An infant receiving medical treatment for NEC has rising lactate, falling platelets, falling serum sodium and new abdominal-wall erythema. Ventilator and vasoactive support requirements are increasing. Repeat abdominal radiographs show no free air. What is the next best action?

An infant has substantial small-bowel loss after surgery for NEC. Small human-milk feeds are tolerated, the abdomen is soft, and ostomy output is stable, but parenteral nutrition is still needed to meet nutrient requirements. Which feeding strategy best supports intestinal adaptation and growth?

A stable 3-day-old infant has abdominal distension, bilious gastric drainage, and has not passed meconium. The anus is patent and an upper GI study has excluded malrotation. There is no evidence of perforation or enterocolitis. Which study best evaluates the colon for abnormal caliber, a transition zone, or obstructing material?

A 26-week infant on day of life 3 is receiving total fluids of 120 mL/kg/day and has lost 12% of birth weight. Serum sodium has increased from 145 to 155 mEq/L over 12 hours and urine output is 5 mL/kg/hr. Blood pressure and perfusion remain reassuring. Review of all infusions confirms the ordered intake and no excessive sodium delivery. Which fluid adjustment should the NNP make?

A preterm infant with previously normal mineral levels develops anuria and a rising serum creatinine during an acute illness. Ionized calcium is 0.78 mmol/L, magnesium is 2 mg/dL, and pH is 7.36. Calcium replacement has begun. Which additional laboratory test should the NNP prioritize to evaluate the cause of the hypocalcemia?

A 5-week-old infant has increasingly forceful nonbilious vomiting after feeds. The infant remains hungry after vomiting, but weight gain has slowed and the number of daily wet diapers has decreased. The abdomen is soft and nondistended. What diagnosis is most likely?

A preterm infant develops abdominal distension, mild tenderness, and a bloody stool. Perfusion remains stable, with no metabolic acidosis or coagulopathy. Abdominal radiography shows pneumatosis intestinalis without portal venous gas or free air. Which modified Bell stage is most consistent with these findings?

A clinically stable preterm infant receiving fortified human milk has a total calcium of 6.9 mg/dL, albumin of 2.1 g/dL, and ionized calcium of 1.16 mmol/L. The infant has no jitteriness, apnea, or seizures. Which management plan should the NNP implement?

Why must daily weight be interpreted with intake, urine output, sodium, and environmental exposure when estimating insensible water loss?

A preterm infant with a birthweight of 1.8 kg is receiving 35 mL of 24-kcal/oz fortified milk every 3 hours. Feeds were interrupted and the administration record shows that only 225 mL was delivered over the past 24 hours. How many kcal/kg/day did the infant actually receive?