AGA Abstracts composite response. Graded-stimulus-volume response relationships are shown (Table 1). Conclusions: In infants with sBPD, mechano-, osmo-, and chemo- sensitive stimuli evoke volume-dependent specific peristaltic, UES contractile, and LES relaxation reflexes at 42 and 50 weeks PMA. Recruitment of these reflexes is also dependent on physiochemical properties of the stimuli. Although at these studied PMAs, the patterns of recruitment of reflexes during maturation in sBPD are similar, there was a significant increase in EDR with acidic stimulus at advanced maturation. *Supported in part by PPG-P01 DK 068051 (Jadcherla/Shaker) Table 1. Graded stimulus-response relationship across maturation in sBPD Mo1189 Severe Exocrine Pancreatic Dysfunction in Children With Severe Acute Malnutrition; A Comparison of Faecal Elastase-1 Levels in Children With Marasmus and Kwashiorkor Rosalie H. Bartels, Sophie Meyer, Robert Bandsma, Wieger Voskuijl Introduction: Severe Acute Malnutrition (SAM) is one of the most prevalent causes of mortality in children under the age of 5 years. Improving our understanding of the pathophysiology is urgently needed to improve clinical interventions and outcome. Some data have suggested possible disturbances in exocrine pancreatic function. We aimed to evaluate exocrine pan- creatic function before and during nutritional rehabilitation in children with SAM. Objectives: To assess the percentage of children with SAM that suffers from exocrine pancreas insuffi- ciency as measured by faecal elastase-1 (FE-1) and to investigate differences between oede- matous SAM patients (kwashiorkor) and those with wasting (marasmus). Methods: A retro- spective analysis was conducted of 90 SAM patients that were admitted to the nutritional rehabilitation unit of the Queen Elizabeth Central Hospital in Blantyre, Malawi. In this trial, the "TranSAM" study, we randomly assigned SAM children to 1 of the 3 WHO refeeding diets. Stool samples of each patient were collected and FE-1 levels were measured. We analysed FE-1 levels on admission and day 3 into admission. Results: 90 children with SAM (marasmus: N=32, 35.6%, kwashiorkor: N=58, 64.4%) were included. Median age was 20.9 months (range 6-59) and 36.7% was HIV positive (marasmus: N=17, 51.5%, kwashiorkor: N=16, 48.5%). On admission, 81.6% of children with SAM showed evidence of pancreatic insufficiency as measured by faecal elastase-1 (FE-1 levels below 200 μg/g of stool). Children with kwashiorkor had lower FE-1 levels compared to patients with marasmus (p=0.06). The number of children with pancreatic insufficiency, as well as severe pancreatic insufficiency (FE-1 levels below 100 μg/g of stool) was higher in the kwashiorkor group compared to patients with marasmus. FE-1<200 μg/g: kwashiorkor: N=48 (84.2%) versus N=23 (76.6%) in the marasmus group (p=0.4) and FE-1<100 μg/g: kwashiorkor N=43 (75.4%) versus N= 16 (53.3%) in the marasmus group (p=0.05). During admission there was an increase in FE-1 levels in the kwashiorkor group, whereas the FE-1 levels in the marasmus group remained unchanged. Conclusions: Exocrine pancreatic dysfunction is highly prevalent in children with SAM, especially in kwashiorkor children. These results could have important implications for designing new dietary formulations to treat children with SAM. Mo1190 Utilizing Ostomy in Continuity (OIC) in the Management of Children With Short Bowel Syndrome (SBS) at the Intestinal Rehabilitation Program (IRP) at Children's National-Washington D.C. Sona Sehgal, Parvathi Mohan, Clarivet Torres Background: Children with congenital intestinal obstruction often need an initial end- ostomy in addition to the primary resection. Once the patient is stable, the ostomy is closed to improve absorption and decrease diarrhea. Many patients fail ostomy takedown and have persistent feeding intolerance leading to chronic complications such as poor growth, need for parenteral nutrition (PN), advanced liver disease and recurrent central venous catheter infections (CVCI), The feeding intolerance in these patients is caused by an inherently dysmotile intestine worsened by the discrepancy between the dilated small bowel and the unused colon. We used OIC as a salvage procedure to decompress the proximal bowel while still using the remnant colon. Methods: Fifteen PN dependent patients (7 male) who had undergone OIC, Bishop-Koop or Santulli procedure were enrolled in the study from IRP, which was established in 2007. Median age of the patients at enrollment was 6 months. Among the 15 patients, 7 had gastroschisis, 10 had intestinal atresia, 2 had NEC and 3 had S-634 AGA Abstracts volvulus (7 patients had a combination of these diagnoses). Median intestinal length was 52 cm. Mean energy requirement from PN was 95%. Thirteen patients had advanced liver disease, 10 had liver biopsies of which 6 had stage 3 and 4 had stage 2 fibrosis. Seven patients had mean bilirubin of 8.2 mg/dl. Direct bilirubin (DB), weight and height z scores, albumin and platelets were checked at entry and the end of the study. The indication for OIC was persistent feeding intolerance in SBS, PN dependent patients with - 1. Significant discrepancy in the bowel diameter between the proximal bowel and the colon. 2. Severe dysmotility. 3. Failure of previous medical and surgical treatment. 4. Chronic complications such as recurrent CVCI and liver disease associated with #1 and #2 Results: All 15 patients with intestinal failure showed significant improvement in their enteral tolerance. PN caloric requirement decreased from 95% to 22%. Eight patients (53%) were weaned off PN. Seven patients are in the process of being weaned. Seven patients with hyperbilirubinemia had normalized DB, mean DB decreased from 8.20 to 0.46mg/dl after OIC. All had decreased rate of CVCI. There was significant improvement in all laboratory and nutritional parameters. The median weight Z score improved from -1.0 (range +1.16 to -5.80) to 0.41 (range 1.99 to -4.76); the median height Z score improved from -1.9 (range -10.59 to 0.85) to -0.76 (range -10.23 to 1.13). None required transplant. Survival rate of the patients was 100%. Conclusions: OIC is an underutilized surgery in patients with SBS. It improves enteral tolerance and decreases reliance on PN thereby improving liver function, decreasing CVCI and avoids the need for liver and small bowel transplantation. Parameters Measured Before and After Placement of OIC Mo1191 Segmentation and Analysis of Brain MRIs of Human Premature Infants With Dysphagia Are Distinct Nasser H. Kashou, Irfaan Dar, Ish K. Gulati, Charles Pluto, Mark Smith, David G. Bates, Sudarshan Jadcherla Background: Neonatal dysphagia is a known morbidity among infants with perinatal neuro- logical injury. Anatomical areas of brain associated with neonatal dysphagia have been described. However, the extent of injury and the preserved brain volume in infants with dysphagia is unknown. Objective: We investigated the volumes of specific cortical and subcortical areas involved in the hierarchical regulation of swallowing pathways and catego- rized in relation to feeding outcomes. We hypothesized that dysphagic neonates have smaller brain volume in specific areas of sensory and motor regulation of feeding. Methods: Neonates (N=39), born at 31.7±0.8 wks gestation and 2.0±0.2 kg birth weight, with dysphagia underwent brain MRI for anatomical evaluation. Standard clinical scans were administered on a 1.5 or 3 Tesla General Electric (GE) Scanner. Total scanning time was approximately 30 minutes per patient. Axial T1 and T2 weighted contrast images were used for segmentation. MRI sequences were anonymized to protect patient identity and were uploaded into Ana- lyzeDirect software. Cortical and subcortical regions of interest (ROIs) were segmented and volumetrics were calculated and normalized per cm of head circumference. Comparisons were made between those discharged on full oral feeds (N=19) vs. g-tube (N=20) using t- tests and linear regression methods, with p < 0.05 considered significant. Data reported as Mean±SE. Results: At evaluation the post menstrual age (PMA) for the fully oral-fed group was 41.7±0.9 wks, and for the g-tube fed group 43.7±1.9 wks (p=0.3). Weight at evaluation was 3.6±0.3 kg for the fully oral-fed group and 4.1±0.3 kg for the g-tube fed group (p= 0.2). Frequency of lesions were 26% for fully oral-fed vs 30% for g-tube fed (p=0.8). Specific brain regions of interest are shown (Table 1). Volumetric data is shown (Figure 1). Conclusion: Functional abnormalities of cortical and brainstem neural networks may be responsible for dysphagia in g-tube fed infants despite relatively larger volumes. Volumetrics normalized by head circumference are more closely related to PMA for infants discharged on oral feeds compared to infants discharged on g-tube. Orally-fed NICU infants are likely to have an increase in volume per cm of head circumference of the cerebrum, brainstem, cerebellum, and basal ganglia with increase in PMA. *Supported in part by R01 DK068158 (Jadcherla) Table 1. Analysis of Volume/Head Circumfere (mm 3 /cm) per Feeding Outcome at Discharge