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1
Drs Shah, Farine and Perlman first raise the issue of selection bias. We included every child in our analyses, for which, needed data were available. We had to review a large database for two reasons. First, the sudden onset of unremitting fetal bradycardia is uncommon. Second, only a rare child who experienced such bradycardia had more than one or two of the laboratory test results required for our analyses.
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2
We agree that bradycardia of more than a few minutes duration reflects ‘questionable’ obstetrical care. Some of our cases in that category originated more than a decade ago. In other instances, a physician had to be called from home, a nurse did not promptly notify the obstetrician or the obstetrician did not act appropriately.
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3
The term ‘injury’ is appropriate because it was the thromboplastic products of such injury entering the blood of a fetus or neonate that led to the time reliable changes in blood platelet counts and thus the ability of such counts to identify when a child's organ damage had begun.
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4
When lymphocyte counts were available so, usually, were the counts of platelets and normoblasts. When available they were always included in our analyses.
Drs Shah, Farine and Perlman first raise the issue of selection bias. We included every child in our analyses, for which, needed data were available. We had to review a large database for two reasons. First, the sudden onset of unremitting fetal bradycardia is uncommon. Second, only a rare child who experienced such bradycardia had more than one or two of the laboratory test results required for our analyses.
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