Necrotizing Enterocolitis in Multiple Gestation-Reply

In Reply —The debate about feeding practices and NEC continues to rage in the pediatric literature. Although most authors still mention a strong association between NEC and feeding, teasing out this relationship has been difficult. Recently, Ostertag et al 1 have shown that starting feedings on day 1, even in infants at high risk for NEC, did not increase the incidence of the disease compared with a similar group of infants fed later. However, all infants in the study had feedings advanced extremely slowly, and the feedings remained hypocaloric for some time. Goldman's study, as well as ours, emphasizes that rapidly advancing feedings in apparently stable infants may be a significant contributing factor to the development of NEC. Further prospective studies on early initiation of feedings with very gradual advancement of volume and strength deserve to be done, and one such study will be undertaken in our institution.