Catherine Larson-Nath, MD, is in a rare field: helping infants and children who suffer from intestinal failure, including those may need an intestinal transplant.
Larson-Nath, a pediatric gastroenterologist at University of Minnesota Masonic Children’s Hospital, is focused on ensuring that children who have intestinal failure are able to get the nutrients they need to grow and thrive. The work is challenging and sometimes difficult, Larson-Nath says. For that very reason, it’s also very rewarding.
We spoke with Larson-Nath about her work, the relationships she builds with families and her collaborative work with other specialists to help patients.
The most common problem we deal with is short bowel syndrome, which occurs in roughly three to five of every 100,000 births. Short bowel syndrome happens when a child has lost part of his or her intestine and cannot absorb fluid and other vital nutrients needed to sustain growth. We also see intestinal failure in children with a normal amount of intestines who are unable to get they need because of poor motility or a problem with how their intestines absorb nutrients, though this is less common.
The two most common causes of short bowel syndrome are: necrotizing enterocolitis—which is most common in infants born prematurely and occurs when the cells of intestinal tissue begin to die, and intestinal atresia—which is poor development of part of the intestine. Children with these conditions often need surgery to remove part of the damaged intestine, and this can make it difficult for them to absorb the nutrition they need. We manage the nutritional needs of these children. In the rare case that transplantation is needed, we are one of few centers in country that can perform intestinal transplants.
Infants and children actually face the most risk after surgery. All children need careful monitoring of their growth and nutritional status. Children needing IV nutrition, called parenteral nutrition, are at risk for infection and liver failure. The main goal of our program is to help minimize these complications, so that children have time for their intestinal tracts to adapt and take over for the parts of the intestine that have been removed. I often spend years with my patients.
These children may be at risk even when they’re eating normally, and do not need IV nutrition any more. Because they’re missing part of their gut, they may be able to absorb the nutrition they need to grow, but are not able to absorb all the micronutrients they need for complete health. Puberty is another time of high risk because children have higher nutritional needs.
Because I spend years working closely with my patients, I develop long-term relationships with them and their families. Some of these children are very sick when they arrive at our hospital, and I’m able to watch them grow, get healthier and become able to eat by mouth without the assistance of IV nutrition or tube feeds. It’s very rewarding for me to see that progression.
Our multidisciplinary team approach. Several studies have shown improved outcomes for kids when they’re cared for by a comprehensive team dedicated to treatment of the whole patient. Our patients are seen by a gastroenterologist, a dietitian, pediatric surgeons, a transplant surgeon, nurses and other providers—all of whom work seamlessly together to care for our patients.