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This 2 month old infant presented with failure to thrive related to medical issues including apnea, reflux, and airway inflammation. Testing showed aspiration and reflux, requiring a G-tube and other procedures. The infant was taking in an average of 96 kcal/kg and 1.85 g protein/kg daily via bottle feedings, below the recommended daily allowances. Once receiving feeds via G-tube, the initial plan would be 3 feeds per day of 2 oz each of a 22 kcal/oz formula. The infant meets the criteria for severe malnutr

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