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When patients cannot decide and no directive exists, surrogates use substituted judgment—making decisions based on what the patient would have wanted. Beneficence obliges clinicians to provide interventions with potential benefit while minimizing harm. In a persistent vegetative state, PN provides biologic sustenance but little meaningful recovery, raising ethical debate. The care team should provide balanced counseling, including burdens (infection risk, complications) and lack of evidence for improved outcomes. Justice, veracity, and confidentiality are ethical principles but not central in this scenario. Ultimately, shared decision-making with surrogates aligns care with presumed patient values.

Beneficence refers to promoting the good of the patient, such as initiating PN when it prevents malnutrition. Autonomy = respecting patient choice; justice = fairness in care; nonmaleficence = avoiding harm. Beneficence is central to ethical nutrition care.

Vitamin D is essential for calcium and phosphate absorption and bone mineralization. Deficiency in premature infants leads to rickets, characterized by weak bones and deformities. Vitamin C deficiency causes scurvy, vitamin K deficiency causes bleeding, and vitamin E deficiency causes hemolysis. PN must include vitamin D to prevent metabolic bone disease.

Without colon continuity, fat and bile salt malabsorption is severe, causing deficiencies of vitamins A, D, E, and K. PN supplementation is often required. Hyperglycemia may occur but is not specific; hyperkalemia is not characteristic; iron overload is unrelated.

A p-value of 0.03 means that if the null hypothesis were true, there would be a 3% probability of observing a difference at least this large due to chance. It does not indicate the probability that the hypothesis is “true” or “false.” Nor does it guarantee clinical significance; statistical significance and clinical relevance are distinct. P-values must be interpreted alongside effect sizes and confidence intervals. For example, a mortality reduction with EN vs PN may be statistically significant but clinically trivial if the absolute risk reduction is small. Critical appraisal skills are vital for nutrition support clinicians to apply evidence judiciously.