Dear Sir: Koretz1 reviews a large multicenter trial2 of early administration of a formula
(Impact; Sandoz Nutrition, Minneapolis, MN) containing additives (arginine, RNA, and v-3
fatty acids) to modulate the immune response with a standard enteral formula (Osmolite HN;
Ross, Columbus, OH). There are several misconceptions in his review. The first is that there
should be serious concern about a higher mortality rate in the study population than in the
controls despite a significantly lower mortality in both groups than anticipated, based on …