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The Pediatric Forum |

Outcomes After “Benign” Extra-Axial Fluid

Kenneth Harkavy, MD
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Copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

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Arch Pediatr Adolesc Med. 2004;158(10):1017-1017. doi:10.1001/archpedi.158.10.1017-a
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While the article “Benign” extra-axial fluid in survivors of neonatal intensive care”1 was interesting from a prognostic perspective, there are several “science” issues that the editorial staff failed to address. First is the use of the word control for the group without fluid. In no way are they a control population but simply a reference population. The word control refers to a population managed in the traditional way without the experimental intervention. The 2 populations were not assigned to each group but happened to turn out that way.

Second, it is clear from the description of the origin of the patients and the extremely wide standard deviations that there are 2 distinct populations: the very small and the large (patients who required use of extracorporeal membrane oxygenation [ECMO] ). This bimodial clustering should not be analyzed with means and standard deviations but with nonparametric statistics. Of note is the 10 of 26 prevalence of ECMO in the “benign” extra-axial fluid (BEAF) group and only 4 of 43 in the non-BEAF group. In other words, 10 of 14 patients in the ECMO group (who by most ECMO criteria are [near] term) had BEAF, and only 16 of 55 premature infants had BEAF. The head circumference growth charts show that the larger infants had the most extreme head circumference values. The analysis would have been more helpful had the authors presented the data for each of the 3 weight groups as well as the linear regression model.

It would have been helpful had 2 other pieces of information been provided. Do the authors know the incidence of BEAF in normocephalic infants in their group, especially after ECMO? The poor outcome for patients with BEAF after receiving ECMO doesn't bode well for patients receiving ECMO if BEAF is at all common after ECMO. Between what postconceptual ages does one see the onset of BEAF? Was it present at discharge from the hospital, or did it develop after discharge?

AUTHOR INFORMATION

Correspondence: Dr Harkavy, 9709 Hall Rd, Potomac, MD 20854 (klhark46@aol.com).

Lorch  SA, D'Agostino  JA, Zimmerman  R, Bernbaum  J. “Benign” extra-axial fluid in survivors of neonatal intensive care. Arch Pediatr Adolesc Med 2004;158178- 182
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Lorch  SA, D'Agostino  JA, Zimmerman  R, Bernbaum  J. “Benign” extra-axial fluid in survivors of neonatal intensive care. Arch Pediatr Adolesc Med 2004;158178- 182
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