Reply

We appreciate the interest in our recent report and the critiques offered by Madenci et al, but we respectfully disagree with their assertions. Although "regression to the mean" is certainly a valid concept in population studies, it is not applicable in a study of a subset of 17 infants with extreme, life-threatening pulmonary hypertension. These infants represent the outliers in the cohort of 164 infants with congenital diaphragmatic hernia described in our study. The extraordinarily high mortality associated with severe, persistent pulmonary hypertension in infants with congenital diaphragmatic hernia1-3 indicates that this type of pulmonary hypertension does not regress, to the mean or otherwise.

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