The co-occurrence of congenital heart disease (CHD) and congenital neurological anomalies presents a particularly vexing challenge in neonatology. A new retrospective study attempts to quantify the impact of this comorbidity on clinical outcomes. But as always, clinicians should approach retrospective analyses with caution, particularly when dealing with complex, multifactorial conditions. Is the observed association causal, or merely correlational? And how should these data inform clinical decision-making at the bedside?

The complexities inherent in managing these vulnerable patients demand a rigorous assessment of the available evidence, acknowledging both its strengths and inherent limitations. We must drill into the methodology to understand what—if anything—this adds to our knowledge base.