CSP CSP Enteral & Parenteral Nutrition Support 1 — Questions and Answers
Question 1: Which enteral formula type is most appropriate for a premature infant requiring concentrated nutrition due to fluid restriction?
- Standard 20 kcal/oz term formula
- Nutrient-enriched preterm formula (24–30 kcal/oz) (Correct answer)
- Whole cow's milk
- Elemental amino acid formula
Correct answer: Nutrient-enriched preterm formula (24–30 kcal/oz)
Nutrient-enriched preterm formulas provide higher caloric density and elevated protein, calcium, and phosphorus needed by premature infants under fluid restriction.
Question 2: What is the primary indication for transpyloric (post-pyloric) enteral feeding in a pediatric patient?
- Cow's milk protein allergy
- Severe gastroesophageal reflux with aspiration risk (Correct answer)
- Iron-deficiency anemia
- Short bowel syndrome
Correct answer: Severe gastroesophageal reflux with aspiration risk
Post-pyloric feeding bypasses the stomach and reduces aspiration risk in children with severe GERD or delayed gastric emptying.
Question 3: In pediatric parenteral nutrition, which electrolyte imbalance is most characteristic of refeeding syndrome?
- Hyperkalemia
- Hypophosphatemia (Correct answer)
- Hypernatremia
- Hypercalcemia
Correct answer: Hypophosphatemia
Refeeding syndrome is characterized by severe hypophosphatemia as glucose shifts phosphate intracellularly during anabolism.
Question 4: What is the recommended maximum dextrose infusion rate (mg/kg/min) when initiating parenteral nutrition in a stable term neonate?
- 2–3 mg/kg/min
- 6–8 mg/kg/min (Correct answer)
- 12–14 mg/kg/min
- 18–20 mg/kg/min
Correct answer: 6–8 mg/kg/min
Starting dextrose at 6–8 mg/kg/min for term neonates matches hepatic glucose oxidation capacity and avoids hyperglycemia.
Question 5: Which complication is specifically associated with long-term parenteral nutrition use in pediatric patients?
- Rickets
- Intestinal failure-associated liver disease (IFALD) (Correct answer)
- Scurvy
- Pellagra
Correct answer: Intestinal failure-associated liver disease (IFALD)
IFALD (formerly PN-associated liver disease) occurs due to phytosterols in soy-based lipid emulsions, lack of enteral stimulation, and sepsis in children on long-term PN.
Question 6: A 3-year-old with short bowel syndrome is transitioning from PN to enteral nutrition. Which strategy best promotes intestinal adaptation?
- Providing all nutrition as bolus gastric feeds immediately
- Gradually introducing small volumes of enteral feeding while weaning PN (Correct answer)
- Switching entirely to an oral diet to stimulate gut function
- Administering high-osmolality formulas to maximize absorption
Correct answer: Gradually introducing small volumes of enteral feeding while weaning PN
Gradual introduction of enteral feeds stimulates intestinal adaptation via trophic effects while PN is slowly weaned to maintain nutrition.
CSP CSP Enteral & Parenteral Nutrition Support 1
Which enteral formula type is most appropriate for a premature infant requiring concentrated nutrition due to fluid restriction?