The objective of this thesis was to evaluate the effect of implementation of a multidisciplinary intestinal rehabilitation program (IRP) on clinical outcomes of pediatric intestinal failure (IF). This was attained by two comprehensive reviews and three related research projects that contribute both clinical and methodological knowledge. Pediatric IF is a complex medical condition. Advances have been made clinically in recent years, but research in the field has suffered from methodological challenges and poor quality. Many of these were outlined and solutions suggested in this thesis. The first project compared clinical outcomes of three eras of pediatric IF-management using univariate categorical and time-to-event analysis. While IRP-introduction led to an increased transplantation rate and improved clinical outcomes, further progress was made and the natural course of the disease changed with IRP-maturation and adoption of novel treatment strategies. The second project quantified the continuous change over time of pediatric IF over a 15-year time period and tested systematically introduced treatments using novel methods. Multivariate time series analysis was applied to assess the relationship between new treatment options and change in clinical outcomes. The study showed that IRP-introduction and omega-3 lipid emulsions independently decreased disease-specific mortality from liver failure and sepsis when adjusted for disease severity, while serial transverse enteroplasty and ethanol locks did not impact mortality significantly. With improved mortality of pediatric IF, assessment of morbidity became imperative. After having identified a severe lack in methodology to measure neonatal and infant health-related quality of life (NIHRQOL) in a systematic literature review, the conceptual meaning of NIHRQL was explored in the final project. It concluded that NIHRQOL is a multidimensional, multilayered and interconnected concept, in which the childâ s needs are fundamental factors, and the caregiverâ s and societyâ s ability to meet those needs characterize the interdependence between the child and its caregiving environment. In summary, the complexity of pediatric IF and related methodological challenges were identified. Methodological solutions were described and illustrated. Clinical advancements of pediatric IF were quantified, and IRP-introduction and omega-3 lipid emulsions recognized as strongest contributors. Finally, the meaning of NIHRQOL was explored and organized in a conceptual framework in this thesis.

A complex disease entity, intestinal failure (IF) has only recently become accepted as a distinct clinical syndrome. Improvements across a wide range of disciplines-including critical care and organ transplantation as well as surgical, medical, and nutritional therapies-have led to a steady rise in survival and quality of life for patients with IF.

This practical 'how to' manual for the multidisciplinary team managing this difficult patient population. This book considers the diagnosis, treatment (both medical and surgical) and management of adult and pediatric patients with intestinal failure. It provides a long term view in dealing with these patients to improve results, quality of life and patient care. It brings together an editorial team to encompass adult and pediatric gastroenterology, surgery and nutrition. Intestinal failure is a challenging, emerging field that has been the subject of much research and debate in recent years and has only recently become widely accepted as a distinct clinical syndrome. This book provides an in-depth review of scientific theory and clinical practice relating to intestinal failure with specific emphasis on assessment and management as part of a multidisciplinary team. This book provides a practical how-to guide to the management of adult and pediatric patients with intestinal failure, focusing on quality-of-life issues that are at the heart of patient care.

Short bowel syndrome (SBS) is defined as intestinal failure following a loss of intestinal length which causes marked maldigestion and malabsorption of dietary nutrients and induces major fecal issues, loss of energy, nitrogen, and fat. Intestinal failure and SBS continue to be important clinical problems due to their high mortality and morbidity rates, as well as their devastating socioeconomic effects. Although intestinal transplantation has emerged as a feasible alternative in the treatment of children with SBS in the last two decades, intestinal adaptation remains the only chance for survi.

Advances in Pediatrics reviews the most current practices in pediatrics. A distinguished editorial board, led by Dr. Carol Berkowitz, identifies key areas of major progress and controversy and invites expert pediatricians to contribute original articles devoted to these topics. These insightful overviews bring concepts to a clinical level and explore their everyday impact on patient care. Topics such as fetal diagnosis and surgical intervention, updates in pharmacology, and fatty liver disease are represented, highlighting the most current and relevant information in the field.

Encyclopedia of Gastroenterology, Second Edition provides a comprehensive and concise reference on all aspects of gastroenterology and hepatology, including the organs in the gastrointestinal system, their functions in health and disease, and strategies or procedures to resolve or prevent problems and disease. This concise, up-to-date information includes comprehensive sections on the impact of nutrition, gastrointestinal microbiota, lifestyle, commonly used drugs, and surgical procedures on health and disease. Since the first edition, attention to the roles of nutrition and gastrointestinal microorganisms (microbiota, formerly Microbiota) in health and disease has skyrocketed. In addition, an entirely new section on obesity and diabetes is included. Presents comprehensive coverage of every topic within gastroenterology Offers researchers a one-stop, fully-referenced resource to explore questions Includes teaching tools, multimedia and interactive elements Provides readers with multi-layered content and a media-rich learning resource for both instructors and students Covers hot new topics in GI health and disease, including new sections on stem cells, intestinal bacteria, obesity and intestinal microbiota

For this important and unique issue of Gastroenterology Clinics, Consulting Editor Dr. Alan Buchman decided to serve as co-Guest Editor with Dr. David Hackam to provide a “bench to bedside look at intestinal failure. Authors have contributed reviews on the status of the science behind artificial organs while emphasizing how to clinically prepare for intestinal failure. Articles are devoted to the following topics: Initial Evaluation and Care of the Patient with New Onset Intestinal Failure; Getting the Patient Ready for Home Parenteral Nutrition; Pediatric Intestinal Failure: Etiology and Management; Predictors of Intestinal Adaptation in Children; Management of the Patient with Chronic Intestinal Pseudo-obstruction and Intestinal Failure; Intestinal Growth and Adaptation Following Resection in Intestinal Failure; Fluid and Electrolyte Management and Prevention of Dehydration in Intestinal Failure; The Oley Foundation and Consumer Support Groups; Weaning from Parenteral Nutrition; Hepatobiliary Complications of Intestinal Failure; Non-Transplant Surgery in Intestinal Failure; Indications for Intestinal Transplantation in Intestinal Failure; Intestinal Regeneration and the Artificial Gut; Bench to Bedside Approaches for Engineered Intestine, Esophagus and Colon; and Fetal and Amniotic Stem Cells in Gut Engineering. Readers will come away with a true state-of-the-art look at how to manage intestinal failure.