The use of postnatal corticosteroids for extremely preterm infants continues to be one of the most controversial therapies in neonatology. The risk of off-target effects on neurodevelopment have led to the creation of lower dosage regimens used for shorter periods of time. As reported in this volume of The Journal, Marr et al randomized 59 extremely preterm infants with significant evolving chronic lung disease between 10 and 21 days of life to 1 of 2 regimens of dexamethasone. Both groups began at 0.5 mg/kg/day for 3 days; 1 group was then tapered over 42 days (total dose of ∼8 mg/kg) and the second group was tapered over 9 days (∼2.6 mg/kg for each course, with the possibility of up to 2 more 9-day courses if clinical deterioration occurred). The study was masked and did not allow for any open label use of inhaled or intravenous steroids during the study period. Infants who received the 42-day course were extubated almost 2 weeks earlier, although rates of bronchopulmonary dysplasia (BPD) and use of discharge on home oxygen therapy were similar between the groups. The most remarkable feature of this study was that 96% of the infants were evaluated with cognitive testing at age 7. Children in the 42-day group were more likely to be without neurodevelopmental impairment, have an IQ >70, and be in regular school without an individualized educational plan (75% vs 38% for the 9-day taper). There continues to be uncertainty about which infants with BPD benefit from corticosteroids and about which infants might be harmed without benefit. The study by Marr et al cannot fully answer these questions as it was conducted in a single center with a high survival rate and did not have an untreated control group. However, few studies include the all-important school age outcomes, which pediatricians and parents will certainly view as more meaningful than interim outcomes such as BPD. These findings suggest that if a high-risk, ventilator dependent infant is committed to a course of dexamethasone, there may be an important long-term advantage to continuing treatment through and beyond the time of extubation. Article page 20▸ Randomized Trial of 42-Day Compared with 9-Day Courses of Dexamethasone for the Treatment of Evolving Bronchopulmonary Dysplasia in Extremely Preterm InfantsThe Journal of PediatricsVol. 211PreviewTo compare pulmonary and neurodevelopmental outcomes in extremely preterm infants with evolving bronchopulmonary dysplasia treated with either a 42-day course of dexamethasone or 9-day course(s) of dexamethasone. Full-Text PDF