Infants with hypoplastic left heart syndrome often experience difficulty with oral feeding, which contributes to growth failure, morbidity, and mortality. In response to feeding difficulty, clinicians often change the bottle nipple, and thus milk flow rate. Slow-flow nipples have been found to reduce the stress of feeding in other fragile infants, but no research has evaluated the responses of infants with hypoplastic left heart syndrome to alterations in milk flow. The purpose of this study was to evaluate the physiological and behavioural responses of an infant with hypoplastic left heart syndrome to bottle feeding with either a slow-flow (Dr. Brown’s Preemie) or a standard-flow (Dr. Brown’s Level 2) nipple. A single infant was studied for three feedings: two slow-flow and one standard-flow. Oral feeding, whether with a slow-flow or a standard-flow nipple, was distressing for this infant. During slow-flow feeding, she experienced more coughing events, whereas during standard-flow she experienced more gagging. Disengagement and compelling disorganisation were most common during feeding 3, that is slow-flow, which occurred 2 days after surgical placement of a gastrostomy tube. Clinically significant changes in heart rate, oxygen saturation, and respiratory rate were seen during all feedings. Heart rate was higher during standard-flow and respiratory rate was higher during slow-flow. Further research is needed to examine the responses of infants with hypoplastic left heart syndrome to oral feeding and to identify strategies that will support these fragile infants as they learn to feed. Future research should evaluate an even slower-flow nipple along with additional supportive feeding strategies.

Field observations of small (<20 mm) individuals of Mytulus galloprovincialis at Littlehampton (West Sussex) on the south-eastern coast of England showed that many collected as recently dead shells had a distinctive pattern of damage around the posterior valve margins. Laboratory experiments confirmed that small Carcinus maenas (<22 mm carapace width) were capable of inflicting a similar style of damage. Small C. maenas fed successfully on a range of mussel sizes (5–20 mm shell length), positively correlated with carapace width. All used the same technique to access the bivalve prey, that is, by marginal mandibular chipping in order to achieve sufficient damage to allow insertion of a chelal dactyl between the valves. Mandibular chipping has previously been reported upon from non-chelate decapods and juvenile lobsters. The chelae of juvenile C. maenas are small and have a lower mechanical advantage than has been reported upon for adult conspecifics which, in any case, are not highly adapted for durophagy. We suggest that because of the poor mechanical performance and small gape of the chelae juvenile C. maenas behave as though they were achelate. As well as broadening our understanding of the repertoire of known feeding behaviours of C. maenas, our study may also provide an insight into the evolution of durophagy within the Decapoda.

The effect of a therapeutically administered high calorie diet in a severely malnourished patient is discussed in this case report. In patients with advanced head and neck cancer prolonged periods of malnutrition prior to admission are frequently encountered. This case report highlights the need to constantly monitor the electrolyte and vitamin levels during the early stages of instituting enteral or parenteral nutrition. By vigilant monitoring and a high index of suspicion re-feeding syndrome or severe hypophosphataemia and its associated complications can be avoided.