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Comment & Response |

Surgery and Neurodevelopmental Impairment Need for Time-Dependent Covariates to Correct for Confounding by Indication

Dany E. Weisz, MD1; Lucia Mirea, PhD2; Prakesh S. Shah, MD, MSc3
[+] Author Affiliations
1Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
2Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
3Department of Pediatrics, Mt Sinai Hospital, Toronto, Ontario, Canada
JAMA Pediatr. 2014;168(12):1168-1169. doi:10.1001/jamapediatrics.2014.1781.
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To the Editor We read with interest the study by Morriss et al1 and the accompanying editorial recently published in JAMA Pediatrics.2 We applaud their use of a propensity score modeling approach to answer the following question facing neonatologists and surgeons: is it the surgery or the underlying condition/status of the infant that is associated with neurodevelopmental impairment? However, we wish to highlight an important shortcoming in the authors’ attempt to reduce bias owing to confounding by indication.


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December 1, 2014
Abhik Das, PhD; Shampa Saha, PhD; Frank H. Morriss Jr, MD, MPH
1Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland
2Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
3Department of Pediatrics, University of Iowa, Iowa City
JAMA Pediatr. 2014;168(12):1169. doi:10.1001/jamapediatrics.2014.1787.
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