A 4-Week-Old Boy Is Being Evaluated in the Neonatal Intensive

question 456

Multiple Choice

A 4-week-old boy is being evaluated in the neonatal intensive care unit.  The patient was born at 31 weeks gestation to a 26-year-old primigravida via spontaneous vaginal delivery.  The mother had an uneventful pregnancy prior to the onset of labor.  At delivery, the patient had breathing difficulty and required mechanical ventilation until age 4 days, when he was weaned to nasal cannula.  He also received intravenous antibiotics until cultures were sterile at 36 hours.  In addition, the patient has been receiving total parenteral nutrition exclusively since birth.  Enteral feeds were introduced today, and weight has been stable at the 75th percentile for gestational age.  Temperature is 37.4 C (99.3 F) , pulse is 130/min, and respirations are 38/min.  Pulse oximetry is 90% on 3 L/min of oxygen through a nasal cannula at 40% fraction of inspired oxygen.  Examination reveals mild subcostal retractions and bilateral faint crackles.  Cardiac examination is unremarkable.  The abdomen is mildly protuberant but soft.  Bowel sounds are present.  This patient is at highest risk for developing which of the following complications?

• A)Air dissection into lung perivascular space
• B)Bronchial wall cystic dilation with mucus plugs
• C)Progressive gastrointestinal protein loss
• D)Reduced septation of the alveoli
• E)Refeeding-induced metabolic disturbance

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Definitions:

Infection

The invasion and multiplication of microorganisms such as bacteria, viruses, and parasites that are not normally present within the body. An infection often leads to illness.

Biologic Agent

A virus, bacterium, toxin, or other substance used in biotechnology or as a weapon.

Hyperglycemia

A condition characterized by an abnormally high level of glucose in the blood, often associated with diabetes.

Muscle Weakness

A reduction in the strength of one or more muscles, making it difficult to perform movements normally.