The use of temporary EADs is common in pediatric care. There is wide variation in how placement of these tubes is verified.

Background Determine the tube-related complications and feeding outcomes of infants discharged home from the NICU with nasogastric (NG) tube feeding or gastrostomy (G-tube) feeding. Material & Methods We performed a chart review of 335 infants discharged from our NICU with home NG tube or G-tube feeding between January 2009 – December 2013. The primary outcome was the incidence of feeding tube-related complications requiring emergency department (ED) visits, hospitalizations, or deaths. Secondary outcome was feeding status at 6 months post-discharge. Univariate and multivariate analyses were conducted. Results There were 322 infants discharged with home enteral tube feeding, 84 NG tube and 238 G-tube, with available out-patient data for the 6 month post-discharge period. A total of 115 ED visits, 28 hospitalizations, and 2 deaths were due to a tube-related complication. The incidence of tube-related complications requiring an ED visit was significantly higher in the G-tube group compared to the NG tube group (33.6% vs 9.5%, p < 0.001). Two patients died due to a G-tube related complication. By 6 months post-discharge, full oral feeding was achieved in 71.4% of infants in the NG tube group compared to 19.3% in the G-tube group (p < 0.001). Type of feeding tube and percentage of oral feeding at discharge were significantly associated with continued tube feeding at 6 months post-discharge. Conclusion Home NG tube feeding is associated with fewer ED visits for tube-related complications compared to home G-tube feeding. There may be some infants who could benefit from a trial home NG tube feeding.

Central venous catheters are often necessary in the pediatric population. Access may be challenging, and each vessel presents its own unique set of risks and complications. Central venous catheterization is useful for hemodynamic monitoring, rapid fluid infusion, and administration of hyperosmolar medications, including vasopressors, antibiotics, chemotherapy, and parenteral nutrition. Recent advances have improved the catheters used as well as techniques for insertion. A serious complication of central access is infection, which is associated with morbidity, mortality, and significant financial costs. Reduction of catheter-related bloodstream infections is realized with use of ethanol locks, single lumens when appropriate, and prudent adherence to insertion and maintenance bundles. Ultrasound guidance used for central venous catheter placement improves accuracy of placement, reducing time and unsuccessful insertion and complication rates. Patients with central venous catheters are best served by multidisciplinary team involvement.

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This is a case series in which 3 infants with gastrojejunostomy tube (GJT) insertion developed delayed perforation secondary to pressure necrosis. A review of all patients who underwent a GJT placement in 2013 was performed. Three of these patients developed surgically confirmed perforation secondary to pressure necrosis during this time period; no patients developed perforation at the time of GJT insertion. The indications for GJT insertion for all 3 patients were severe gastroesophageal reflux disease; 2 patients also had recurrent aspiration. The patients were between 9 weeks and 10 months of age at the time of GJT insertion. The site of perforation for all 3 cases occurred just distal to the ligament of Treitz between 48 and 72 hours following insertion. Given our 3 cases of perforation in patients weighing <10 kg, there may be a higher risk of perforation in low-weight patients.

A structured team approach to laboratory monitoring of home PN patients can simplify PN management, significantly decrease monthly laboratory costs, and lead to fewer laboratory draws while improving micronutrient monitoring and preventing deficiencies.

There is no concordance between current diagnostic criteria for failure to thrive (FTT). We analyzed validity of the Semi-Objective Failure to Thrive (SOFTT) diagnosis tool, which uses a combination of subjective and objective components to make the diagnosis of FTT. The tool was used to diagnose FTT in 94 patients who met 1 of 7 accepted criteria for FTT. Concurrent and predictive validity were demonstrated using anthropometric z-scores and change in anthropometric z-scores, respectively. SOFTT results correlated with differences in anthropometric z-scores for length ( P = .011), weight, weight-for-length, body mass index, mid-upper arm circumference, and triceps skinfold thickness ( P < .0001) between those diagnosed as normal and those with FTT. At follow-up, children with FTT compared with children rated as normal had significantly higher change in weight ( P ≤ .001) and body mass index ( P = .026) z-scores. The SOFTT tool leads to the accurate diagnosis of FTT demonstrated by concurrent and predictive validity.

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