PREMATURITY is a major contributing factor to neonatal mortality. The premature infant has lower nutritional reserves, is more susceptible to infections, and has a more fragile vascular system than his full-term counterpart. In addition, sucking and swallowing result in fatigue, with increasing nutritional deficits and a higher incidence of aspiration pneumonia. The mortality and morbidity from all of these factors increase strikingly in infants weighing less than 1,250 gm (2 lb 12 oz) at birth. Pediatricians routinely attempt to overcome these difficulties by either delaying the nourishment of small premature infants or with gavage, intravenous, or medicine-dropper feedings.
Several investigators have suggested feeding gastrostomies to prevent aspiration and to minimize the handling, and resulting fatigue, of the baby. Berg et al performed 11 gastrostomies which resulted in four early deaths from respiratory failure.1 They suggested delaying the operation for two or three days until the danger of hyaline membrane