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We thank Dr. Manzar for his interest [1] in our single-center study on the impact of change in tracheal suction guidelines for nonvigorous infants born through meconium-stained amniotic fluid (MSAF)[2]. We agree that while the incidence of NICU admission for respiratory indications increased in the no-suction era (17.9% vs. 60%), duration of respiratory support, mechanical ventilation, and hospital stay showed a non-significant decrease. While this may suggest reduced severity of illness, the small number of patients in this study and lack of statistical significance prevent us from making definitive conclusions or implying causation. Chiruvolu et al reported a similar increase in respiratory admissions in the no-suction era in their single-center study but did not observe any difference in duration of oxygen therapy (4.4±4.6 vs. 6.4±6.8 d), mechanical ventilation (1.3±2.6 vs. 2.1±3.9 d) or length of stay (7.7±6.3 vs. 9.1±11 d …