1. A very wide range in the incidence of meconium aspiration syndrome (MAS) from 1.62% to 34.4% has been reported in the literature [1-3]. We could not find the incidence of MAS in the vigorous infants only, and thus, we decided to go by the incidence (15%) observed in our institution. Another reason of considering our own institutional incidence of MAS was similar demographic profile of the mothers and infants.　

2. A vigorous infant was defined at birth as: spontaneous breathing/crying; HR >10 in 6 seconds; and good muscle tone. All infants were monitored by Downe’s scoring for the development of respiratory distress after birth until 72 hrs of age; the first assessment was done at 30-45 min of age. Infants who developed dyspnea during this period and had radiological evidence of meconium aspiration were diagnosed as MAS.

3. Intestinal peristalsis might be affected in the infants born to mothers receiving methyldopa as anti-hypertensive medication. Therefore, these infants were excluded from this study where feed intolerance was being studied.

4. Meconium-stained amniotic fluid (MSAF) may be aspirated in utero in the majority of cases. However, it can also be aspirated after birth when an infant vomits out meconium stained liquor causing secondary MAS. The definition of MAS includes respiratory distress, radiological evidence of meconium aspiration and birth through MSAF. All infants who aspirate meconium do not develop MAS and we agree that in an asymptomatic infant there is no need to do X-ray chest. But our premise is that gastric lavage will prevent development of secondary MAS where meconium is aspirated after birth. The X-ray chest was, therefore, done in this study within 4 hrs in all infants to document any radiological evidence of the intrauterine aspiration of MSAF.