Tom Jaksic

Boston Children's Hospital, Boston, Massachusetts, United States

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Publications (124)294.8 Total impact

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    ABSTRACT: The distribution of surgical care of very low birth weight (VLBW) neonates among centers with varying specialized care remains unknown. This study quantifies operations performed on VLBW neonates nationally with respect to center type. VLBW neonates born 2009-2012 were assessed using a prospectively collected multi-center database encompassing 80% of all VLBW neonates in the United States. Surgical centers were categorized based on availability of pediatric surgery (PS) and anesthesia (PA). 48,711 major procedures (29,512 abdominal operations) were performed on 24,318 neonates. Of all patients, 20,892 (85.9%) underwent surgery at centers with PS and PA available on site. 1663 (6.8%) patients were treated at centers with neither specialty on site. Neonates requiring complex operations were more likely to receive surgery at centers with both PS and PA on staff than those requiring non-complex operations (95.6% vs 93.6%). This study confirms that most operations on VLBW neonates in the U.S. are performed at centers with pediatric surgeons and anesthesiologists on staff. Further research is necessary, however, to elucidate why a significant minority of this challenging population continues to be managed at centers without pediatric specialists. Copyright © 2014 Elsevier Inc. All rights reserved.
    Journal of pediatric surgery. 12/2014; 49(12):1821-1824.e8.
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    ABSTRACT: Pediatric intestinal failure (IF) patients require many surgical procedures over the course of their illness. The number and variety of surgical procedures, as well as patient characteristics associated with this burden of surgical procedures, remain largely unknown.Methods Data from a large, multicenter retrospective study of pediatric intestinal failure (PIFCON) were reviewed. Infants from 14 multidisciplinary IF programs were enrolled, with study entry defined as PN dependence for > 60 days.ResultsA total of 272 infants were followed for a median (IQR) of 33.5 (16.2, 51.5) months, during which time they underwent 4.0 (3.0, 6.0) abdominal surgical procedures. Intestinal resections were performed in 88/97 (92%) necrotizing enterocolitis patients versus 138/175 (80%) in non-NEC patients (P < 0.05). Patients who underwent ≥ 5 operations had more septic events, compared to those who underwent ≤ 2 operations (3 (1, 6) versus 1 (0, 3), respectively, P < 0.01). Patients treated at centers with transplantation capability had lower odds of undergoing > 2 abdominal operations [OR 0.37 (95% CI: 0.21, 0.65)] after multivariable adjustment.Conclusions Individual and center-specific characteristics may help determine surgical practices experienced by infants with IF. Further study may delineate additional details about the nature of these characteristics, with the goal of optimizing patient care and minimizing individual and overall healthcare burden.
    Journal of Pediatric Surgery. 11/2014;
  • 2014 American Academy of Pediatrics National Conference and Exhibition; 10/2014
  • 2014 American Academy of Pediatrics National Conference and Exhibition; 10/2014
  • 2014 American Academy of Pediatrics National Conference and Exhibition; 10/2014
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    ABSTRACT: Background: Children with intestinal failure (IF) frequently require gastrostomy tubes (GTs) for long-term nutrition support. Risk factors for persistent gastrocutaneous fistulae (GCFs) in pediatric patients with IF are largely unknown but may include underlying nutrition status and duration of indwelling GT. Materials and Methods: Records of patients with IF having undergone GT removal and allowed a trial at spontaneous closure were reviewed. Nonparametric continuous variables were analyzed using the Wilcoxon rank sum test. Post hoc analysis was performed to identify the optimal threshold of GT duration predicting probability of spontaneous closure identified using receiver operating characteristic curve analysis. Results: Fifty-nine children with IF undergoing GT removal were identified. Spontaneous closure occurred in 36 (61%) sites, while 23 (39%) underwent operative closure at a median 67 days after GT removal. The duration of indwelling GT was significantly shorter in the spontaneous closure group (11.5 vs 21 months, P = .002). Of 33 GT indwelling for ≤18 months, 28 (85%) closed spontaneously, compared with only 9 of 26 (35%) with duration >18 months (P < .001). With GCF persisting beyond 7 days, only 21% (6/28) of sites closed spontaneously, but this dropped to 6% (1/18) of cases with concurrent GT duration >18 months. Conclusions: Of the risk factors evaluated, only prolonged GT duration was associated with an increased likelihood of failure to close spontaneously. It is significantly less likely in pediatric patients with IF in whom GCF persists >7 days, particularly if the duration of GT is >18 months. Relatively earlier operative closure should be considered in this group.
    JPEN. Journal of parenteral and enteral nutrition. 07/2014;
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    ABSTRACT: To examine the agreement of multifrequency bioelectric impedance analysis (BIA) and anthropometry with reference methods for body composition assessment in children with intestinal failure (IF). We conducted a prospective pilot study in children 14 years of age or younger with IF resulting from either short bowel syndrome (SBS) or motility disorders. Bland Altman analysis was used to examine the agreement between BIA and deuterium dilution in measuring total body water (TBW) and lean body mass (LBM); and between BIA and dual X-ray absorptiometry (DXA) techniques in measuring LBM and FM. Fat mass (FM) and percent body fat (%BF) measurements by BIA and anthropometry, were also compared in relation to those measured by deuterium dilution. Fifteen children with IF, median (IQR) age 7.2 (5.0, 10.0) years, 10 (67%) male, were studied. BIA and deuterium dilution were in good agreement with a mean bias (limits of agreement) of 0.9 (-3.2, 5.0) for TBW (L) and 0.1 (-5.4 to 5.6) for LBM (kg) measurements. The mean bias (limits) for FM (kg) and %BF measurements were 0.4 (-3.8, 4.6) kg and 1.7 (-16.9, 20.3)% respectively. The limits of agreement were within 1 SD of the mean bias in 12/14 (86%) subjects for TBW and LBM, and in 11/14 (79%) for FM and %BF measurements. Mean bias (limits) for LBM (kg) and FM (kg) between BIA and DXA were 1.6 (-3.0 to 6.3) kg and -0.1 (-3.2 to 3.1) kg, respectively. Mean bias (limits) for FM (kg) and %BF between anthropometry and deuterium dilution were 0.2 (-4.2, 4.6) and -0.2 (-19.5 to 19.1), respectively. The limits of agreement were within 1 SD of the mean bias in 10/14 (71%) subjects. In children with intestinal failure, TBW and LBM measurements by multifrequency BIA method were in agreement with isotope dilution and DXA methods, with small mean bias and clinically acceptable limits of agreement. In comparison to deuterium dilution, BIA was comparable to anthropometry for FM and %BF assessments with small mean bias, but the limits of agreement were large. BIA is a reliable method for TBW and LBM assessments in population studies. However, its reliability in individual patients, especially for FM assessments, cannot be guaranteed.
    Journal of pediatric gastroenterology and nutrition 03/2014; · 2.18 Impact Factor
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    ABSTRACT: Purpose Patients with intestinal failure (IF) are known to have impaired absorption of nutrients required for maintenance of skeletal mass. Rates and risk factors of low bone mineral density (BMD) are unknown in pediatric IF patients. Methods Following IRB approval, patients with IF having undergone DXA scans were identified and laboratory, clinical, and nutritional intake variables were recorded. Low BMD was defined by a z-score of less than or equal to − 2.0. Univariate followed by multivariable regression analysis was performed. Results Sixty-five patients underwent a total of 99 routine DXA scans. Twenty-seven (41%) had vitamin D deficiency, 22 (34%) had low BMD, and nineteen (29%) had a history of fractures. Variables noted to be associated with low BMD (p < 0.1) on univariate analysis were considered for multivariable regression. Multivariable regression identified WAZ and serum calcium levels (p < 0.05) as independent predictors of low BMD z-score. None of the other evaluated factors were associated with the risk of low BMD. Low BMD was not associated with risk of fractures. Conclusion There is a significant incidence of low BMD in children with IF. WAZ and lower serum calcium levels are associated with risk of low BMD. Additional long term prospective studies are needed to further characterize the risk factors associated with low BMD.
    Journal of Pediatric Surgery. 01/2014;
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    ABSTRACT: Since its introduction as an alternative intestinal lengthening technique, serial transverse enteroplasty (STEP) has been increasingly used as the surgical treatment of choice for patients with refractory short bowel syndrome (SBS). While primary STEP for the treatment of congenital conditions was proposed in the original description of the procedure, emphasis was placed on a delayed or staged approach to these patients. To date, a comprehensive review of the outcomes from this sub-population has not been reported by the International STEP Data Registry. A retrospective review of the International STEP Data Registry was performed to identify all patients who underwent STEP as a primary operative procedure for the treatment of congenital SBS. Changes in pre- and post-STEP values were assessed using paired t-tests with significance set at p<0.05. Data are presented as mean ± standard deviation. Fifteen patients underwent primary STEP for congenital SBS between September 1, 2004, and April 10, 2012. Thirteen patients had follow-up information available. Causes of congenital SBS included closing gastroschisis, small bowel atresia, and midgut volvulus. Twelve patients had pre- and post-STEP bowel measurements taken. Average pre- and post-STEP bowel lengths were 32 ± 16 cm and 47 ± 22 cm, respectively. Intestinal length was increased by a mean of 15 ± 12 cm for a relative small bowel length increase of 50.4 ± 27.3% (p<0.001). Only one patient required an ostomy at the time of primary STEP. A second patient required a temporary ostomy at 3months of age that was later closed. There was one death from intestinal failure associated liver disease (IFALD). Another patient experienced IFALD progression and required liver and intestinal transplantation. The most commonly reported complication following primary STEP was obstruction or bowel re-dilatation requiring additional operative interventions. Nine patients underwent second STEP procedures under these circumstances. Eight patients remain dependent on parenteral nutrition, while three patients achieved enteral autonomy. Primary STEP is a feasible and safe surgical option for the treatment of congenital conditions resulting in SBS. Primary STEP establishes early bowel continuity, creates intestinal length from congenitally dilated bowel, and appears to obviate the need for interval stomas and their associated loss of bowel length in neonates with congenital SBS. However, with recent changes in SBS management emphasizing intestinal rehabilitation, additional studies are needed to assess the long-term impact on intestinal adaptation of STEP performed in the neonatal period prior to adoption of this technique.
    Journal of Pediatric Surgery 01/2014; 49(1):104-8. · 1.38 Impact Factor
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    ABSTRACT: Purpose Citrulline, a non-protein amino acid synthesized by enterocytes, is a biomarker of bowel length and the capacity to wean from parenteral nutrition. However, the potentially variant effect of jejunal versus ileal excision on plasma citrulline concentration [CIT] has not been studied. This investigation compared serial serum [CIT] and mucosal adaptive potential after proximal versus distal small bowel resection. Methods Enterally-fed Sprague-Dawley rats underwent sham operation or 50% small bowel resection. Either proximal (PR) or distal (DR). [CIT] was measured at operation and weekly for 8 weeks. At necropsy, histologic features reflecting bowel adaptation were evaluated. Results By week 6-7, [CIT] in both resection groups significantly decreased from baseline (P < 0.05) and was significantly lower than the concentration in sham animals (P < 0.05). There was no difference in [CIT] between PR and DR at any point. Villus height and crypt density were higher in the PR than in the DR group (P ≤ 0.02). Conclusion CIT] effectively differentiates animals undergoing major bowel resection from those with preserved intestinal length. The region of intestinal resection was not a determinant of [CIT]. The remaining bowel in the PR group demonstrated greater adaptive potential histologically. [CIT] is a robust biomarker for intestinal length, irrespective of location of small intestine lost.
    Journal of Pediatric Surgery. 01/2014;
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    ABSTRACT: Purpose Serial transverse enteroplasty (STEP) lengthens and tapers bowel in patients with intestinal failure. Evaluation and treatment of serious late gastrointestinal bleeding (GIB) in three STEP patients is described. Methods Patients participating in an interdisciplinary intestinal rehabilitation program were reviewed to identify those who underwent STEP and had GIB requiring transfusion. Results Of 296 patients, 23 underwent STEP, and 3 (13%) had subsequent GIB requiring transfusion. Diagnoses were vanishing gastroschisis/atresia, malrotation/atresia, and gastroschisis.. STEP was performed at ages 3–5 months, using 5–15 stapler-firings with an increase in mean bowel length from 39 to 62 cm. GIB was diagnosed 5–30 months post-op and resulted in 1–7 transfusions per patient. Endoscopy demonstrated staple-line ulceration in two patients and eosinophilic enterocolitis in the third. All were treated with enteral antibiotics, sulfasalazine, and luminal steroids. Those with ulcers responded to bowel rest, and the patient with eosinophilic enterocolitis stabilized with luminal steroids. In all three, hemoglobin levels improved despite persistent occult bleeding. Conclusions Significant GIB is a potential late complication of STEP. Endoscopy identified the underlying source of GIB in all three patients. A combination of enteral antibiotics, anti-inflammatory medications, and bowel rest was effective in treating post-STEP GIB, without the need for additional bowel resection.
    Journal of Pediatric Surgery. 01/2014;
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    ABSTRACT: Background Malnutrition is prevalent among congenital diaphragmatic hernia (CDH) survivors. We aimed to describe the nutritional status and factors that impact growth over the 12-months following discharge from the pediatric intensive care unit (PICU) in this cohort. Methods CDH survivors, who were discharged from the PICU from 2000 to 2010 with follow-up of at least 12 months, were included. Nutritional intake, anthropometric, and clinical variables were recorded. Multivariable linear regression was used to determine factors associated with weight-for-age Z-scores (WAZ) at 12 months. Results Data from 110 infants, 67% male, 50% patch repair, were analyzed. Median (IQR) WAZ for the cohort was − 1.4 (− 2.4 to − 0.3) at PICU discharge and − 0.4 (− 1.3 to 0.2) at 12-months. The percentage of infants with significant malnutrition (WAZ < − 2) decreased from 26% to 8.5% (p < 0.001). Patch repair (p = 0.009), protein intake < 2.3 g/kg/day (p = 0.014), and birth weight (BW) < 2.5 kg (p < 0.001) were associated with lower WAZ at 12-months. Conclusions CDH survivors had a significantly improved nutritional status in the 12-months after PICU discharge. Patch repair, lower BW, and inadequate protein intake were significant predictors of lower WAZ at 12-months. A minimum protein intake in the PICU of 2.3 g/kg/day was essential to ensure optimal growth in this cohort.
    Journal of Pediatric Surgery. 01/2014;
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    ABSTRACT: To determine, in a cohort of young children with intestinal failure (IF), if estimates of basal metabolic rate (BMR) by standard equations, approximate measured REE by indirect calorimetry (IC). IC was performed by dilutional canopy technique. REE measurements were compared to standard, age-based estimation equations (WHO) for BMR. Subjects were classified as hypermetabolic (REE > 110% BMR), hypometabolic (REE < 90% BMR), or normal (REE = 90-110% BMR). Twenty-eight IF patients (11 female, 17 male) had an underlying diagnosis of necrotizing enterocolitis (n = 10) or a congenital gastrointestinal defect (n = 18). Median age was 5.3 months. Median (IQR) REE was 46 (42, 58) kcal/kg/day. Median (IQR) total energy intake provided 209 (172, 257)% of REE, with parenteral nutrition providing 76% (23%) of total energy intake. REE was variable, with 39% (n = 11) of measurements hypermetabolic, 39% (n = 11) hypometabolic, and the remaining 21% (n = 6) normal. Although REE was well correlated with estimated BMR (r = 0.82, P < 0.0001), estimated BMR was not consistently an adequate predictor of REE. BMR over- or under-estimated REE by more than 10 kcal/kg/d in 15/28 (54%) patients. REE was not significantly correlated with severity of liver disease, nutritional status, total energy intake or gestational age. Energy expenditure is variable among children with IF and IFALD, with nearly 80% of our cohort exhibiting either hypo- or hypermetabolism. Standard estimation equations frequently do not correctly predict individual REE. Longitudinal studies of energy expenditure and body composition may be needed to guide provision of nutrition regimens.
    Journal of pediatric gastroenterology and nutrition 12/2013; · 2.18 Impact Factor
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    ABSTRACT: Children who require long-term parenteral nutrition (PN) have central venous catheters (CVCs) in place to allow the safe and effective infusion of life-sustaining fluids and nutrition. Many consider recreational swimming to be a common part of childhood, but for some, the risk may outweigh the benefit. Children with CVCs may be at increased risk of exit site, tunnel, and catheter-related bloodstream infections (CRBSIs) if these catheters are immersed in water. The purpose of this review is to evaluate the current literature regarding the risk of infection for patients with CVCs who swim and determine if there is consensus among home PN (HPN) programs on this controversial issue. A total 45 articles were reviewed and 16 pediatric HPN programs were surveyed regarding swimming and CVCs. Due to the limited data available, a firm recommendation cannot be made. Recreational water associated outbreaks are well documented in the general public, as is the presence of human pathogens even in chlorinated swimming pools. As a medical team, practitioners can provide information and education regarding the potential risk, but ultimately the decision lies with the parents. If the parents decide swimming is worth the risk, they are encouraged to use products designed for this use and to change their child's dressing immediately after swimming. Due to our experience with a fatal event immediately after swimming, we continue to strongly discourage patients with CVCs from swimming. Further large and well-designed studies regarding the risk of swimming with a CVC are needed to make a strong, evidence-based recommendation.
    Nutrition in Clinical Practice 12/2013; · 1.58 Impact Factor
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    ABSTRACT: Patients with Intestinal failure (IF) require parenteral nutrition (PN) support to obtain enough nutrients to sustain growth. long-term PN use is associated with significant liver damage. OBJECTIVE:: To analyze the utility of a non-invasive test, the aspartate aminotransferase (AST) to platelet ratio index (APRI), in the diagnosis of liver disease in pediatric patients with IF. METHODS:: Medical records of all Boston Children's Hospital patients who received PN and underwent a liver biopsy from January 2006 until November 2010 were reviewed. Patients with a clinical diagnosis with IF were selected. APRI was calculated as follows (AST (U/L)/upper normal limit) × 100/platelets (10/L). Presence of fibrosis and cirrhosis was estimated using the METAVIR score in liver biopsies. RESULTS:: 62 liver biopsies from 48 patients (22 female) were studied. Mean APRI values in the different METAVIR categories (0-1; 2-3; 4) were: 1.80, 1.17, and 4.24 respectively (ANOVA; P = 0.053; Bonferroni test for cirrhosis versus fibrosis P = 0.048). APRI could significantly predict cirrhosis (OR 1.2.; 95% CI 1.001-1.43) but not significant fibrosis (METAVIR 2-3, OR 1.00; 95% CI = 0.86-1.18). Area under the receiver operating characteristic curve for cirrhosis was 0.67 (95% CI = 0.45-0.89; P = 0.13). CONCLUSION:: APRI, a non invasive, easy to obtain bedside test significantly predicts cirrhosis but not fibrosis in pediatric patients with IFALD. As the clinicians need a non invasive test to differentiate among different stages of liver fibrosis rather than differentiating cirrhosis from normal, we cannot recommend the use of this test in pediatric patients with IFALD for this purpose.
    Journal of pediatric gastroenterology and nutrition 05/2013; · 2.18 Impact Factor
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    ABSTRACT: BACKGROUND: The International Serial Transverse Enteroplasty (STEP) Data Registry is a voluntary online database created in 2004 to collect information on patients undergoing the STEP procedure. The aim of this study was to identify preoperative factors that are significantly associated with transplantation or death or attainment of enteral autonomy after STEP. STUDY DESIGN: Data were collected from September 2004 to January 2010. Univariate and multivariate logistic regression analyses were applied to determine the predictors of transplantation or death or enteral autonomy post-STEP. Time to reach full enteral nutrition was estimated using a Kaplan-Meier curve. RESULTS: Fourteen of the 111 patients in the Registry were excluded due to inadequate follow-up. Of the remaining 97 patients, 11 patients died and 5 progressed to intestinal transplantation. On multivariate analysis, higher direct bilirubin and shorter pre-STEP bowel length were independently predictive of progression to transplantation or death (p = 0.05 and p < 0.001, respectively). Of the 78 patients who were 7 days of age or older and required parenteral nutrition at the time of STEP, 37 (47%) achieved enteral autonomy after the first STEP. Longer pre-STEP bowel length was also independently associated with enteral autonomy (p = 0.002). Median time to reach enteral autonomy based on Kaplan-Meier analysis was 21 months (95% CI, 12-30). CONCLUSIONS: Overall mortality post-STEP was 11%. Pre-STEP risk factors for progressing to transplantation or death were higher direct bilirubin and shorter bowel length. Among patients who underwent STEP for short bowel syndrome, 47% attained full enteral nutrition post-STEP. Patients with longer pre-STEP bowel length were significantly more likely to achieve enteral autonomy.
    Journal of the American College of Surgeons 01/2013; · 4.50 Impact Factor
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    ABSTRACT: Background Necrotizing enterocolitis (NEC) is a leading cause of death in very low birth weight (VLBW) neonates. The overall mortality of NEC is well documented. However, those requiring surgery appear to have increased mortality compared to those managed medically. The objective of this study was to establish national birth-weight-based benchmarks for the mortality of surgical NEC and describe the utilization and mortality of laparotomy versus peritoneal drainage. Study Design 655 U.S. centers prospectively evaluated 188,703 VLBW neonates (401-1500g) between 2006-2010. Survival was defined as living in-hospital at one-year or hospital discharge. Results 17,159(9%) had NEC with mortality of 28%. 8,224 patients did not receive operations (medical NEC,mortality 21%). 8,935 were operated upon (mortality 35%). On multivariable regression, lower birth weight, laparotomy, and peritoneal drainage were independent predictors of mortality (p <0.0001). In surgical NEC, a plateau mortality of around 30% persisted despite birth weights >750g while medical NEC mortality fell consistently with increasing birth weight. For example, in neonates weighing 1251-1500g, mortality was 27% in surgical versus 6% in medical NEC (OR=6.10, 95% CI=4.58-8.12). Of those treated surgically, 6,131(69%) underwent laparotomy only (mortality 31%), 1,283 received peritoneal drainage and a laparotomy (mortality 34%), and 1,521 had peritoneal drainage alone (mortality 50%). Conclusions 52% of VLBW neonates with NEC underwent surgery, which was accompanied by a substantial increase in mortality. Regardless of birth weight, surgical NEC showed a plateau in mortality at approximately 30%. Laparotomy was the more frequent method of treatment (69%) and of those managed by drainage, 46% also had a laparotomy. The laparotomy alone and drainage with laparotomy groups had similar mortalities while the drainage alone treatment cohort was associated with the highest mortality.
    Journal of the American College of Surgeons 01/2013; · 4.50 Impact Factor
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    ABSTRACT: Background Spontaneous intestinal perforation (SIP) has been recognized as a distinct disease entity. This study sought to quantify mortality associated with laparotomy confirmed SIP and to compare it to mortality of laparotomy confirmed necrotizing enterocolitis (NEC). Methods Data were prospectively collected on 177,618 very low birth weight (VLBW, 401-1500 g) neonates born between January 2006 and December 2010 admitted to U.S hospitals participating in the Vermont Oxford Network (VON). SIP was defined at laparotomy as a focal perforation of the intestine without features suggestive of NEC or other intestinal abnormalities. The primary outcome was in-hospital mortality. Results At laparotomy, 2,036 (1.1%) neonates were diagnosed with SIP and 4,076 (2.3%) with NEC. Neonates with laparotomy confirmed SIP had higher mortality (19%) than infants without NEC or SIP (5%, P = 0.003). However, laparotomy confirmed SIP patients had significantly lower mortality than those with confirmed NEC (38%, P < 0.0001). Mortality in both NEC and SIP groups decreased with increasing birth weight and mortality was significantly higher for NEC than SIP in each birth weight category. Indomethacin and steroid exposure were more frequent in the SIP cohort than the other two groups (P < 0.001). Conclusions In VLBW infants, the presence of laparotomy confirmed SIP increases mortality significantly. However, laparotomy confirmed NEC mortality was double that of SIP. This relationship is evident regardless of birth weight. The variant mortality of laparotomy confirmed SIP versus laparotomy confirmed NEC highlights the importance of differentiating between these two diseases both for clinical and research purposes.
    Journal of Pediatric Surgery. 01/2013;
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    ABSTRACT: PURPOSE: The serial transverse enteroplasty (STEP) operation tapers and lengthens dilated small bowel. Some patients demonstrate bowel re-dilation following STEP. Factors associated with bowel re-dilation and its effect upon clinical outcome were evaluated. METHODS: Twenty STEP operations were reviewed. Sixteen cases were operated for failure to advance enteral feeding and were further analyzed. Available pre- and post-STEP radiographs were independently assessed for bowel re-dilation by two experienced pediatric radiologists. Potential factors of re-dilation were evaluated. Full enteral autonomy was defined as no longer requiring parenteral nutrition (PN) and remaining off PN for at least 12 months after STEP. RESULTS: There was complete concordance between the radiologists. 9 of 16 patients demonstrated radiographic bowel re-dilation following STEP. Age, follow-up duration, time interval between STEP and last imaging reviewed, gender, diagnoses, pre- and post-STEP bowel length and width were not significantly associated with re-dilation. However, median post-STEP duration of PN was significantly longer in the re-dilated group than in the non-dilated group (41 vs. 3 months, p = 0.006). In addition, only 1 of 9 re-dilated patients achieved enteral autonomy as compared with 6 of 7 non-dilated patients (p = 0.009). CONCLUSION: Longer PN duration after STEP increases probability of bowel re-dilation. Patients who re-dilated following STEP are significantly less likely to achieve enteral autonomy. Larger prospective data collections are warranted to further explore these relationships.
    Pediatric Surgery International 11/2012; · 1.22 Impact Factor
  • Biren P Modi, Tom Jaksic
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    ABSTRACT: Emerging developments in the care of intestinal failure (IF) patients have drastically improved their overall prognosis, with recently reported survival rates over 90%. IF patients remain an extremely complex population who benefit from specialized, multidisciplinary care. Advances in the provision of parenteral and enteral nutrition, progress in the management of IF-associated liver disease with parenteral fish oil and catheter-associated blood stream infection with ethanol lock therapy, and the availability of novel surgical interventions, such as the serial transverse enteroplasty procedure, have made this a dynamic health care field with the promise of ongoing improvements in outcomes for these patients.
    Surgical Clinics of North America 06/2012; 92(3):729-43, x. · 2.02 Impact Factor

Publication Stats

3k Citations
294.80 Total Impact Points

Institutions

  • 2002–2014
    • Boston Children's Hospital
      • • Center for Advanced Intestinal Rehabilitation
      • • Department of Radiology
      Boston, Massachusetts, United States
  • 1989–2014
    • Harvard Medical School
      • Department of Surgery
      Boston, Massachusetts, United States
  • 1997–2013
    • University of Texas Medical School
      • • Department of Pediatric Surgery
      • • Department of Pediatrics
      Houston, Texas, United States
  • 2006
    • Beverly Hospital, Boston MA
      Beverly, Massachusetts, United States
  • 2005
    • University of Southern California
      • Department of Surgery
      Los Angeles, CA, United States
  • 2004
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2001
    • University of Chicago
      • Specialty of Pediatric Surgery
      Chicago, IL, United States
  • 1996–2001
    • Texas Children's Hospital
      Houston, Texas, United States
  • 1995–2000
    • Baylor College of Medicine
      • Department of Surgery
      Houston, TX, United States
  • 1992
    • SickKids
      • Division of General Surgery
      Toronto, Ontario, Canada
  • 1987
    • Massachusetts Institute of Technology
      • School of Science
      Cambridge, MA, United States