We thank the authors for a critical appraisal of our paper.

Based on the CDC criteria for diagnosis of VAP, a combination of clinical, radiological and laboratory features are essential for diagnosis of VAP. Though such stringent criteria are fine for an epidemiological diagnosis, by the time all criteria are evident, the outlook for the neonate may become grave. Hence the objective of our study was to evaluate the utility of endotracheal aspirate microscopy, culture and endotracheal tube tip culture for early diagnosis of ventilator-associated pneumonia in neonates. We considered 　　the fact that the presence of pathogens in a normally sterile lower respiratory tract or lung parenchyma increases the likelihood of VAP.

Unfortunately, there is no single gold standard test for diagnosis of VAP for comparison. Hence we compared the time-to-diagnosis using ET aspirate studies versus time-to-diagnosis based on CDC VAP criteria and found a significantly shorter time-to-diagnosis based on the former criteria. As far as the ETA microscopy and culture were concerned, these tests were performed by the microbiologists who were blind to the presence or absence of VAP　in the study cohort.

Saline instillation was done for few babies where yield of secretions was insufficient and not as a routine as per methodology reported by Hagedorn (Reference 8 of article). This aspect was part of the protocol put up to the institutional ethics committee, with whose approval the study was conducted.