Reply to Letter to the Editor by Lohmann and Fernandes

Most patients with congenital diaphragmatic hernia (CDH) who developed pneumothorax on mechanical ventilation have an underlying pulmonary hypoplasia, in which the lung has a physiologically small volume and consequently a low compliance. The Japanese CDH Study Group (JCDHSG) conducted multicenter retrospective cohort studies of pneumothorax development in patients with CDH between 2006 and 2018 [1,2]. Pneumothorax was more likely to develop in patients with CDH associated with larger diaphragmatic defects and was associated with a fatal outcome in neonates with CDH, especially those with large diaphragmatic defects [1,2].