In the September 2003 issue of Pediatrics, Stege et al discuss the effect of new therapies for congenital diaphragmatic hernia (CDH) on survival. They point out that studies reporting improved survival using high-frequency ventilation, extracorporeal membrane oxygenation, inhaled nitric oxide, and delayed surgery are flawed by selection bias and conclude, after assessing 185 cases of CDH from a regional database, that survival is determined principally by the rate of antenatal termination and incidence of associated anomalies. Literature supporting a very promising approach to CDH, gentle ventilation, spearheaded by Wung et al, was not presented. In a study reporting 89 consecutive patients with CDH at a single institution, patients treated with gentle ventilation had a 78% overall survival (89% of treated infants survived), compared with 15% and 44% survival during earlier eras in which paralysis, hyperventilation, alkalinization, and extracorporeal membrane oxygenation were used in the absence of gentle...

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