Lieberthal essentially restates the position taken in the recommendations of the AAP subcommittee and dismisses the evidence documented in our comprehensive review of the relationship of hypoxia and cognition as not relevant to bronchiolitis. His main point is that the review only documented high-quality evidence for congenital heart disease (CHD) and sleep-disordered breathing (SDB). This is not accurate. Our evidence review included direct evidence analyzed in a systematic review, as well as a review of previously published comprehensive reviews of both direct and indirect evidence germane to the question. Direct evidence that showed impaired development and behavior in children was cited not only for CHD and SDB but also for asthma and respiratory instability in infants. The review article, however, in addition to citing evidence of an association, took the further step of analyzing each group of studies to determine if they fulfilled the far-more-rigorous criteria of causation...

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