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In Reply.— We read with interest the comments made by Drs Weinberg et al concerning our management of the infant reported in Pediatrics.1 We agree with their conclusion that arterial catheters in critically ill neonates are potentially dangerous and should be monitored closely. We disagree with Dr Weinberg's contention that thrombolytic therapy was not indicated in this case. Our patient demonstrated deteriorating renal function due to the thrombus. In view of progression of renal failure on hepanin therapy, thrombolytic therapy was clearly appropriate in this case.

CASE REPORT The patient was a 2800-g black girl delivered by primary cesarean section because of fetal distress and meconium aspiration after 42 weeks' gestation. Her mother's pregnancy had been complicated by cocaine use. The baby's Apgar score was 5 at 1 minute and 7 at 5 minutes. Maternal and neonatal urine toxicology screens were positive for cocaine, and the infant was treated with phenobarbital because of withdrawal symptoms. She was transferred to Children's Hospital and Health Center for treatment of CO2 retention and probable meconium aspiration syndrome. She was mechanically ventilated, and an umbilical artery catheter was inserted. The infant improved and was extubated after 4 days; the umbilical catheter was removed on day 8 of life. She did well until 11 days of life when she became tachypneic and acidotic with a systemic blood pressure of 130/106 mm Hg.

In Reply.— As we mentioned in the discussion section of our paper,1 parathyroidectomy may have been deleterious to this patient. The experience of Hodsman et al2 with the inappropriateness of parathyroidectomy in nondialyzed uremic patients with osteomalacia could not be applied to our patient because that literature was not in print at the time our patient was treated. Evidence for toxicity of aluminum has, until recently, been controversial. The literature of the past year clearly shows that aluminum can be toxic to bone.