Clinical Research

Short Bowel Syndrome

We are currently interested in examining our outcomes in neonates and infants with intestinal failure and short bowel syndrome. Our group has found that a major short come of previous studies which have examined this problem is that absolute lengths of small bowel have been used. We have adjusted small bowel length to the gestational age of the neonate. By doing this we are able to much more tightly correlate the outcome of our neonates to small bowel length.


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References

Website Link: Department of Surgery Pediatric Short Bowel Syndrome Website

Recent publications by our group:

pdf.jpg Pediatric short-bowel syndrome: the cost of comprehensive care.  Spencer AU, Kovacevich D, McKinney-Barnett M, Hair D, Canham J, Maksym C, Teitelbaum DH.  Am J Clin Nutr. 2008 Dec;88(6):1552-9.

pdf.jpg  Pediatric short bowel syndrome: redefining predictors of success.  Spencer AU, Neaga A, West B, Safran J, Brown P, Btaiche I, Kuzma-O'Reilly B, Teitelbaum DH.  Ann Surg. 2005 Sep;242(3):403-12.

pdf.jpg  The 2 STEP: an approach to repeating a serial transverse enteroplasty.  Ehrlich PF, Mychaliska GB, Teitelbaum DH.  J Pediatr Surg. 2007 May;42(5):819-22.

pdf.jpg  Novel agents in the treatment of intestinal failure: humoral factors.  Yang H, Teitelbaum DH.  Gastroenterology. 2006 Feb;130(2 Suppl 1):S117-21.


pdf.jpg  Pediatric short-bowel syndrome: the cost of comprehensive care. Spencer, AU, Kovacevich, D, McKinney-Barnett, M, Hair, D, Canham, J, Maksym, C, Teitelbaum, DH: Am J Clin Nutr. 2008 Dec;88(6):1552-9.  This is the first article which describes the full cost of caring for pediatric patients with short bowel syndrome.

Spencer AU, Neaga A, West B, Safran J, Brown P, Btaiche I, Kuzma-O'Reilly B, Teitelbaum DH.: Pediatric short bowel syndrome: redefining predictors of success.  Ann Surg. 2005 Sep;242(3):403-9; discussion 409-12.

Miyasaka EA, Brown PI, Kadoura S, Harris MB, Teitelbaum DH.: The adolescent child with short bowel syndrome: new onset of failure to thrive and need for increased nutritional supplementation. J Pediatr Surg. 2010 Jun;45(6):1280-6.


Hirschsprung disease

We are currently interested in understanding methods of preventing the development of Hirschsprung-associated enterocolitis (HAEC). We are heading up a multi-center prospective study which is testing whether the prophylactic use of probiotics can prevent or decrease the incidence of HAEC. The study is sponsored by the VSL Pharmaceutical Corp, Milan, Italy.


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Figure Legend: Theoretical etiologies of Hirschsprung – associated enterocolitis. Potential mechanisms include bacterial overgrowth due to stasis; alteration of mucin production which may compromise the barrier function; or a deficiency in the mucosal immune system.



References

Website Link: Department of Surgery Pediatric Hirschsprung disease Website

Recent publications by our group:
Are the long-term results of the transanal pull-through equal to those of the transabdominal pull-through? A comparison of the 2 approaches for Hirschsprung disease.

Posterior myotomy/myectomy for persistent stooling problems in Hirschsprung's disease.

A decade of experience with the primary pull-through for hirschsprung disease in the newborn period: a multicenter analysis of outcomes.

Kim AC, Langer JC, Pastor AC, Zhang L, Sloots CE, Hamilton NA, Neal MD, Craig BT, Tkach EK, Hackam DJ, Bax NM, Dillon PA, Chamberlain JN, Teitelbaum DH.: Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach. J Pediatr Surg. 2010 Jun;45(6):1213-20.


Pastor AC, Osman F, Teitelbaum DH, Caty MG, Langer JC.: Development of a standardized definition for Hirschsprung's-associated enterocolitis: a Delphi analysis. J Pediatr Surg. 2009 Jan;44(1):251-6.


Stranzinger E, DiPietro MA, Teitelbaum DH, Strouse PJ.: Imaging of total colonic Hirschsprung disease.  Pediatr Radiol. 2008 Nov;38(11):1162-70.

TPN-Associated Liver Disease

A major problem with the administration of TPN to neonates and long-term in older patients is the development of cholestatic liver disease. This can be devastating, and is highly correlated to poor survival in these patients. We are currently exploring whether a reduction in lipids to neonates requiring long-term TPN will reduce the incidence or severity of this disease process.

Website Link: Department of Surgery Pediatric Short Bowel Syndrome Website



Clinical References:
Department of Surgery Pediatric Complications of TPN in Neonates Website

Spencer AU, Yu S, Tracy TF, Aouthmany MM, Llanos A, Brown MB, Brown M, Shulman RJ, Hirschl RB, Derusso PA, Cox J, Dahlgren J, Strouse PJ, Groner JI, Teitelbaum DH.: Parenteral nutrition-associated cholestasis in neonates: multivariate analysis of the potential protective effect of taurine. JPEN J Parenter Enteral Nutr. 2005 Sep-Oct;29(5):337-43; discussion 343-4.

Teitelbaum DH, Tracy TF Jr, Aouthmany MM, Llanos A, Brown MB, Yu S, Brown MR, Shulman RJ, Hirschl RB, Derusso PA, Cox J, Dahlgren J, Groner JI, Strouse PJ.: Use of cholecystokinin-octapeptide for the prevention of parenteral nutrition-associated cholestasis.  Pediatrics. 2005 May;115(5):1332-40.


Cober MP, Teitelbaum DH.: Prevention of parenteral nutrition-associated liver disease: lipid minimization.  Curr Opin Organ Transplant. 2010 Jun;15(3):330-3.



Molecular mechanisms contributing to TPN-associated cholestasis:

Tazuke Y, Teitelbaum DH.: Alteration of canalicular transporters in a mouse model of total parenteral nutrition.  J Pediatr Gastroenterol Nutr. 2009 Feb;48(2):193-202.


Tazuke Y, Wildhaber BE, Yang H, Washburn J, Teitelbaum DH.: Total parenteral nutrition leads to alteration of hepatocyte cell cycle gene expression and proliferation in the mouse. Dig Dis Sci. 2007 Apr;52(4):920-30.

Tazuke Y, Drongowski RA, Btaiche I, Coran AG, Teitelbaum DH.: Effects of lipid administration on liver apoptotic signals in a mouse model of total parenteral nutrition (TPN). Pediatr Surg Int. 2004 Apr;20(4):224-8.


Tazuke Y, Kiristioglu I, Heidelberger KP, Eisenbraun MD, Teitelbaum DH.: Hepatic P-glycoprotein changes with total parenteral nutrition administration.  JPEN J Parenter Enteral Nutr. 2004 Jan-Feb;28(1):1-6