Superior thyroid cornu syndrome may be a rare cause of cervical dysphagia. It may be diagnosed by careful laryngoscopy with laryngeal palpation followed by a computed tomography scan. Surgical resection of the affected superior thyroid cornu by transoral pharyngotomy appears to be effective in relief of symptoms.

Children with ESLD and malnutrition who have failed enteral feeding may benefit from PN to improve and/or resolve malnutrition before liver transplant.

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Background SMOFlipid is a mixed‐lipid emulsion approved for adults in the United States as an alternative to soybean oil–based lipid (SO). There are limited data on the use of SMOFlipid in pediatrics and its effect on the fatty acid (FA) profile. Our objective was to characterize changes in FA profile, liver function, and growth in pediatric patients with intestinal failure (IF), following transition from SO or a fish‐oil (FO) and SO combination to SMOFlipid. Methods A retrospective case series was conducted on pediatric parenteral nutrition–dependent IF patients transitioned to SMOFlipid. Demographics, anthropometrics, labs, and achievement of nutrition goals were assessed. Linear mixed‐effect models assessed effects on FA levels and clinical outcomes. Results One hundred thirty‐nine FA panels were collected from 20 patients. Median SMOFlipid dose at study completion was 2 g/kg/d (interquartile range, 1.6–2). During the 1.5 years after SMOFlipid initiation, ω‐6 FA increased to physiologic levels, arachidonic acid increased from 298 to 461 nmol/mL (P < .001), and linoleic acid increased from 1172 to 1922 nmol/mL (P < .001). ω‐3 FA remained within normal limits. Body mass index z‐score and length z‐score increased, though no significant changes were found. In addition, no significant changes were found in mead acid, hepatic function, triene‐to‐tetraene ratio, or triglycerides. Conclusion In 20 pediatric IF patients, SMOFlipid allowed greater ω‐6 FA provision while maintaining ω‐3 FA, hepatic function, and patient growth. This longitudinal study identified improved FA profile associated with SMOFlipid use in comparison with SO with or without FO.

Routine supplementation of iodine in parenteral nutrition (PN) solutions is not current practice in the United States. In this case study, we describe an incidental finding of goiter in a long-term PN-dependent adolescent. With increased iodine screening, we then identified additional patients with undetectable urinary iodine concentrations in our population of children with short bowel receiving long-term PN. We hypothesize that 2 practice changes are possibly reducing iodine provision to long-term PN-dependent patients: transition to alcohol-based skin preparations and lipid minimization.