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Live Event Content
2025 Pediatric Surgery Update Course - Updates in NEC Management
hosted by Dr. Todd Ponsky
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Update Course Rewind 2025: Updates in NEC Management
11 min · Published Jul 2026
Video
STAT trial: stoma or intestinal anastomosis for necrotizing enterocolitis: a multicentre randomized controlled trial
57 s · Published Apr 2025
Podcast
Necrotizing Enterocolitis with Dr. Gail Besner
46 min · Published May 2017
Video
2025 Pediatric Surgery Update Course - Updates in Pediatric Surgery feat. non-JPS Journals
Dr. Todd Ponsky · 22 min · Published Aug 2025
Video
Update Course Rewind: Laparotomy Over PPD 2022
Published Jul 2023
Video
Availability, utilization, and barriers to bowel ultrasound for necrotizing enterocolitis...
55 s · Published Jul 2026
Video
Clinical & Research Update: Renal Tumors with Drs. Ethan Smith, Lindsay Haacker, Michael Daugherty, and Meera Kotagal
71 min · Published Sep 2026
Video
Clinical & Research Update: Neuroblastoma with Drs. Katherine Somers, Cara Morin, Juan Gurria, and Meera Kotagal
67 min · Published Sep 2026
Video
Clinical & Research Update: Sarcoma w/ Drs. Roshni Dasgupta, Joseph Pressey, Arthur Meyer, Luke Pater
66 min · Published Sep 2026
Video
2026 Laparoscopic Pediatric Hernia Repair
123 min · Published Jun 2026
Video
Beyond the Spectrum: Diagnosis, Myths & Management - Caitlin Couch & Leslie Lopez - APP Conference 2026
50 min · Published May 2026
Video
Dysautonomia: Navigating the Journey - Martha Willis - APP Conference 2026
55 min · Published May 2026
What the experts said
Abdominal X-rays for NEC have high specificity but very low sensitivity, with studies showing sensitivity between 13 and 25%
Ultrasound can detect bowel wall thickening, thinning, perfusion, peristalsis, and peritoneal and hepatic findings that X-ray cannot
Ultrasound is indicated when the neonate does not appear to have NEC and X-ray is equivocal, in early stages of NEC when X-ray sensitivity is very low, or when the baby is very sick and X-ray does not match clinical scenario
High-risk ultrasound findings for bowel perforation include pneumoperitoneum, focal fluid collections, and complex free fluid
Intermediate-risk ultrasound findings include increased bowel wall echogenicity, absent perfusion, portal venous gas, and bowel thinning or thickening; the more of these present, the more likely surgical intervention is needed
NEC is a progressive disease; the bowel is a symptom or result of the illness, not the cause, and the disease can still progress even after resection
Spontaneous intestinal perforation is totally different from NEC and was an exclusion criterion for the trial
Pancolitis represents the other end of the spectrum where you cannot do an anastomosis
At Great Ormond Street Hospital, primary anastomosis has been the operative choice for quite some time under the guidance of Mr. Kiely, Professor Spitz, and Agostino Pierro
The RCT used intraoperative randomization, with consent obtained preoperatively but final eligibility determined by surgeon's judgment during laparotomy after examining the bowel
Infants with very small perforations (spontaneous intestinal perforation) where no one would realistically do a stoma, and those with very extensive disease where no one would want to do primary anastomosis, were excluded from randomization
More than 20 babies were randomized intraoperatively by the speaker for the trial; randomization involved unscrubbing and going to the computer during the operation
The trial was never going to be powered for mortality or neurodevelopmental outcomes, so time on parenteral nutrition was chosen as the primary outcome
The primary outcome of the RCT was time on parenteral nutrition; those who had primary anastomosis got onto full enteral feeds sooner and finished parenteral nutrition earlier
There was no significant difference in mortality between primary anastomosis and stoma groups; if anything, mortality was slightly higher in the stoma group but not significantly different
Stoma complications were inevitably present in the stoma group; there were some complications in the primary anastomosis group, but overall complications were worse in the stoma group
The trial conclusions were that primary anastomosis led to reduced duration of parenteral nutrition, reduced intestinal complications, and no difference in mortality
A randomized controlled trial of mucus fistula refeeding is ongoing, with time to full enteral feeds as the primary outcome; most of the population is NEC but includes other neonates with bowel resection
Exclusion from the trial was mainly upfront when parents did not want to give consent due to distress; intraoperatively, those with focal intestinal perforation and instability, pancolitis, or distal colonic disease were not considered
Radiologists can detect perforation by ultrasound even when not visible on plain film; some babies will have clear evidence of perforation at operation that was missed on X-ray but detected by ultrasound
A 2017 meta-analysis highlighted potential advantages of primary anastomosis compared to stoma but concluded that a randomized controlled trial was necessary due to lack of RCT evidence and potential differences in disease severity between groups
Evidence for mucus fistula refeeding is not strong based on a systematic review and meta-analysis by Bonnie Gisani from Toronto SickKids
A recent paper in Journal of Surgical Research showed that early stoma closure (less than 8 weeks) appears safe, but the study is underpowered and concerning because two infants had repeat episodes of NEC