The apparent basis of Dr. Keitel's disapproval of the use of gastrostomy in feeding certain premature infants, as stated in his first letter (Pediatrics, 34:293, 1964), rests in his premise "that gastrostomies may have increased the mortality rate." In that letter he noted that the over-all national mortality rate for infants weighing about 1,000 gm at birth is approximately 90%, and that approximately 65% expire within the first 24 hours. Subtracting 65% from 90% he determined that "the approximate death rate of infants with a birth weight of about 1,000 gm after the first day of life is 25%," a figure which (for reasons given below) was inappropriate for comparison with our mortality rate of 36% who survived the first day of life.

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