F.I.R.S.T. Intestinal Rehabilitation

Salah Foundation Children’s Hospital at Broward Health Medical Center is one of only a few centers in the United States to offer expert care in pediatric intestinal rehabilitation. Our F.I.R.S.T. (Florida Intestinal Rehabilitation Support and Treatment) program focuses on providing an alternative to intestinal transplant for children with intestinal failure, such as short bowel syndrome or nutrition absorption disorders.

Led by Debora Duro, M.D., M.S., the F.I.R.S.T. program combines highly specialized treatment and compassionate care to help your child on a path toward a healthy and full life. Our team combines the experience of specialists in all areas of pediatric and gastrointestinal care to help ensure we are providing high-quality treatment for your child.

To request more information about intestinal rehabilitation or to schedule an appointment, call 954-712-6623.

What is intestinal rehabilitation?

Intestinal rehabilitation combines medicine and dietary changes to train the intestine to gradually absorb nutrients and digest food. Our goal with intestinal rehabilitation is to give your child a better quality of life by weaning them off of nutrition delivered through IVs when possible or optimizing the IV nutrition to avoid liver disease (also called parenteral nutrition). 

Why does my child need intestinal rehabilitation?

Your child may need intestinal rehabilitation if they have intestinal failure, such as short bowel syndrome. These conditions prevent the body from absorbing necessary nutrients and digesting food properly.

How does the intestinal rehabilitation program work?

Intestinal rehabilitation may be a good treatment option if your child uses IV nutrition. Intestinal rehabilitation helps wean a child off of IV nutrition without needing invasive transplant surgery, which has low long-term success rates. Intestinal rehabilitation is designed to improve health outcomes and can help children live a longer and more normal life. 

Assessment
In many cases, our patients are born here at Salah Foundation Children’s Hospital and begin their intestinal rehabilitation treatment soon after they are diagnosed with intestinal failure. Some patients also come to our F.I.R.S.T. program after looking for an alternative to intestinal transplant.

If you visit the Salah Foundation Children’s Hospital for a second opinion, our team will meet with you and your child to assess their current treatment and diagnosis. After this initial meeting, your child may stay in the hospital under our care for a few days. During this time, we will conduct all the necessary tests to help determine an individualized treatment plan for your child. During these few days in the hospital stay completes an assessment that may normally take several months of outpatient visits, and it helps us quickly optimize treatment so your child can start recovery faster.

Treatment
Once we determine a course of treatment, our highly skilled team will develop a nutrition formula that caters to your child’s specific needs. This formula is delivered through a central line catheter (a thin tube that is placed in a vein in the chest). We will also determine the right medicines to combine with the formula to improve your child’s ability to absorb nutrients from food. Depending on your child’s diagnosis and condition, they may need IV treatment for only a few hours a day or up to 18 hours per day, typically from the comfort of your home.

Home care
We will work closely with you to show you how to care for your child and deliver IV nutrition at home. Most importantly, we will train you on how you can help prevent IV infections, so your child can stay healthy and avoid any treatment setbacks.

Check-ups
Depending on your child’s needs and condition, you will visit us every two to six weeks for a check-up. During this time, we will assess your child’s progress and adjust the nutrition formula if necessary. We will also work closely with dietitians and pharmacists to ensure your child is getting the best treatment possible.

Why is intestinal rehabilitation better for my child than an Intestinal transplant?

Research has shown that intestinal rehabilitation provides improved outcomes and a higher quality of life for patients with intestinal failure.1

  • Patients who receive IV nutrition instead of intestinal transplant average a 96% survival rate after five years.2
  • Patients who receive an intestine transplant average a 75% survival rate after five years.2
  • Patients who receive intestine and liver transplant average a 62% survival rate after five years.2

Transplants can often cause serious infections or the body can reject the donated organ, sometimes years after surgery. Transplant surgery also requires significant preparation and a lengthy hospital stay, and the child must stay isolated for a period of time after the transplant to prevent infection.

It’s important to always get a second opinion with an established intestinal rehabilitation center before seeking a transplant option. In most cases, children can be treated effectively without this invasive surgery.

What kind of outcome can I expect from intestinal rehabilitation?

With intestinal rehabilitation, our goal is to have your child live as close to a normal life as possible. To do this, we will slowly wean your child off of IV nutrition and onto a regular solid food diet. Some patients may need intestinal rehabilitation for years before they are weaned off completely and eating only solid food, while others may only require a couple of months of rehabilitation.

It’s important to remember that the intestinal rehabilitation process takes time and your child may need some treatment adjustments along the way.

While we hope to completely transition your child off of IV nutrition, some children will require daily treatment for the rest of their lives. Fortunately, many children who undergo intestinal rehabilitation can get to a point where they only require IV nutrition treatment for a few hours a day. In these cases, children often hook up to IV treatment at night while they are sleeping.

About Dr. Duro

Debora Duro, M.D., M.S., is the medical director of the F.I.R.S.T. program, as well as the program director for pediatric gastroenterology, hepatology and nutrition at Salah Foundation Children’s Hospital. With more than 15 years of experience in intestinal rehabilitation, she has extensive knowledge in treating pediatric intestinal failure using IV nutrition and helping patients avoid transplant surgery.

Dr. Duro is board certified in pediatric gastroenterology, hepatology and nutrition. She earned her medical degree from the Pontifical Catholic University of Rio Grande do Sul in Brazil and finished her pediatric residency at Miami Children’s Hospital. After her residency, she completed a fellowship in pediatric gastroenterology, hepatology and nutrition at Boston Children’s Hospital and Massachusetts General Hospital, both of which are affiliated with Harvard Medical School.

References:
  1. Fullerton, B. S., Hong, C. R., & Jaksic, T. (2017). Long-term outcomes of pediatric intestinal failure. Seminars in Pediatric Surgery, 26(5), 328-335. doi: 10.1053/j.sempedsurg.2017.09.006
  2. Duggan, C.P., Jaksic, T. (2017). Pediatric intestinal failure. New England Journal of Medicine, 377(7), 666-675. doi: 10.1056/NEJMra1602650

Available At