To the Editor.

I read with interest the report by Strauss et al entitled “Tubefeeding and Mortality in Children With Severe Disabilities and Mental Retardation” (Pediatrics, 1997;99:358–362). In this study, a large, statewide database was used to evaluate the association between tubefeeding (any type) and subsequent mortality. The conclusions stated in this study were that tube feedings were associated with an approximately doubled mortality rate among those with less severe disabilities when compared to a non-tubefed cohort. They then further their conclusions (see the “Conclusions” section of the abstract) with a causal linkage to “aspiration after tube placement,” despite the lack of any data regarding aspiration. Although the authors offer many disclaimers about “the retrospective nature of the analysis,” the message of linking any type of enteral feeding with an increased mortality is clear, and so is the questioning of the utility/cost-effectiveness of feeding access procedures. The authors...

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