Reopening the Debate on Corticosteroids: To the Editor

Abstract

To the Editor. — Doyle et al1 are to be congratulated for putting forward a study that highlights the potential of low-dose dexamethasone as a short-term intervention in ventilator-dependent extremely low birth weight (ELBW) infants after 1 week of age. I was particularly interested in their discussion of spontaneous intestinal perforations (SIPs) and the possibility that a more mature postnatal intestine might be less likely to acquire SIP with steroid exposure. It is an idea that may have merit. However, I think some perspective is in order regarding how we should “reopen the debate on corticosteroids and … future RCTs [randomized, controlled trials]” in this patient population. First, I want to state why I think Doyle et al might be correct in their supposition that the earlier an ELBW infant receives steroids, the greater the chance he or she will acquire SIP and, therefore, that later administration may be safer. Using the Pediatrix database, we recently obtained a national cohort of 633 patients with SIP and found that there was a significant association with both early postnatal steroid and indomethacin exposure …