We read with interest the recent article, “Transpyloric feeding is associated with adverse in-hospital outcomes in infants with severe bronchopulmonary dysplasia” by Levin et al. [1]. The authors, our colleagues within the BPD Collaborative [2], conducted a multicenter retrospective review of 1039 patients with severe bronchopulmonary dysplasia (sBPD) born at <32 weeks post menstrual age (PMA) to examine the association between transpyloric feeding (TPF) and adverse outcomes such as tracheostomy or death. Associations were observed between TPF and tracheostomy or death as well as between TPF and prolonged length of stay or death. In our hospitals, this article has spurred conversations as to whether TPF should no longer be attempted given this association with worse outcomes.

We write to concur with the important limitations the authors describe in their thoughtful discussion. Specifically, that “the retrospective nature of the study does not imply causality between TPF and the outcomes”. They acknowledged that TPF may be a “marker of illness severity” and that “there may be residual confounding beyond ventilation support and FiO2 at 36 weeks’ PMA.” We write to emphasize this point, knowing that in the clinical setting, TPF is typically attempted in patients with severe lung disease who are not tolerating gastric feeds.