CSP CSP Enteral & Parenteral Nutrition Support 2 — Questions and Answers
Question 1: Which lipid emulsion is preferred in pediatric PN to reduce the risk of IFALD compared to soy-based emulsions?
- Pure soy-based lipid emulsion (Intralipid)
- Fish oil-based lipid emulsion (Omegaven) or mixed emulsions (SMOF) (Correct answer)
- Medium-chain triglyceride oil alone
- Corn oil-based emulsion
Correct answer: Fish oil-based lipid emulsion (Omegaven) or mixed emulsions (SMOF)
Fish oil-based or mixed lipid emulsions (SMOF) contain omega-3 fatty acids and lower phytosterol content, reducing hepatic injury risk.
Question 2: What is the primary purpose of adding carnitine to parenteral nutrition in preterm neonates?
- To prevent hypercalcemia
- To facilitate long-chain fatty acid transport into mitochondria for oxidation (Correct answer)
- To reduce osmolality of the PN solution
- To serve as a glucose precursor
Correct answer: To facilitate long-chain fatty acid transport into mitochondria for oxidation
Carnitine is essential for transporting long-chain fatty acids across the mitochondrial membrane for beta-oxidation, and preterm infants have limited endogenous synthesis.
Question 3: Which clinical finding most strongly suggests catheter-related bloodstream infection (CRBSI) in a child receiving home PN?
- Mild increase in serum alkaline phosphatase
- Fever coinciding with PN infusion that resolves when infusion stops (Correct answer)
- Moderate hyperglycemia
- Increased stool frequency
Correct answer: Fever coinciding with PN infusion that resolves when infusion stops
Fever that begins during PN infusion and resolves after stopping is a hallmark presentation of CRBSI, indicating the central venous catheter as the infection source.
Question 4: For a pediatric patient requiring cyclic PN, what is the primary clinical benefit of cycling infusion over 12–16 hours nocturnally?
- Reduces caloric intake to promote weight loss
- Allows periods of fasting that reduce hepatic fat deposition and improve liver function (Correct answer)
- Eliminates the need for lipid emulsion
- Prevents hypophosphatemia
Correct answer: Allows periods of fasting that reduce hepatic fat deposition and improve liver function
Cyclic PN provides fasting periods that lower insulin levels, reduce hepatic lipogenesis, and allow for biliary flow, thereby protecting liver function.
Question 5: A preterm neonate on PN develops hypercalcemia. Which modification to the PN formulation is most appropriate?
- Increase phosphorus to improve calcium:phosphorus ratio
- Reduce calcium and vitamin D content in the PN (Correct answer)
- Add more dextrose to dilute serum calcium
- Increase amino acid concentration
Correct answer: Reduce calcium and vitamin D content in the PN
Hypercalcemia in PN-dependent neonates is managed by reducing calcium and vitamin D content to lower the calcium load being infused.
Question 6: Which formula characteristic is most important when selecting an enteral formula for a child with compromised GI absorption (e.g., Crohn's disease with stricture)?
- High fiber content
- Hydrolyzed or elemental protein with reduced osmolality (Correct answer)
- High osmolality to maximize caloric density
- Intact protein with added long-chain triglycerides
Correct answer: Hydrolyzed or elemental protein with reduced osmolality
Hydrolyzed or elemental formulas reduce the digestive burden and improve absorption in children with impaired GI function.
CSP CSP Enteral & Parenteral Nutrition Support 2
Which lipid emulsion is preferred in pediatric PN to reduce the risk of IFALD compared to soy-based emulsions?