Gains and losses from dexamethasone for neonatal chronic lung disease

Abstract

Chronic lung disease is a common outcome of neonatal intensive care, especially among infants born very much before term. Inflammation is important in the pathogenesis of chronic lung disease. Because of their anti-inflammatory properties, corticosteroids should have a favourable impact on the disease process. Yet, two multicentre trials 1 Collaborative Dexamethasone Trial GroupDexamethasone therapy in neonatal chronic lung disease: an international, placebo-controlled trial. Pediatrics. 1991; 88: 421-427 PubMed Google Scholar , 2 Shinwell ES Karplus M Zmora E et al. Failure of early postnatal dexamethasone to prevent chronic lung disease in infants with respiratory distress syndrome. Arch Dis Child. 1996; 74: F33-F37 Crossref Google Scholar did not show that corticosteroids conferred any long-term benefit. Possible explanations were either that the corticosteroids were given too late (after 3 weeks of age) 1 Collaborative Dexamethasone Trial GroupDexamethasone therapy in neonatal chronic lung disease: an international, placebo-controlled trial. Pediatrics. 1991; 88: 421-427 PubMed Google Scholar or that, when given “early” (within 14 days of birth), the course was too short (only 3 days). 2 Shinwell ES Karplus M Zmora E et al. Failure of early postnatal dexamethasone to prevent chronic lung disease in infants with respiratory distress syndrome. Arch Dis Child. 1996; 74: F33-F37 Crossref Google Scholar Other, smaller, trials 3 Rastogi A Akintorin SM Bez ML Morales P Pildes RS A controlled trial of dexamethasone to prevent bronchopulmonary dysplasia in surfactant treated infants. Pediatrics. 1996; 98: 204-210 PubMed Google Scholar , 4 Yeh TF Lin YY Hseih WS et al. Early postnatal dexamethasone therapy for the prevention of chronic lung disease in preterm infants with respiratory distress syndrome: a multicentre clinical trial. Pediatrics. 1997; 100: E3 Crossref PubMed Scopus (146) Google Scholar of early but longer courses of dexamethasone have shown a positive effect.