Rebecca Brown

136 statements · 4 topics

Abdominal Wall Defects · guest expert Etiologies (Gastroschisis/NEC/Atresia/Volvulus) · guest expert Intestinal Rehab · guest expert Pectus Excavatum · guest expert

Featured statements

▶ Ep 39 · 4:45
The 3 year recurrence rate when you fix umbilical hernia was twice as high in children less than 4 years of age versus if they were greater than 4 years of age.
quote · Abdominal Wall Defects
▶ Ep 39 · 3:21
Incarceration with umbilical hernias, it's actually pretty rare, less than 0.2%, and it's more common if you have a smaller defect.
quote · Abdominal Wall Defects
▶ Ep 59 · 6:03
If that umbilical hernia was persistent at age 3, spontaneous closure was 20% by 4 years and 35% by 5 years.
quote · Etiologies (Gastroschisis/NEC/Atresia/Volvulus)
▶ Ep 59 · 4:26
Early surgical repair before age 4 was not indicated regardless of the size of the defect.
quote · Etiologies (Gastroschisis/NEC/Atresia/Volvulus)
▶ Ep 89 · 6:43
Indications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and consideration for large proboscoid hernias in patients about to start school.
guideline · Intestinal Rehab
▶ Ep 89 · 7:22
Umbilical hernia repair technique involves dissecting around the hernia sac, dividing it, trimming excess sac, closing the fascia with interrupted absorbable sutures (such as Vicryl), and recreating the umbilicus.
clinical · Intestinal Rehab

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Rebecca's statements about Abdominal Wall Defects 22 statements

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Umbilical Disorders with Dr. Rebeccah Brown

▶ Ep 39 · 1:12
quote And it's a bacterial colonization of that umbilical stump. ↗
▶ Ep 39 · 1:12
clinical Omphalitis is bacterial colonization of the umbilical stump, most commonly due to staph and strep from skin flora. ↗
▶ Ep 39 · 1:30
clinical In advanced omphalitis cases, patients need hospital admission and pediatric surgery consultation. ↗
▶ Ep 39 · 2:17
epidemiological Umbilical hernias are more common in African Americans, low birth weight infants, and premature infants. ↗
▶ Ep 39 · 3:21
quote Incarceration with umbilical hernias, it's actually pretty rare, less than 0.2%, and it's more common if you have a smaller defect. ↗
▶ Ep 39 · 3:21
epidemiological Incarceration with umbilical hernias is rare, occurring in less than 0.2% of cases, and is more common with smaller defects. ↗
▶ Ep 39 · 3:42
epidemiological In Tiffany Zinz's study of 308 umbilical hernia repairs, there was a higher incidence of complications if patients were less than 4 years of age versus greater than 4 years of age. ↗
▶ Ep 39 · 4:06
guideline A literature review of 787 manuscripts (28 meeting quality criteria) showed that early surgical repair of umbilical hernias before age 4 was not indicated regardless of defect size. ↗
▶ Ep 39 · 4:26
quote Early surgical repair before age 4 was not indicated regardless of the size of the defect. ↗
▶ Ep 39 · 4:40
epidemiological In a 2020 study of 9,809 patients, the 3-year recurrence rate after umbilical hernia repair was twice as high in children less than 4 years of age versus those greater than 4 years of age. ↗
▶ Ep 39 · 4:45
quote The 3 year recurrence rate when you fix umbilical hernia was twice as high in children less than 4 years of age versus if they were greater than 4 years of age. ↗
▶ Ep 39 · 6:03
quote If that umbilical hernia was persistent at age 3, spontaneous closure was 20% by 4 years and 35% by 5 years. ↗
▶ Ep 39 · 6:03
epidemiological If an umbilical hernia persisted at age 3, spontaneous closure occurred in 20% by age 4 and 35% by age 5. ↗
▶ Ep 39 · 6:34
opinion Dr. Brown's opinion is that hernias with a huge defect that are proboscoid are probably not going to close spontaneously. ↗
▶ Ep 39 · 6:34
quote If it has a huge defect and it's proboscoid, it's probably not gonna close. ↗
▶ Ep 39 · 6:43
guideline Indications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and consideration for large proboscoid hernias in patients about to start school. ↗
▶ Ep 39 · 7:11
quote I think in general, 5 years, regardless of size, if it hasn't closed, fix it. If until then, leave it alone unless they're having symptoms. ↗
▶ Ep 39 · 7:11
opinion Dr. Brown's approach is to repair umbilical hernias at 5 years regardless of size if they haven't closed, or earlier if the patient is having symptoms. ↗
▶ Ep 39 · 7:22
clinical Umbilical hernia repair technique involves dissecting around the hernia sac, dividing it, trimming excess sac, closing the fascia with interrupted absorbable sutures (such as Vicryl), and recreating the umbilicus. ↗
▶ Ep 39 · 8:52
epidemiological Umbilical granulomas are the most common umbilical masses in newborns. ↗
▶ Ep 39 · 9:17
clinical Dr. Brown recommends neutralizing silver nitrate burns by applying water after silver nitrate application to prevent skin damage and keep it from spreading. ↗
▶ Ep 39 · 9:40
clinical Bright red, pedunculated umbilical lesions that bleed easily are more difficult to treat and may represent polyps rather than simple granulomas. ↗
Rebecca's statements about Etiologies (Gastroschisis/NEC/Atresia/Volvulus) 22 statements

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Umbilical Disorders with Dr. Rebeccah Brown

▶ Ep 59 · 1:12
quote And it's a bacterial colonization of that umbilical stump. ↗
▶ Ep 59 · 1:12
clinical Omphalitis is bacterial colonization of the umbilical stump, most commonly due to staph and strep from skin flora. ↗
▶ Ep 59 · 1:30
clinical In advanced omphalitis cases, patients need hospital admission and pediatric surgery consultation. ↗
▶ Ep 59 · 2:17
epidemiological Umbilical hernias are more common in African Americans, low birth weight infants, and premature infants. ↗
▶ Ep 59 · 3:21
quote Incarceration with umbilical hernias, it's actually pretty rare, less than 0.2%, and it's more common if you have a smaller defect. ↗
▶ Ep 59 · 3:21
epidemiological Incarceration with umbilical hernias is rare, occurring in less than 0.2% of cases, and is more common with smaller defects. ↗
▶ Ep 59 · 3:42
epidemiological In Tiffany Zinz's study of 308 umbilical hernia repairs, there was a higher incidence of complications if patients were less than 4 years of age versus greater than 4 years of age. ↗
▶ Ep 59 · 4:06
guideline A literature review of 787 manuscripts (28 meeting quality criteria) showed that early surgical repair of umbilical hernias before age 4 was not indicated regardless of defect size. ↗
▶ Ep 59 · 4:26
quote Early surgical repair before age 4 was not indicated regardless of the size of the defect. ↗
▶ Ep 59 · 4:40
epidemiological In a 2020 study of 9,809 patients, the 3-year recurrence rate after umbilical hernia repair was twice as high in children less than 4 years of age versus those greater than 4 years of age. ↗
▶ Ep 59 · 4:45
quote The 3 year recurrence rate when you fix umbilical hernia was twice as high in children less than 4 years of age versus if they were greater than 4 years of age. ↗
▶ Ep 59 · 6:03
epidemiological If an umbilical hernia persisted at age 3, spontaneous closure occurred in 20% by age 4 and 35% by age 5. ↗
▶ Ep 59 · 6:03
quote If that umbilical hernia was persistent at age 3, spontaneous closure was 20% by 4 years and 35% by 5 years. ↗
▶ Ep 59 · 6:34
quote If it has a huge defect and it's proboscoid, it's probably not gonna close. ↗
▶ Ep 59 · 6:34
opinion Dr. Brown's opinion is that hernias with a huge defect that are proboscoid are probably not going to close spontaneously. ↗
▶ Ep 59 · 6:43
guideline Indications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and consideration for large proboscoid hernias in patients about to start school. ↗
▶ Ep 59 · 7:11
opinion Dr. Brown's approach is to repair umbilical hernias at 5 years regardless of size if they haven't closed, or earlier if the patient is having symptoms. ↗
▶ Ep 59 · 7:11
quote I think in general, 5 years, regardless of size, if it hasn't closed, fix it. If until then, leave it alone unless they're having symptoms. ↗
▶ Ep 59 · 7:22
clinical Umbilical hernia repair technique involves dissecting around the hernia sac, dividing it, trimming excess sac, closing the fascia with interrupted absorbable sutures (such as Vicryl), and recreating the umbilicus. ↗
▶ Ep 59 · 8:52
epidemiological Umbilical granulomas are the most common umbilical masses in newborns. ↗
▶ Ep 59 · 9:17
clinical Dr. Brown recommends neutralizing silver nitrate burns by applying water after silver nitrate application to prevent skin damage and keep it from spreading. ↗
▶ Ep 59 · 9:40
clinical Bright red, pedunculated umbilical lesions that bleed easily are more difficult to treat and may represent polyps rather than simple granulomas. ↗
Rebecca's statements about Intestinal Rehab 22 statements

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Umbilical Disorders with Dr. Rebeccah Brown

▶ Ep 89 · 1:12
clinical Omphalitis is bacterial colonization of the umbilical stump, most commonly due to staph and strep from skin flora. ↗
▶ Ep 89 · 1:12
quote And it's a bacterial colonization of that umbilical stump. ↗
▶ Ep 89 · 1:30
clinical In advanced omphalitis cases, patients need hospital admission and pediatric surgery consultation. ↗
▶ Ep 89 · 2:17
epidemiological Umbilical hernias are more common in African Americans, low birth weight infants, and premature infants. ↗
▶ Ep 89 · 3:21
epidemiological Incarceration with umbilical hernias is rare, occurring in less than 0.2% of cases, and is more common with smaller defects. ↗
▶ Ep 89 · 3:21
quote Incarceration with umbilical hernias, it's actually pretty rare, less than 0.2%, and it's more common if you have a smaller defect. ↗
▶ Ep 89 · 3:42
epidemiological In Tiffany Zinz's study of 308 umbilical hernia repairs, there was a higher incidence of complications if patients were less than 4 years of age versus greater than 4 years of age. ↗
▶ Ep 89 · 4:06
guideline A literature review of 787 manuscripts (28 meeting quality criteria) showed that early surgical repair of umbilical hernias before age 4 was not indicated regardless of defect size. ↗
▶ Ep 89 · 4:26
quote Early surgical repair before age 4 was not indicated regardless of the size of the defect. ↗
▶ Ep 89 · 4:40
epidemiological In a 2020 study of 9,809 patients, the 3-year recurrence rate after umbilical hernia repair was twice as high in children less than 4 years of age versus those greater than 4 years of age. ↗
▶ Ep 89 · 4:45
quote The 3 year recurrence rate when you fix umbilical hernia was twice as high in children less than 4 years of age versus if they were greater than 4 years of age. ↗
▶ Ep 89 · 6:03
epidemiological If an umbilical hernia persisted at age 3, spontaneous closure occurred in 20% by age 4 and 35% by age 5. ↗
▶ Ep 89 · 6:03
quote If that umbilical hernia was persistent at age 3, spontaneous closure was 20% by 4 years and 35% by 5 years. ↗
▶ Ep 89 · 6:34
quote If it has a huge defect and it's proboscoid, it's probably not gonna close. ↗
▶ Ep 89 · 6:34
opinion Dr. Brown's opinion is that hernias with a huge defect that are proboscoid are probably not going to close spontaneously. ↗
▶ Ep 89 · 6:43
guideline Indications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and consideration for large proboscoid hernias in patients about to start school. ↗
▶ Ep 89 · 7:11
opinion Dr. Brown's approach is to repair umbilical hernias at 5 years regardless of size if they haven't closed, or earlier if the patient is having symptoms. ↗
▶ Ep 89 · 7:11
quote I think in general, 5 years, regardless of size, if it hasn't closed, fix it. If until then, leave it alone unless they're having symptoms. ↗
▶ Ep 89 · 7:22
clinical Umbilical hernia repair technique involves dissecting around the hernia sac, dividing it, trimming excess sac, closing the fascia with interrupted absorbable sutures (such as Vicryl), and recreating the umbilicus. ↗
▶ Ep 89 · 8:52
epidemiological Umbilical granulomas are the most common umbilical masses in newborns. ↗
▶ Ep 89 · 9:17
clinical Dr. Brown recommends neutralizing silver nitrate burns by applying water after silver nitrate application to prevent skin damage and keep it from spreading. ↗
▶ Ep 89 · 9:40
clinical Bright red, pedunculated umbilical lesions that bleed easily are more difficult to treat and may represent polyps rather than simple granulomas. ↗
Rebecca's statements about Pectus Excavatum 70 statements

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Pectus Excavatum Pathway

▶ Ep 19 · 0:05
quote I am Rebecca L. Brown, and I'm a pediatric surgeon at Cincinnati Children's and the co-director of the Chestwall Center. ↗
▶ Ep 19 · 0:05
quote I am Rebecca L. Brown, and I'm a pediatric surgeon at Cincinnati Children's and the co-director of the Chestwall Center. ↗
▶ Ep 19 · 0:19
clinical The pectus excavatum clinical care pathway has five major components: pain management, mobility, lung recruitment, daily intake, and daily output. ↗
▶ Ep 19 · 0:19
quote There are 5 major components to the clinical care pathway pain management, mobility, lung recruitment, daily intake, and daily output. ↗
▶ Ep 19 · 0:19
clinical The pectus excavatum clinical care pathway has five major components: pain management, mobility, lung recruitment, daily intake, and daily output. ↗
▶ Ep 19 · 0:19
quote There are 5 major components to the clinical care pathway pain management, mobility, lung recruitment, daily intake, and daily output. ↗
▶ Ep 19 · 0:27
clinical Preoperatively, compression boots are applied for pectus excavatum repair. ↗
▶ Ep 19 · 0:27
clinical Preoperatively, compression boots are applied for pectus excavatum repair. ↗
▶ Ep 19 · 0:31
clinical A type and screen is performed preoperatively for pectus excavatum repair. ↗
▶ Ep 19 · 0:31
clinical A type and screen is performed preoperatively for pectus excavatum repair. ↗
▶ Ep 19 · 0:33
clinical Ancef is given prior to incision, or vancomycin if the patient is MRSA positive. ↗
▶ Ep 19 · 0:33
clinical Preoperative washes of Dynahex or Hibiclens scrub are applied to prevent infection after pectus excavatum surgery. ↗
▶ Ep 19 · 0:33
clinical Preoperative washes of Dynahex or Hibiclens scrub are applied to prevent infection after pectus excavatum surgery. ↗
▶ Ep 19 · 0:33
clinical Ancef is given prior to incision, or vancomycin if the patient is MRSA positive. ↗
▶ Ep 19 · 0:46
clinical Patients are placed on continuous pulse oximetry postoperatively. ↗
▶ Ep 19 · 0:46
clinical Patients are placed on continuous pulse oximetry postoperatively. ↗
▶ Ep 19 · 0:49
clinical Patients are given clear liquids and advanced as tolerated to a full regular diet on postoperative day 0. ↗
▶ Ep 19 · 0:49
clinical Patients are given clear liquids and advanced as tolerated to a full regular diet on postoperative day 0. ↗
▶ Ep 19 · 0:55
clinical Patients are encouraged to be out of bed to the chair and then to ambulate on postoperative day 0, especially if they are the first case of the day. ↗
▶ Ep 19 · 0:55
clinical Patients are encouraged to be out of bed to the chair and then to ambulate on postoperative day 0, especially if they are the first case of the day. ↗
▶ Ep 19 · 1:01
clinical Incentive spirometry is performed 10 times per hour postoperatively. ↗
▶ Ep 19 · 1:01
clinical Incentive spirometry is performed 10 times per hour postoperatively. ↗
▶ Ep 19 · 1:11
clinical Patients receive Ancef times 3 doses postoperatively, or clindamycin if they are MRSA positive. ↗
▶ Ep 19 · 1:11
clinical Patients receive Ancef times 3 doses postoperatively, or clindamycin if they are MRSA positive. ↗
▶ Ep 19 · 1:19
clinical An epidural is routinely used for pain management after pectus excavatum repair, supplemented with Valium, Robaxin, Toradol, IV Tylenol, methadone times 1, and scheduled Zofran for nausea. ↗
▶ Ep 19 · 1:19
clinical An epidural is routinely used for pain management after pectus excavatum repair, supplemented with Valium, Robaxin, Toradol, IV Tylenol, methadone times 1, and scheduled Zofran for nausea. ↗
▶ Ep 19 · 1:31
clinical Patients are encouraged to chew gum 5 separate times a day for 20 minutes if fully awake postoperatively. ↗
▶ Ep 19 · 1:31
clinical Patients are encouraged to chew gum 5 separate times a day for 20 minutes if fully awake postoperatively. ↗
▶ Ep 19 · 1:33
clinical For bowel management, patients are given Senna and MiraLax twice a day as well as Movantik. ↗
▶ Ep 19 · 1:33
clinical For bowel management, patients are given Senna and MiraLax twice a day as well as Movantik. ↗
▶ Ep 19 · 1:43
clinical The Foley catheter inserted during surgery is continued on postoperative day 1. ↗
▶ Ep 19 · 1:43
clinical The Foley catheter inserted during surgery is continued on postoperative day 1. ↗
▶ Ep 19 · 1:49
clinical On postoperative day 1, patients are encouraged to be out of bed, up to a chair, and ambulating about the room 3 times a day. ↗
▶ Ep 19 · 1:49
clinical On postoperative day 1, patients are encouraged to be out of bed, up to a chair, and ambulating about the room 3 times a day. ↗
▶ Ep 19 · 1:56
clinical The Foley catheter is removed on postoperative day 1 to encourage ambulation. ↗
▶ Ep 19 · 1:56
clinical The Foley catheter is removed on postoperative day 1 to encourage ambulation. ↗
▶ Ep 19 · 2:03
clinical On postoperative day 1, the epidural remains in place and medications are supplemented with Valium, Robaxin, Toradol, IV Tylenol, and oxycodone is started orally once patients are tolerating a diet. ↗
▶ Ep 19 · 2:03
clinical On postoperative day 1, the epidural remains in place and medications are supplemented with Valium, Robaxin, Toradol, IV Tylenol, and oxycodone is started orally once patients are tolerating a diet. ↗
▶ Ep 19 · 2:21
clinical Maintenance IV fluids are continued until the patient is drinking well and urinates after Foley removal. ↗
▶ Ep 19 · 2:21
clinical Maintenance IV fluids are continued until the patient is drinking well and urinates after Foley removal. ↗
▶ Ep 19 · 2:34
clinical Zofran, initially given routinely every 8 hours, is changed to as needed on postoperative day 1. ↗
▶ Ep 19 · 2:34
clinical Zofran, initially given routinely every 8 hours, is changed to as needed on postoperative day 1. ↗
▶ Ep 19 · 2:49
clinical On postoperative day 2, IV fluids are discontinued if still running. ↗
▶ Ep 19 · 2:49
clinical On postoperative day 2, IV fluids are discontinued if still running. ↗
▶ Ep 19 · 2:53
clinical The epidural catheter is stopped at 6 in the morning on postoperative day 2. ↗
▶ Ep 19 · 2:53
clinical The epidural catheter is stopped at 6 in the morning on postoperative day 2. ↗
▶ Ep 19 · 2:57
clinical The epidural is removed when the pain team rounds later in the morning on postoperative day 2. ↗
▶ Ep 19 · 2:57
clinical The epidural is removed when the pain team rounds later in the morning on postoperative day 2. ↗
▶ Ep 19 · 3:01
clinical On postoperative day 2, the patient is transitioned to all oral pain medications including oxycodone, Valium, Robaxin, Motrin, and Tylenol. ↗
▶ Ep 19 · 3:01
clinical On postoperative day 2, the patient is transitioned to all oral pain medications including oxycodone, Valium, Robaxin, Motrin, and Tylenol. ↗
▶ Ep 19 · 3:10
clinical A two-view chest X-ray is obtained on postoperative day 2 to evaluate bar location and to rule out any pleural effusion or pneumothorax. ↗
▶ Ep 19 · 3:10
clinical A two-view chest X-ray is obtained on postoperative day 2 to evaluate bar location and to rule out any pleural effusion or pneumothorax. ↗
▶ Ep 19 · 3:19
clinical Dressings are removed and the chest is washed daily starting on postoperative day 2. ↗
▶ Ep 19 · 3:19
clinical Dressings are removed and the chest is washed daily starting on postoperative day 2. ↗
▶ Ep 19 · 3:26
clinical On postoperative day 2, patients are encouraged to ambulate at least 3 times in the halls. ↗
▶ Ep 19 · 3:26
clinical On postoperative day 2, patients are encouraged to ambulate at least 3 times in the halls. ↗
▶ Ep 19 · 3:51
clinical On postoperative day 3, physical therapy and occupational therapy work with the patient to help them walk up and down the stairs, and PT/OT will sign off once they are able to do this. ↗
▶ Ep 19 · 3:51
clinical On postoperative day 3, physical therapy and occupational therapy work with the patient to help them walk up and down the stairs, and PT/OT will sign off once they are able to do this. ↗
▶ Ep 19 · 4:02
clinical Prescriptions are filled and the medication schedule is given to the parent and patients on postoperative day 3. ↗
▶ Ep 19 · 4:02
clinical Prescriptions are filled and the medication schedule is given to the parent and patients on postoperative day 3. ↗
▶ Ep 19 · 4:27
clinical The patient should be on oral pain medication only by postoperative day 3. ↗
▶ Ep 19 · 4:27
clinical The patient should be on oral pain medication only by postoperative day 3. ↗
▶ Ep 19 · 4:31
clinical The patient is discharged home on postoperative day 3 if pain is well controlled and the patient is tolerating oral intake. ↗
▶ Ep 19 · 4:31
clinical The patient is discharged home on postoperative day 3 if pain is well controlled and the patient is tolerating oral intake. ↗
▶ Ep 19 · 4:46
quote Since institution of our clinical care pathway about 2 to 3 years ago, we have reduced our length of stay from 4.5 days to 3 days and have also increased our patient satisfaction. ↗
▶ Ep 19 · 4:46
clinical Since institution of the clinical care pathway about 2 to 3 years ago, patient satisfaction has increased. ↗
▶ Ep 19 · 4:46
clinical Since institution of the clinical care pathway about 2 to 3 years ago, length of stay has been reduced from 4.5 days to 3 days. ↗
▶ Ep 19 · 4:46
clinical Since institution of the clinical care pathway about 2 to 3 years ago, patient satisfaction has increased. ↗
▶ Ep 19 · 4:46
clinical Since institution of the clinical care pathway about 2 to 3 years ago, length of stay has been reduced from 4.5 days to 3 days. ↗
▶ Ep 19 · 4:46
quote Since institution of our clinical care pathway about 2 to 3 years ago, we have reduced our length of stay from 4.5 days to 3 days and have also increased our patient satisfaction. ↗