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

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

Correct Answer:

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