1. The sequence of performing suctioning and drying during initial steps of delivery room resuscitation is not evidence-based. The purpose of suctioning (clearing airway) is to prevent aspiration of secretions and respiratory distress while drying helps to prevent hypothermia. In our study, we compared the sequence of the two approaches (suctioning first versus drying first). We feel that without using the composite outcome of admission hypothermia or respiratory distress, we would have favored one group over the other, compromising the validity of the trial. 　Separate analysis of the incidences of admission hypothermia or respiratory distress did not show any significant difference between the two groups.

2. Relative risk should be interpreted in relation to the 95% confidence interval, which was quite wide (0.14-1.38). Based on our findings, there was no significant difference between the two approaches. We therefore differ with the reader that depressed newborns should always be suctioned first followed by drying. Interestingly, the upcoming eighth edition of NRP by the American Academy of Pediatrics has reordered the sequence of initial steps (drying first and suctioning later, if needed) to better reflect the common practice [2]. It appears that the proposed change is based on expert opinion rather than any evidence. In fact, our study provides evidence to this change of practice.

3. We agree to the concern of the authors. Our NICU is close to both labor room and maternity operation theatre. Babies are transported to NICU well swaddled. We do not have transport incubator. Currently we are using Embrace to maintain temperature during transportation. However, its use does not entirely eliminate the problem of admission hypothermia.

1. Kumar A, Yadav RP, Basu S, Singh TB. Suctioning first or drying first during delivery room resuscitation: A randomized controlled trial. Indian Pediatr. 2021;58:25-9.

2. NRP 8th Edition Busy People Update #1 – December 2020. Accessed March 01, 2021. Available from: https://downloads.aap. org/AAP/PDF/NRP%208th%20Edition%20Busy%20People% 20Update%20.pdf