This study reports on a cohort of infants with single ventricle physiology following the hybrid procedure and found the incidence of aspiration to be lower than previously reported. Improved clinical bedside evaluation guidelines are needed so that clinicians can predict more reliably which infants are at risk for aspiration following the hybrid procedure.

OBJECTIVE : To examine the cost-effectiveness of intensive interdisciplinary behavioral treatment (IIBT) to address severe pediatric feeding difficulties and lead to the removal or prevention of gastrostomy tubes (G tubes) from the perspective of the insurance company.  METHODS : Costs associated with G tubes and IIBT were compiled from the available literature and national databases. Costs were updated to price at the start of 2015 to allow data from different years to be analyzed on the same scale.  RESULTS : One-way sensitivity and two-way threshold analyses demonstrated that IIBT may be a cost-effective treatment for prevention and removal of G tubes over 5 and 10 years.  DISCUSSION : Data from this study can be used to justify cost of services for IIBT, and programs can use these data to discuss conservative savings of IIBT based on their treatment model and level of effectiveness.

Introduction:Enteral feeding pumps at times may deliver different volumes than are prescribed, which can negatively impact growth, nutrition, and well-being. This study sought to assess whether challenges with pump accuracy for patients on food-based formulas contributed to challenges with weight gain.Methods:Chart review identified complex feeding patients receiving food-based enteral nutrition via feeding pump with unexpected weight loss. Relevant data, such as enteral formula type, and anthropometric information were extracted.Results:Five complex pediatric feeding patients were identified and 2 of these cases were summarized as representative examples, showing weight loss in children following the introduction of enteral food-based formulas because of feeding pump inaccuracy.Conclusions:Complex pediatric feeding patients may display unexpected and poor weight gain and growth while receiving food-based enteral feeding interventions because of pump errors. It is vital for providers to be aware of these challenges for timely intervention.

Increased survival of premature infants with severe bronchopulmonary dysplasia (BPD) has led to new challenges in optimizing both clinical management and neurodevelopmental outcomes. Numerous studies have shown a strong association between severe BPD and neurocognitive dysfunction at follow-up. Data demonstrate substantial differences between similar centers within the same neonatal network in the United States. Presumably, variations in outcome are related to differences in care practices, which suggests that improvements in care practices could result in improvement in respiratory and/or neurocognitive outcomes. Emerging questions regarding optimal management include the following: 1) What is the optimal respiratory strategy? 2) What is the optimal timing for undergoing tracheostomy placement? 3) What is the best way to address comfort needs? 4) What is the optimal environment for promoting neurodevelopmental progress? Here we discuss the benefits of achieving and maintaining a progrowth, prodevelopment state in infants with severe BPD. It is increasingly clear that growth and development overlap considerably, and each are related to a number of physiologic, nutritional, and environmental factors. A progrowth, prodevelopment state is best reached by achieving a complex balance of adequate respiratory support, consistent oxygenation, and positive, age-appropriate social and developmental experiences. Moreover, optimal management is achieved by minimizing pain and stress, inflammation, infection, and medications that suppress lung and brain growth. Because the care of these infants is chronic and progressive, it is important to use an interdisciplinary team model, with consistent feedback loops to monitor and maintain these goals.