Center for Advanced Intestinal Rehabilitation (CAIR)

CAIR has been in the forefront of clinical research advances in the field, including innovations in nutritional, hormonal, and surgical therapy. These are just some of the approaches that have been developed and refined at Boston Children's.

If your child has an intestinal obstruction or extremely shortened intestines, surgery may help improve absorption by enhancing the surface area of the intestines or prolonging transit time through the bowel.

In 2002, Boston Children's doctors performed the world's first serial transverse enteroplasty (STEP) procedure, a surgical technique developed by Heung Bae Kim, MD, and Tom Jaksic, MD, PhD. This approach lengthens the intestines of children with short bowel syndrome. Since then, our clinicians have performed many of these procedures with increasing success, establishing Boston Children's as one of the preeminent hospitals in the world for the treatment of short bowel syndrome.

Omegaven is a unique fish oil-based emulsion developed by Mark Puder, MD, PhD, and Kathleen Gura, PharmD, that appears to help treat liver disease resulting from total parenteral nutrition. Boston Children's is the hospital with the most established use of Omegaven on a compassionate basis.

Since its inception, CAIR has been among the most prolific centers for research on short bowel syndrome and related topics. We have published papers on a wide variety of subjects, including predictors of PN weaning, survival outcomes, leading edge nutrition management, infection management, micronutrient deficiencies, and more. The following studies and papers are some of our most notable.

• Duggan CP, Jaksic T. Pediatric Intestinal Failure. N Engl J Med. 2017;377(7):666-75. Epub 2017/08/17. doi: 10.1056/NEJMra1602650. PubMed PMID: 28813225.
• Stamm DA, Hait E, Litman HJ, Mitchell PD, Duggan C. High Prevalence of Eosinophilic Gastrointestinal Disease in Children With Intestinal Failure. J Pediatr Gastroenterol Nutr. 2016;63(3):336-9. doi: 10.1097/MPG.0000000000001158. PubMed PMID: 27548247; PMCID: PMC4994974.
• Fullerton BS, Sparks EA, Hall AM, Duggan C, Jaksic T, Modi BP. Enteral autonomy, cirrhosis, and long term transplant-free survival in pediatric intestinal failure patients. J Pediatr Surg. 2016;51(1):96-100. doi: 10.1016/j.jpedsurg.2015.10.027. PubMed PMID: 26561248; PMCID: PMC4713317.
• Khan FA, Squires RH, Litman HJ, Balint J, Carter BA, Fisher JG, Horslen SP, Jaksic T, Kocoshis S, Martinez JA, Mercer D, Rhee S, Rudolph JA, Soden J, Sudan D, Superina RA, Teitelbaum DH, Venick R, Wales PW, Duggan C. Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study. J Pediatr. 2015;167(1):29-34.e1. Epub 2015/04/29. doi: 10.1016/j.jpeds.2015.03.040. PubMed PMID: 25917765; PMCID: Pmc4485931.
• Khan FA, Fisher JG, Bairdain S, Sparks EA, Zurakowski D, Modi BP, Duggan C, Jaksic T. Metabolic bone disease in pediatric intestinal failure patients: prevalence and risk factors. J Pediatr Surg. 2015;50(1):136-9. doi: 10.1016/j.jpedsurg.2014.10.010. PubMed PMID: 25598110; PMCID: PMC4620573.
• Mehta NM, Raphael B, Guteirrez IM, Quinn N, Mitchell PD, Litman HJ, Jaksic T, Duggan CP. Comparison of body composition assessment methods in pediatric intestinal failure. J Pediatr Gastroenterol Nutr. 2014;59(1):99-105. Epub 2014/03/13. doi: 10.1097/mpg.0000000000000364. PubMed PMID: 24614122; PMCID: PMC4409423.
• Khan FA, Mitchell PD, Fisher JG, Sparks EA, Jaksic T, Duggan C, Teitelbaum DH, Modi BP. Magnitude of surgical burden associated with pediatric intestinal failure: a multicenter cohort analysis. J Pediatr Surg. 2014;49(12):1795-8. Epub 2014/12/10. doi: 10.1016/j.jpedsurg.2014.09.026. PubMed PMID: 25487486; PMCID: Pmc4620568.
• Gosselin KB, Duggan C. Enteral nutrition in the management of pediatric intestinal failure. J Pediatr. 2014;165(6):1085-90. Epub 2014/09/23. doi: 10.1016/j.jpeds.2014.08.012. PubMed PMID: 25242686; PMCID: PMC4253063.
• Squires RH, Duggan C, Teitelbaum DH, Wales PW, Balint J, Venick R, Rhee S, Sudan D, Mercer D, Martinez JA, Carter BA, Soden J, Horslen S, Rudolph JA, Kocoshis S, Superina R, Lawlor S, Haller T, Kurs-Lasky M, Belle SH, Pediatric Intestinal Failure C. Natural history of pediatric intestinal failure: initial report from the Pediatric Intestinal Failure Consortium. J Pediatr. 2012;161(4):723-8 e2. doi: 10.1016/j.jpeds.2012.03.062. PubMed PMID: 22578586; PMCID: 3419777.
• Carter BA, Cohran VC, Cole CR, Corkins MR, Dimmitt RA, Duggan C, Hill S, Horslen S, Lim JD, Mercer DF, Merritt RJ, Nichol PF, Sigurdsson L, Teitelbaum DH, Thompson J, Vanderpool C, Vaughan JF, Li B, Youssef NN, Venick RS, Kocoshis SA. Outcomes from a 12-Week, Open-Label, Multicenter Clinical Trial of Teduglutide in Pediatric Short Bowel Syndrome. J Pediatr. 2017;181:102-111.
• Jones BA, Hull MA, Richardson DS, Zurakowski D, Gura K, Fitzgibbons SC, Duro D, Lo CW, Duggan C, Jaksic T. Efficacy of ethanol locks in reducing central venous catheter infections in pediatric patients with intestinal failure. J Pediatr Surg. 2010;45(6):1287-93.
• Gura KM, Lee S, Valim C, Zhou J, Kim S, Modi BP, Arsenault DA, Strijbosch RA, Lopes S, Duggan C, Puder M. Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease. Pediatrics 2008;121(3):e678-86.
• de Meijer VE, Gura KM, Le HD, Meisel JA, Puder M. Fish Oil-Based Lipid Emulsions Prevent and Reverse Parenteral Nutrition-Associated Liver Disease: The Boston Experience. JPEN 2009;33(5):541-7.
• Fallon EM, Mitchell PD, Nehra D, Potemkin AK, O'Loughlin AA, Gura KM, Puder M. Neonates with short bowel syndrome: an optimistic future for parenteral nutrition independence. JAMA Surg. 2014;149(7):663-70.
• Yang CF, Duro D, Zurakowski D, Lee M, Jaksic T, Duggan C. High prevalence of multiple micronutrient deficiencies in children with intestinal failure: a longitudinal study. J Pediatr 2011;159(1):39-44.