Dear Editor, This letter is in response to the letter to editor titled “Breastfeeding and congenital heart disease a critical, review of the methodology” received by the journal for our article titled: “Systematic survey of breastfeeding practices in mothers of infants with congenital heart disease undergoing cardiac surgery in a tertiary care center in India” that was published in Annals of Pediatric Cardiology in August 2025.1 We thank the authors for their interest in our article and for their comments. We appreciate the opportunity to clarify the points raised. Regarding the terminology used in the title, we would like to clarify that the term “systematic survey” was not intended to imply a systematic review. The term “systematic” is to be interpreted in conjunction with the noun it qualifies. While a systematic review refers to a structured synthesis of existing literature conducted to answer a specific research question, a systematic survey denotes a methodical and predefined approach to primary data collection within a study. In our work, the term “systematic survey” was used to describe the structured, comprehensive, and uniform process by which data were collected from a defined population, rather than to imply a review of previously published research. With regard to the concern about recall bias, we acknowledge that the retrospective component of phase 1 could introduce recall bias. This limitation was explicitly recognized and stated in the methodology section of the article as follows: “Although recall bias was acknowledged as a limitation, the survey offered vital insights into baseline breastfeeding practices within the cardiac care context and highlighted initial barriers and trends.” While it may have been reiterated separately under the limitations section, we believe the acknowledgment within the methodology reflects our awareness of this inherent constraint. Importantly, phase 1 was conceived as a pilot phase to identify prevailing trends and inform questionnaire development. To address this limitation, we subsequently conducted a prospective observational phase (Phase 2), in which mother–infant dyads were enrolled perioperatively and followed longitudinally through direct interviews and observation, thereby minimizing recall bias. Furthermore, as outlined in the article, an additional intervention phase has since been completed prospectively, focusing on targeted lactation support strategies. The results of this phase are currently being compiled and will be communicated in a subsequent correspondence. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Yenduri et al. (Sat,) studied this question.