In the United States, approximately 1 in 3600 infants are born with a congenital diaphragmatic hernia (CDH), in which incomplete development of one or both hemidiaphragm allows herniation of abdominal viscera into the chest [1]. Infants with CDH can be critically ill, with hypoxemia, hypercarbia, and/or cardiorespiratory failure resulting from underlying pulmonary hypertension (PH) and lung hypoplasia. Some patients may require advanced support modalities including extracorporeal membrane oxygenation (ECMO).

In the United States, approximately 1 in 3600 infants are born with a congenital diaphragmatic hernia (CDH), in which incomplete development of one or both hemidiaphragm allows herniation of abdominal viscera into the chest [1]. Infants with CDH can be critically ill, with hypoxemia, hypercarbia, and/or cardiorespiratory failure resulting from underlying pulmonary hypertension (PH) and lung hypoplasia. Some patients may require advanced support modalities including extracorporeal membrane oxygenation (ECMO).

EA is the most frequent congenital esophageal malformation. Long gap EA remains a therapeutic challenge for pediatric surgeons. A case case-control prospective study from a multi-institutional national French data base was performed to assess the outcome, at age of 1 and 6 years, of long gap esophageal atresia (EA) compared with non-long gap EA/tracheo-esophageal fistula (TEF). The secondary aim was to assess whether initial treatment (delayed primary anastomosis of native esophagus vs. esophageal replacement) influenced mortality and morbidity at ages 1 and 6 years.

We would like to thank Dr. Tedde for his interest in our study [1]. His supposition is that vacuum bell therapy increases pre-sternal adipose tissue in front of the sternum instead of actually remodeling the cartilage and bone of the sternum to produce various degrees of pectus excavatum correction. He also makes reference that the patients may be wrongly directed in terms of treatment expectations with vacuum bell therapy subjecting them to unnecessary discomfort. We appreciate the opportunity to have this open dialog and respond.

Post-operative fluid shifts, especially after long or complicated surgical procedures and in patients admitted to the intensive care unit (ICU), are common and contribute to increased mortality, prolonged mechanical ventilation and increased risk of morbidities [1–4]. In adult ICU patients, fluid overload of >10% is associated with increased risk of 90-day mortality [1]. In the pediatric ICU population, a 3% increase in mortality has been reported with every 1% increase in overload [2]. Current methods of assessing fluid volume status following complex surgery include pre and post-operative weight, daily intake and output recordings, and clinical assessment of body edema.