ASPEN Self-Study CNSC
QUESTIONS AND ANSWERS
Which of the following is the BEST indication for the use of a soy-
baed infant formula?
1. diarrhea
2. cow's milk protein allergy
3. galactosemia
4. regurgitation with feeds - 3. galactosemia
is a soy formula recommended in infants with acute diarrhea
associated with gastroenteritis who develop secondary lactase
deficiency? - No
Is soy formula recommended in children who have a cow's milk
protein allergy? - No, since a high percentage of children who are
allergic to cow's milk protein will also be allergic to soy protein, the
AAP now recommends a trial use of either a hydrolyzed or free amino
acid-containing formula
What is galactosemia? - An inborn error of metabolism that affects
the body's ability to metabolize galactose
What is the only way to treat galactosemia? - To eliminate galactose
from the diet. Soy based infant formulas are used as substitutes for
milk in galactosemia. The galactose content (approximately 20 mg/L)
of lactose-free cows milk infant formula is considerably higher than
soy and hypoallergenic formulas
Is lactose-free cow's milk infant formula recommended in
galactosemia? - the galactose content (approximately 20 mg/L) of
lactose-free cow's milk infant formula is considerably higher than soy
and hypoallergenic formulas therefore lactose-free cow's milk formula
is not recommended for treatment of galatosemia
,Do soy protein-based formulas have a role in preventing allergy or
managing GIT symptoms? - Soy protein-based formulas have no role
in preventing allergy or in management of non-specific
gastrointestinal symptoms e.g. infantile colic and regurgitation
Which of the following concentrations is considered to be an upper
limit for the osmolality of infant formulas to avoid tolerance issues?
1. 460 mOsm/kg
2. 360 mOsm/kg
3. 260 mOsm/kg
4. 560 mOsm/kg - 1. 460 mOsm/kg
What is the osmolality of standard infant formulas at a caloric density
of 20 kcal/oz? - Generally falls below the limit with a range of 200-
380 mOsm/kg
What is the osmolality of hydrolyzed protein and free amino acid
containing infant formulas? - Generally have a slightly higher
osmolality due to their smaller particle size (330-370 mOsm/kg)
What is the osmolality of a 30 calorie per ounce concentrated standard
infant formula? - About 450 mOsm/kg
How will the addition of a carbohydrate modular impact osmolality? -
Will increase osmolality
How will the addition of a fat modular impact osmolality? - Will not
impact osmolality
Which of the following is FALSE regarding regurgitation in infants?
1. regurgitation is rare in infants
2. regurgitation in neonates is related to relaxation of the lower
esophageal sphincter
3. regurgitation is usually transient and will resolve around 7-12
months of age
,4. regurgitation is associated with delayed gastric emptying - 1.
regurgitation is rare in infants
List 3 possible causes of reflux in children receiving enteral nutrition.
- 1. rapid administration of enteral formula
2. delayed gastric emptying
3. tube migration in to the esophagus
When does regurgitation usually resolve in children? Why? -
Regurgitation usually will resolve around 7-12 months of age with
maturation of the lower esophageal sphincter
Is regurgitation rare in infants? - No, regurgitation is very common in
infants and does not necessarily signify a problem
Which of the following is TRUE regarding aspiration in critically ill
children?
1. the incidence of aspiration directly caused by enteral nutrition is
difficult to determine due to a lack of good clinical research
2. increased gastric residuals are directly related to increased risk for
aspiration
3. children have strong coordination of pharyngeal muscles, making
aspiration less likely than in adults
4. children have strong cough reflex which helps protect them from
aspiration - 1. The incidence of aspiration directly caused by enteral
nutrition is difficult to determine due to a lack of good clinical
research
Why is the incidence of aspiration directly caused by enteral nutrition
difficult to determine? - there have not been standardized definitions
of what constitutes aspiration, nor have there been adequate
descriptions in all studies of the actual cause of aspiration in each
particular patient
Have increased gastric residuals been linked to an increased risk for
aspiration? - No
, What are 2 reasons critically ill children have an increased risk of
aspiration? - 1. Decreased strength and coordination of pharyngeal
muscles
2. Weak cough reflex
Which of the following best describes the appropriate use of
powdered infant formula in healthcare facilities?
1. Freeze open containers and discard after 30 days from opening
2. Refrigerate open containers and discard after 30 days from opening
3. Use interchangeably with comparable sterile liquid formulations
4. Use only when alternative sterile liquid products are not available
and when clinically necessary - 4. Use only when alternative sterile
liquid products are not available and when clinically necessary
Why are powdered infant formulas only used in health care facilities
when clinically necessary and when alternative commercially sterile
liquid products are not available? - Powdered formulas are not sterile,
when there are no other alternatives to infant formula powder,
clinicians need to be aware of potential risks with use of powdered
formulas for immunocompromised patients
Wha is the hang time for expressed human milk when used for
continuous enteral feedings?
1. 2 hours
2. 4 hours
3. 8 hours
4. 12 hours - 2. 4 hours
Is expressed human milk sterile? - No, it is never sterile and contains
a variety of normal skin flora. Contamination can occur during milk
espression and storage, during the preparation and mixing of
ingredients, and while assembling and handling feeding systems
QUESTIONS AND ANSWERS
Which of the following is the BEST indication for the use of a soy-
baed infant formula?
1. diarrhea
2. cow's milk protein allergy
3. galactosemia
4. regurgitation with feeds - 3. galactosemia
is a soy formula recommended in infants with acute diarrhea
associated with gastroenteritis who develop secondary lactase
deficiency? - No
Is soy formula recommended in children who have a cow's milk
protein allergy? - No, since a high percentage of children who are
allergic to cow's milk protein will also be allergic to soy protein, the
AAP now recommends a trial use of either a hydrolyzed or free amino
acid-containing formula
What is galactosemia? - An inborn error of metabolism that affects
the body's ability to metabolize galactose
What is the only way to treat galactosemia? - To eliminate galactose
from the diet. Soy based infant formulas are used as substitutes for
milk in galactosemia. The galactose content (approximately 20 mg/L)
of lactose-free cows milk infant formula is considerably higher than
soy and hypoallergenic formulas
Is lactose-free cow's milk infant formula recommended in
galactosemia? - the galactose content (approximately 20 mg/L) of
lactose-free cow's milk infant formula is considerably higher than soy
and hypoallergenic formulas therefore lactose-free cow's milk formula
is not recommended for treatment of galatosemia
,Do soy protein-based formulas have a role in preventing allergy or
managing GIT symptoms? - Soy protein-based formulas have no role
in preventing allergy or in management of non-specific
gastrointestinal symptoms e.g. infantile colic and regurgitation
Which of the following concentrations is considered to be an upper
limit for the osmolality of infant formulas to avoid tolerance issues?
1. 460 mOsm/kg
2. 360 mOsm/kg
3. 260 mOsm/kg
4. 560 mOsm/kg - 1. 460 mOsm/kg
What is the osmolality of standard infant formulas at a caloric density
of 20 kcal/oz? - Generally falls below the limit with a range of 200-
380 mOsm/kg
What is the osmolality of hydrolyzed protein and free amino acid
containing infant formulas? - Generally have a slightly higher
osmolality due to their smaller particle size (330-370 mOsm/kg)
What is the osmolality of a 30 calorie per ounce concentrated standard
infant formula? - About 450 mOsm/kg
How will the addition of a carbohydrate modular impact osmolality? -
Will increase osmolality
How will the addition of a fat modular impact osmolality? - Will not
impact osmolality
Which of the following is FALSE regarding regurgitation in infants?
1. regurgitation is rare in infants
2. regurgitation in neonates is related to relaxation of the lower
esophageal sphincter
3. regurgitation is usually transient and will resolve around 7-12
months of age
,4. regurgitation is associated with delayed gastric emptying - 1.
regurgitation is rare in infants
List 3 possible causes of reflux in children receiving enteral nutrition.
- 1. rapid administration of enteral formula
2. delayed gastric emptying
3. tube migration in to the esophagus
When does regurgitation usually resolve in children? Why? -
Regurgitation usually will resolve around 7-12 months of age with
maturation of the lower esophageal sphincter
Is regurgitation rare in infants? - No, regurgitation is very common in
infants and does not necessarily signify a problem
Which of the following is TRUE regarding aspiration in critically ill
children?
1. the incidence of aspiration directly caused by enteral nutrition is
difficult to determine due to a lack of good clinical research
2. increased gastric residuals are directly related to increased risk for
aspiration
3. children have strong coordination of pharyngeal muscles, making
aspiration less likely than in adults
4. children have strong cough reflex which helps protect them from
aspiration - 1. The incidence of aspiration directly caused by enteral
nutrition is difficult to determine due to a lack of good clinical
research
Why is the incidence of aspiration directly caused by enteral nutrition
difficult to determine? - there have not been standardized definitions
of what constitutes aspiration, nor have there been adequate
descriptions in all studies of the actual cause of aspiration in each
particular patient
Have increased gastric residuals been linked to an increased risk for
aspiration? - No
, What are 2 reasons critically ill children have an increased risk of
aspiration? - 1. Decreased strength and coordination of pharyngeal
muscles
2. Weak cough reflex
Which of the following best describes the appropriate use of
powdered infant formula in healthcare facilities?
1. Freeze open containers and discard after 30 days from opening
2. Refrigerate open containers and discard after 30 days from opening
3. Use interchangeably with comparable sterile liquid formulations
4. Use only when alternative sterile liquid products are not available
and when clinically necessary - 4. Use only when alternative sterile
liquid products are not available and when clinically necessary
Why are powdered infant formulas only used in health care facilities
when clinically necessary and when alternative commercially sterile
liquid products are not available? - Powdered formulas are not sterile,
when there are no other alternatives to infant formula powder,
clinicians need to be aware of potential risks with use of powdered
formulas for immunocompromised patients
Wha is the hang time for expressed human milk when used for
continuous enteral feedings?
1. 2 hours
2. 4 hours
3. 8 hours
4. 12 hours - 2. 4 hours
Is expressed human milk sterile? - No, it is never sterile and contains
a variety of normal skin flora. Contamination can occur during milk
espression and storage, during the preparation and mixing of
ingredients, and while assembling and handling feeding systems
