In Reply.—I very much appreciate receiving the correspondence from Dr Feingold and associates with reference to our article, "Unequal Cardiac Care for Children With Down's Syndrome." Although I am unable to state an absolute age at which the pediatric cardiology evaluation of each child with Down's syndrome should be performed, our article did note that one child in our series, whose condition was diagnosed at 1 day of age, was inoperable even at that time.
The important point, therefore, is not whether 1 month of age or 9 months of age is the time at which each child with Down's syndrome should have a complete pediatric cardiology evaluation, but that every child with Down's syndrome should have this evaluation early enough in life so that the risk of inoperable pulmonary vascular disease is very small. Consequently, it is important that pediatricians and family practitioners refer all children with Down's