In Reply.—

Although it is difficult to compare the perinatal patient population in Israel directly with that in the US, the Jerusalem experience with persistent pulmonary hypertension (PPH) is encouraging and consistent with that of a number of centers here.

Definitive data on this subject are not currently available, but there is considerable indirect evidence, such as that of Bruckheimer and Eidelman, to support the view that babies born at large centers with comprehensive perinatal services are less likely to require ECMO and, therefore, that some of the need for ECMO may be preventable.

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