Establishing the GROW Program: A New Era for Intestinal Rehabilitation at Norton Children’s Hospital

Before GROW, children with intestinal failure all had to be transferred outside of Kentucky for long-term care. Our goal was to build a comprehensive program right here, keeping these medically complex children close to their families and communities. We are incredibly proud of how much the program has evolved to help more patients stay home. —Dr. Christie Buonpane, GROW Co-Lead

Norton Children’s Hospital launched the Gastrointestinal Rehabilitation and Optimization for Wellness (GROW) program to eliminate the necessity for out-of-state travel for specialized intestinal rehabilitation. Though pediatric intestinal failure is a rare condition with approximately 24.5 cases per 100,000 live births, its intensive management demands specialized, multidisciplinary oversight.

Co-led by Dr. Christie Buonpane and Dr. Linley Harvie, GROW began in the neonatal intensive care unit with dedicated inpatient rounds focused on infants with functional or anatomic intestinal failure unlikely to achieve immediate enteral autonomy. It has since evolved into a fully integrated initiative supporting patients across inpatient, outpatient, and home settings, ensuring that patients who previously established care at out-of-state centers can now transition their management back to Norton Children’s Hospital.

Since its launch, GROW has been involved in the care of 26 children, including 13 active outpatients, and has not required transferring a single patient elsewhere solely for intestinal rehabilitation. Marking a major milestone, the program enabled its first patient to be discharged directly home from the NICU on parenteral nutrition in March 2026, vastly improving continuity of care.

A Collaborative Team Built for Complex Care

Managing intestinal failure requires a coordinated network of specialists:

• Pediatric Gastroenterology
• Pediatric Surgery
• Neonatology
• Dietitians
• Pharmacists
• Clinical Care Coordinators
• Social Work
• Nursing
• Infectious Disease Specialists (as needed)
• Home infusion companies supporting parenteral nutrition after discharge

This multidisciplinary structure addresses both medical and practical needs. The team coordinates central line care, adjusts nutrition, monitors growth, prevents infections, and guides families through daily at-home management. For families living farther away, the program coordinates with local medical centers to handle routine weekly labs, weights, and central line dressing changes locally, allowing results to be reviewed via virtual follow-up visits.

What Long‑Term Parenteral Nutrition Involves

Children with intestinal failure require far more than IV nutrition. Their ongoing care includes:

• Weekly labs
• Frequent growth and nutrition assessments
• Central line maintenance
• Adjustments to parenteral and enteral nutrition
• Management of electrolyte abnormalities
• Support for feeding difficulties and poor growth
• Prevention and treatment of central line infections

Because patient needs change rapidly as intestinal function shifts, the team’s coordinated oversight ensures responsive, safe management focused on promoting intestinal adaptation and eventual enteral autonomy.

By eliminating the barrier of out-of-state transfers, GROW sets a new regional benchmark for pediatric care by ensuring Kentucky children with intestinal failure receive expert, local care to achieve optimal clinical outcomes and long-term developmental stability.