In Reply.—There appears to be a misunderstanding regarding the definition of the VATER association. In the original reports by Quan and Smith,1,2 in which the acronym was first put forth, the frequency of association between vertebral defects, imperforate anus, and tracheoesophageal fistula with esophageal atresia and radial dysplasia was made by ascertaining patients with one of these defects and noting the frequency of the other anomalies. To be included in this study, there was no requirement that a patient have more than two of the four VATER abnormalities. In other words, the VATER association is the association of two or more defects in the same individual. Thus, we believe that we were justified in our study to have included patients with only two of the major VATER association defects.
Furthermore, the VATER association is not a syndrome. Quan and Smith1,2 clearly defined this entity as a nonrandom