infections across pediatric populations
Intestinal failure patients have unique propensity for line infections and different infection types compared to general pediatric population
Toronto experience paper in JPGN examined PICC lines for TPN administration
Complication-free survival of PICC lines is approximately half that of broviacs according to IR literature
Subclavian approach for central lines carries higher risk of stenosis compared to jugular approach
Lack of vascular access is no longer a common indication for intestinal transplant in past 3 years at some centers
Ethanol locks use 70% concentration with 2-6 hour dwell time, can be given 3 times weekly (Monday/Wednesday/Friday) with good results
Ethanol locks work better with 6.6 French catheters than smaller catheters; smaller PICC lines tend to occlude
Younger NPO infants often cannot tolerate TPN windows required for ethanol locks
UK predominantly uses taurolidine locks rather than ethanol locks for line infection prevention
Line care education is crucial; recurrent infections warrant revisiting line care practices before implementing locks
Fungal line infections are pulled more promptly, but some centers now treat through even fungal infections in patients with limited vascular access
Phytosterols in soy-based lipids are cleared poorly, share cholesterol transporter (down-regulated by endotoxemia), and reduce FXR receptor expression causing hepatocyte damage
Limiting lipid intake to 1 g/kg/day reduces cholestasis rate to less than 5% of patients
Fish oil-based lipid (Omegaven) may have anti-inflammatory advantage and benefit patients who don't respond to lipid restriction
Neonatologists often maintain higher lipid doses (2-3 g/kg/day) due to concern about depriving infants of linoleic acid and affecting brain development
With lipid restriction protocols, cholestasis rarely emerges from Cincinnati NICU
Standard metrics for essential fatty acid deficiency are based on malnourished children not on TPN, so altered triene:tetraene ratios may not apply the same way
Symptomatic essential fatty acid deficiency is not seen in practice with lipid restriction protocols
Higher glucose infusion rates become less efficient as caloric source and are pushed toward fatty acid and fat deposition
Age-based glucose infusion rate limits: generally 15-16 in premature/infants, gradually decreasing with age
Intestinal failure patients may not need to maintain 50th percentile growth; unclear what appropriate growth curve should be for this population
Neurodevelopmental outcomes in intestinal failure are multifactorial (prolonged hospitalization, recurrent admissions, neonatal insults), not solely attributable to lipid strategies
Babies with spontaneous intestinal perforation (no functional bowel removed) still require 2-3 months of parenteral nutrition
Feed absorption and ability to progress feeds are the best measures of bowel function, not absolute bowel length
Ability to wean TPN while maintaining good growth is the most important functional measure
Upper GI studies can identify problems but cannot rule them out; absence of findings does not exclude anastomotic issues
Delayed contrast films may reveal that barium flows into anastomosis but doesn't flow out well, suggesting functional problem
Some anastomoses are not strictured but kinked or twisted, creating functional rather than anatomic obstruction
Endoscopy is valuable for visualizing anastomosis diameter; sometimes can get scope on both sides but cannot see anastomosis itself
Motility abnormalities in short bowel syndrome are not well described; manometric assessment is less helpful in this population
Post-gastric tube feeding with gastric decompression can demonstrate distal bowel function and avoid unnecessary surgeries