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Update Course 2021: APSA PDC UPDATES
With Dr. Marjorie Arca
Part of
Midgut Volvulus 6 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The APSA Professional Development Committee was established approximately five years ago to curate information from journals, blogs, and guidelines
The PDC communicates with the American Board of Surgery and provides information for continuous certification
Family-centered care reduces ED visits, decreases anxiety in parents and children, reduces length of stay, reduces medical errors, and improves staff satisfaction
Family-centered care is cost effective and decreases legal claims and legal expenses
Establishing intestinal continuity as soon as possible is imperative because it allows enteral nutrition to start with human milk, which helps with intestinal rehabilitation
Intestinal transplantation is becoming less common because centers are getting very good at intestinal rehabilitation
The ileocecal valve decreases the occurrence of small bowel bacterial overgrowth, which can impede the ability to increase feeds
The valve may be more of a prognosticator of how much terminal ileum remains rather than being independently important, as recent studies show terminal ileum resection is more relevant than valve presence
PPI should be started right away after massive bowel resection, not just when starting feeds
Timing for intestinal lengthening procedure is considered around one year of age when the intestine is wide enough to perform the procedure and when the patient has stalled on feedings
Lengthening procedures have real concerns about deleterious effects on motility, which can be worse than having a short bowel
Intestinal lengthening procedures are becoming rarer due to improvements in medical therapy and intestinal rehabilitation centers
Button batteries create both an alkali burn and an electrical burn in the esophagus
Button battery ingestion requires immediate transfer to a pediatric center and removal under direct visualization in the operating room
Factors associated with achieving enteral autonomy include longer residual small bowel, younger age at time of intestinal resection, preservation of the ileocecal valve, diagnosis other than necrotizing enterocolitis, absence of liver disease, and normal gastrointestinal motility
Current NASPGHAN and ESPGHAN guidelines recommend starting enteral nutrition and advancing enteral feeding as soon as possible to help with intestinal rehabilitation
Human milk (mother's expressed breast milk or donor milk) is associated with fewer days of parenteral nutrition and is protective for the liver
Amino acid based formulas have more favorable outcomes than protein hydrolysis formulas when human milk is not available
Guidelines recommend using SMOF lipids (four combination lipids of soy, fish oil, olive oil, and medium chain triglyceride oil) for parenteral nutrition as they are protective
Omegaven can be used when liver function tests go up and there is evidence of liver dysfunction, but it can decrease the amount of lipids the patient receives
After massive small bowel resection, there is reflex hypergastrinemia that impacts feeding tolerance, and PPI or H2 blockers are recommended with strong recommendation and high level of evidence
Teduglutide (glucagon-like peptide 2) increases epithelial proliferation and has been approved in children, but outcomes are not as impactful as in adults because outcomes measured are number of hours off TPN rather than days
Intestinal lengthening procedures should be delayed for a few months until adaptation starts because this allows more length to be gained from the remaining bowel
For button battery ingestion in children greater than 12 months old, give honey 10 ml every 10 minutes while arranging transfer
For button battery ingestion in children less than 12 months old, give sucralfate suspension 1 gram per 10 ml or 10 ml every hour times 3