In Reply: Criteria for Ventilatory Assistance in Hyaline Membrane Disease

We agree, in the main, with the commentary of Vidyasagar and Pildes concerning our objectively derived criteria1 for early intervention with ventilatory assistance in hyaline membrane disease (HMD). Accumulating experience supports the efficacy and relative freedom from complications of both continuous positive and negative expiratory pressure in the management of HMD. Some infants whose right to left shunts are not large enough to demand assistance by arterial oxygen criteria do seem to have markedly noncompliant lungs and have a tendency to tire on the second to fourth day of their illness.