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Sir.—I am most grateful to Dr. Pender for his comments on my letter to the editor. He has added another point or two regarding the benefit of compression of the infant chest after the head is delivered and just before delivery is complete.Neither of us would challenge the prevailing concept of the importance of surfactant in the expansion of the lung of the newborn, but the value of the "wringer action" in clearing the airway and, as Dr. Pender suggests, in removing other material present in the birth canal has been little regarded.Birth is an intricate process, and the immediate institution and adequacy of respiration may involve a number of factors and not any single one.
SHAW EB. Cause of Respiratory Distress Syndrome-Reply. Am J Dis Child. 1975;129(2):260. doi:10.1001/archpedi.1975.02120390084026