Postnatal steroids and chronic lung disease in the newborn.
BACKGROUND
Chronic lung disease (CLD) represents a condition of persistent inflammation within the airways which may have its origin either in utero or after birth. Corticosteroids, because of their anti- inflammatory actions, have been used to modify the course of CLD. There have been almost 40 randomised controlled trials of postnatal dexamethasone and 12 of inhaled steroids.


METHODS
Systematic reviews of randomised controlled trials of postnatal steroids (either systemic or inhaled) for CLD in the Cochrane Library were evaluated as a guide to clinical practice. Results are presented as relative risks (RR), numbers needed to treat (NNT) or harm (NNH) each with 95% confidence intervals (CI).


RESULTS
Postnatal dexamethasone reduces the incidence of CLD and facilitates earlier extubation but with early treatment there are serious long-term neurological adverse effects. Inhaled steroids used early (<2 wk) reduce the need for later dexamethasone (RR 0.78; 0.62-0.99 and NNT 11; 6-125). Inhaled steroids used late (>2 wk) increase the chances of extubation (RR 0.38; 0.20-0.72 and NNT 3; 2-6) and improve ventilator settings and lung mechanics. There appear to be no serious adverse effects of inhaled steroids but comparative studies suggest that dexamethasone acts more rapidly.


CONCLUSIONS
Postnatal dexamethasone at currently recommended doses should be avoided. Lower dose dexamethasone or inhaled steroids might be indicated for ill, ventilator-dependent infants with CLD after the age of 2 weeks. More trials of inhaled steroids should be undertaken and these should include long-term follow-up.
Royal Maternity Hospital and Department of Child Health, Queen's University of Belfast, Belfast, Northern Ireland. h.halliday@qub.ac.uk
Henry L
HL
Halliday
D002908:Chronic Disease; D003907:Dexamethasone / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D008171:Lung Diseases / Q000188:drug therapy*
D005938:Glucocorticoids; D003907:Dexamethasone