Early Enteral Feeding in Preterm Infants

CPD Questions: Early Enteral Feeding in Preterm Infants

Answer all 15 questions after reading the article. A minimum of 12 correct answers is required to pass.

1. 1. According to the review, early enteral feeding is generally recommended to begin:

   A. After 5 to 7 days of lifeB. Once full parenteral nutrition is establishedC. As soon as feasible following birth in clinically stable infantsD. Only after the first passage of stool

2. 2. Which gastrointestinal change is associated with prolonged exclusive parenteral nutrition?

   A. Increased villous heightB. Enhanced gut motilityC. Promotion of beneficial bacterial developmentD. Intestinal villous atrophy

3. 3. What was one of the reported benefits of advancing enteral feeds at 30–40 mL/kg/day?

   A. Decreased incidence of infection but increased incidence of NECB. Decreased duration of parenteral nutritionC. Increased risk of developing co-morbiditiesD. Increased feeding intolerance

4. 4. For infants weighing ≥ 750 g, human milk fortification is proposed to start when:

   A. Enteral feeding volumes reach 30–40 mL/kg/dayB. Enteral feeding volumes reach 50–60 mL/kg/dayC. When parenteral nutrition is stoppedD. When enteral feeding volumes are advanced by 15 to 25 mL/kg/day

5. 5. Which statement best describes the relationship between early enteral feeding and NEC?

   A. Early feeding consistently increases NEC riskB. Delayed feeding has been proven to prevent NECC. Current evidence does not support delaying feeds solely to reduce NEC riskD. NEC only occurs in early feeding with infant formula

6. 6. What effect may early enteral feeding have on the intestinal microbiome?

   A. Decreased microbial diversityB. Delayed microbial colonizationC. Elimination of non-pathogenic organismsD. Promotion of beneficial bacterial development

7. 7. Which of the following statements does not agree with the Cochrane reviews cited in this article?

   A. Early enteral feeding poses no increased risk of NEC in infants born <23 weeks or <500 gB. There is insufficient evidence to indicate whether holding enteral feeding in infants in need of a blood transfusion has any effect on developing NECC. Clinical evidence reported slow enteral feeding advancement resulted in a borderline increased risk of invasive infections in a large cohort of very low birth weight infantsD. Monitoring gastric residuals is not necessary as an assessment of feeding tolerance to prevent NEC

8. 8. Which factor is identified as a barrier to initiating enteral feeds in preterm infants?

   A. Excessive growth velocityB. Fear of NEC or spontaneous intestinal perforationC. Risk of metabolic bone diseaseD. Fat intake above recommendations

9. 9. In the proposed feeding algorithm, enteral feeding in infants weighing less than 750 g can be initiated:

   A. Should not be initiated for the first week of life, even if hemodynamically stableB. Within the first 24 hours of life at 30–40 mL/kg/dayC. At 15–25 mL/kg/dayD. At 30–40 mL/kg/day

10. 10. What was associated with increased brain volumes in the cerebellum and basal ganglia in the Coviello study?

    A. Increased duration of parenteral nutritionB. Increased enteral fat, but not protein intakeC. Increased parenteral fat, energy and protein intakeD. Increased enteral energy, protein and fat intake

11. 11. Which of the following statements is not true:

    A. Extremely low birth weight infants are not at risk of insufficient vitamin D intake when receiving standard parenteral multivitamin formulationsB. Extremely premature infants are at risk of poor bone mineralizationC. 80% of bone mineralization occurs in the third trimester of fetal developmentD. Optimizing the provision of vitamin D, calcium and phosphorous in the first month of life is crucial for bone development in preterm infants

12. 12. Which statement best reflects the authors' recommendations regarding feeding during treatment of a patent ductus arteriosus (PDA)?

    A. Enteral feeding should always be stopped during treatment for PDAB. It is feasible and safe to continue enteral feeding in infants receiving IndomethacinC. It is not feasible or safe to continue enteral feeding in infants receiving IndomethacinD. Parenteral nutrition should be discontinued during treatment with Indomethacin

13. 13. Which of the following statements is not true regarding the transition period from parenteral to enteral nutrition?

    A. There is an increased risk of growth failure during this periodB. Low protein intake during this period was associated with a decreased fat-free mass at term corrected age in very low birth weight infantsC. Higher parenteral volume may need to be given if enteral feeding is not above 100 mL/kg/dayD. Early fortification of human milk may need to be considered to achieve targeted protein intake

14. 14. The best strategy to address the fear of the development of NEC with early enteral feeding is:

    A. By implementing a feeding protocol consisting of successfully proven feeding strategiesB. By routinely using transpyloric feeding tubesC. To stop all monitoring for feeding intoleranceD. By using hydrolyzed infant formulas

15. 15. Which of the following best summarizes the authors' overall conclusion?

    A. Parenteral nutrition should take preference over enteral feeding during the first few weeks of lifeB. Trophic feeding should be maintained for at least the first two weeks of lifeC. Early enteral feeding should only be initiated in infants >1500 gD. Early initiation and advancement of enteral feeding provide nutritional, developmental, and clinical benefits for preterm infants