Sir.—In the article by Samm and colleagues,1 first-born, low-birth-weight twins, whose feedings were advanced rapidly, developed significantly more necrotizing enterocolitis (NEC) than sicker and slower-fed second-born twins. The authors consider the concept that infants who are regarded as stable might have their feedings advanced rapidly and might therefore be prone to the development of NEC. This is precisely what happened in my 1980 study2: four infants (range of birth weight, 2000 to 2500 g) admitted [ill] excellent condition were fed very rap[ill] idly (daily increases up to 95 mL/kg and subsequently developed sever[ill] NEC. I have also seen several infant with low blood glucose levels, but oth[ill] erwise in excellent condition, who de[ill] veloped NEC after being given larg[ill] amounts of oral feedings to raise the level of blood glucose.
Despite the findings of Samm et a[ill] and other investigators2-5 strongly sug[ill] gesting that feeding practices