A5074229807- Clinical Nutrition and Gastroenterology
- Organ Transplantation Techniques and Outcomes
- Child Nutrition and Feeding Issues
- Intestinal Malrotation and Obstruction Disorders
- Central Venous Catheters and Hemodialysis
- Pediatric Hepatobiliary Diseases and Treatments
- Liver Disease and Transplantation
- Congenital gastrointestinal and neural anomalies
- Organ and Tissue Transplantation Research
- Pharmaceutical studies and practices
- Congenital Anomalies and Fetal Surgery
- Child Nutrition and Water Access
- Gastrointestinal disorders and treatments
- Electrolyte and hormonal disorders
- Abdominal Surgery and Complications
- Organ Donation and Transplantation
- Metabolism and Genetic Disorders
- Teratomas and Epidermoid Cysts
- Iron Metabolism and Disorders
- Renal Transplantation Outcomes and Treatments
- Clinical practice guidelines implementation
- Dialysis and Renal Disease Management
- Thermoregulation and physiological responses
- Gastrointestinal Tumor Research and Treatment
- Transplantation: Methods and Outcomes
Seattle Children's Hospital
2016-2025
University of Washington
2017-2025
Seattle University
2017-2023
University of Washington Medical Center
2023
Children's Hospital of Philadelphia
2015
Children's Hospital of Pittsburgh
2014
Intestinal failure requires the placement and maintenance of a long-term central venous catheter for provision fluids and/or nutrients. Complications associated with this access contribute to significant morbidity mortality, while loss is an increasingly common reason intestinal transplant referral. As more emphasis has been placed on prevention line-associated bloodstream infections new technologies have developed, care lines improved; however, because evolved independently in local...
Pediatric liver retransplantation (rLT) has historically shown poorer outcomes compared to primary transplantation (pLT). Comprehensive studies assessing for pediatric rLT candidates under the modern allocation policy are lacking. OPTN data from January 1, 2010, December 31, 2022 were obtained; exclusion criteria included ≥18years of age and those listed or transplanted multiple organs. 7645 children met inclusion criteria: 7162 pLT 483 candidates. The candidates, despite a shorter median...
Liver transplant (LT) waitlist mortality occurs in 10% of children; innovative strategies to expand access LT can be lifesaving. Outcomes ABO incompatible (ABOi) performed between 1999 and 2023 at a high-volume center were compared compatible (ABOc) LT. 25 ABOi among 270 LT; 72% listed with status 1/1A/1B or median pediatric end-stage liver disease/model for disease 40 (IQR 32,41). Time on the recipients was shorter (median 11 days [IQR 4,46]) ABOc (113 39,252], p < 0.001). graft types 64%...
Biliary atresia (BA) is a pediatric cholangiopathy with unknown etiology occurring in isolated and syndromic forms. Laterality defects affecting the cardiovascular gastrointestinal systems are most common features present BA. Most cases sporadic, although reports of familial have led to hypothesis genetic susceptibility some patients. We identified child BA, malrotation, interrupted inferior vena cava whose father presented situs inversus, polysplenia, panhypopituitarism, mildly dysmorphic...
Background. Unlike other solid organs, no standardized treatment algorithms exist for intestinal transplantation (ITx). We established a consortium of American ITx centers to evaluate current practices. Methods. All performing during the past 3 y were invited participate. As consortium, we generated questions and collect data from each institution. The compiled analyzed. Results. Ten participated, 211 (range, 3–46; mean 21.1). Induction regimens varied widely. Thymoglobulin was most common,...
Body composition prediction equations using skinfolds are useful alternatives to advanced techniques, but their utility across diverse paediatric populations is unknown.To evaluate published and new samples of children with health conditions affecting growth body composition.Anthropometric dual-energy X-ray absorptiometry (DXA) measures were obtained in Down syndrome (n = 59), Crohn disease 128), steroid-sensitive nephrotic 67) a healthy reference group 835). Published evaluated. New...
Malnutrition is a common complication of end-stage liver disease (ESLD) associated with poor transplant outcomes. Nasogastric feeds are used for nutritional supplementation, but some patients remain malnourished. Parenteral nutrition (PN) can be effective, has potential complications. The primary objective was to evaluate the effect PN on anthropometric measures in children ESLD awaiting transplant. Secondary objectives were evaluation PN-associated complications, function tests, pediatric...
Iron deficiency (ID) is the most common nutritional affecting children undergoing intestinal rehabilitation (IR). Patients may be asymptomatic or present with nonspecific symptoms including fatigue, irritability, and dizziness. The diagnosis of ID in this population can complicated by coexistence systemic inflammation other deficiencies which mimic ID. Many routinely available laboratory tests lack specificity no consensus on screening available. Success oral enteral treatment impeded poor...
SMOFlipid is a mixed-lipid emulsion approved for adults in the United States as an alternative to soybean oil-based lipid (SO). There are limited data on use of pediatrics and its effect fatty acid (FA) profile. Our objective was characterize changes FA profile, liver function, growth pediatric patients with intestinal failure (IF), following transition from SO or fish-oil (FO) combination SMOFlipid.A retrospective case series conducted parenteral nutrition-dependent IF transitioned...
Pediatric liver transplantation for small recipients presents significant challenges, particularly in securing suitably sized donor organs. This case report illustrates the feasibility of performing an situ split procurement 18.5-kg toddler, smallest recorded OPTN database to date, a critically ill 8-week-old infant recipient.
Abstract Background The coronavirus disease 2019 (COVID‐19) pandemic has influenced how healthcare is being provided, particularly in patients whose diagnoses require multidisciplinary care, such as pediatric intestinal failure (IF). We sought to ascertain the effects of COVID‐19 on delivery for with IF. Methods A 20‐question survey was administered members North American Society Pediatric Gastroenterology, Hepatology, and Nutrition Intestinal Rehabilitation (IR) Special Interest Group....
Catheter-related thrombosis (CRT) is a devastating complication of central venous catheters in children with intestinal failure (IF), but the optimal preventive therapy CRT unknown. This study assessed efficacy and safety 2 protocols secondary anticoagulation prophylaxis low-molecular-weight heparin (LMWH).This comparative cohort from IF programs who received LMWH for CRT. The short-term protocol group (N = 13) therapeutic dosing until thrombus resolution or ≤3 months. In long-term 26),...
Due to altered nutrition regimens and complex medical needs, pediatric intestinal failure (IF) may have a powerful impact on health-related quality of life (HRQOL). Studies shown that children with IF experience lower HRQOL. Data the HRQOL families are lacking.We performed prospective analysis in regional rehabilitation program from 2011 2018. The Pediatric Quality Life Family Impact Module (FIM) was administered annually parents. FIM scores were regressed risk factors using linear...
This study evaluates whether implementation of a content expert–developed clinical documentation tool can be beneficial to workflow by reducing time from patient arrival encounter closure among pediatric patients receiving intestinal rehabilitation.
Iron supplementation is required for pediatric patients with intestinal failure (IF). There a paucity of literature on optimal iron formulation and outcomes in this patient population that requires ongoing supplementation. The aim study was to assess IF receiving sucrose (IS) vs ferric carboxymaltose (FCM) infusions.This single-center observational cohort requiring intravenous Patients were transitioned from IS FCM as therapy. Longitudinal linear mixed-effects models generalized estimating...
Disorders of intestinal enteroendocrine cells (EEC) are a rare cause congenital diarrhea and diabetes. The gene NEUROG3 is essential in EEC differentiation, mutations this lead to paucity the intestine pancreas, often presenting clinically as diabetes mellitus. We present earliest known diagnosis -associated enteric endocrinopathy, which was identified on neonatal genetic panel sent at 4 weeks age. Our patient presented with severe diarrhea, malnutrition, electrolyte derangements, He started...
A 12-year-old girl with a history of well-controlled constipation presents to the emergency department after having an uncomfortable, large, nonbloody bowel movement at home followed by sacral numbness and bright red blood seeping out her rectum. Her review systems is remarkable for 1 2 soft movements per day occasional cramping, painful defecation (dyschezia), sensation incomplete evacuation (tenesmus). She premenarchal denies any easy bleeding or bruising trauma. additionally...
A 12-year-old girl with a history of well-controlled constipation presents to the emergency department after having an uncomfortable, large, nonbloody bowel movement at home followed by sacral numbness and bright red blood seeping out her rectum. Her review systems is remarkable for 1 2 soft movements per day occasional cramping, painful defecation (dyschezia), sensation incomplete evacuation (tenesmus). She premenarchal denies any easy bleeding or bruising trauma. additionally...