In Reply.—

We appreciate the comments of Degraeuwe and Blanco. In their letter these authors conclude that our findings are in good agreement with those of the only 2 other randomized trials of this subject, summarized by Kennedy and Tyson in a recent systematic review. None of the 3 studies reviewed by Kennedy and Tyson reported a significant increase in the incidence of necrotizing enterocolitis (NEC). Furthermore, the relative risk for NEC reported in this review is remarkably close to a position of equipoise (relative risk: 0.97; 95% confidence interval: 0.50–1.87). Although we agree with Degraeuwe and Blanco that this evidence is not definitive proof of safety, we did not recommend adopting the practice of more rapid advancement of feedings. Moreover, using the same rationale, one should question the validity of advancing feedings at a slower pace, which is equally unproven. Thus, we concluded our article with a...

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