Fantoms
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Shinwell and colleagues report data from the Israel National very low birth weight (VLBW) database. Between 1997 and 2004, the mortality of VLBW infants born at 24–32 weeks of gestation fell from 21.5 to 18.4%. During the same time period postnatal steroid administration fell from 23.5% to 11% and bronchopulmonary dysplasia (BPD), defined as oxygen dependency at 36 weeks, rose from 12.9% to 18.7%. The rise in BPD is too large to be explained solely by the falling mortality amongst the highest risk infants. The authors call for further studies to identify infants in whom the potential benefits of steroid treatment in reducing BPD and its associated neurodevelopmental impairment may exceed the risks. Doyle and colleagues have shown that pooled follow-up data from 20 studies of postnatal steroids suggests that steroids may reduce the risk of death or cerebral palsy in infants at highest risk of BPD1.
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