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Professor Pharoah questions whether the increased rate of cerebral
palsy among newborn infants who were randomly allocated early postnatal
dexamethasone therapy in the trial by Shinwell et al might be because
dexamethasone increased survival of infants who were impaired before
birth, and not because dexamethasone caused cerebral impairment.
However, two recent systematic reviews of randomise...
However, two recent systematic reviews of randomised trials of
postnatal dexamethasone therapy in infants at risk of chronic lung disease
do not support this hypothesis. Halliday and Ehrenkrantz found no
difference in survival in trials of dexamethasone given within 96 hours of
birth. Doyle and Davis found no difference in survival, overall or in
any subgroups, in trials of dexamethasone therapy at any time after birth. Both reviews concluded that postnatal dexamethasone may cause
neurological dysfunction and called for further trials with appropriate
Professor Doyle is currently co-ordinating such a trial in infants
under 1000 g or less than 29 weeks who are ventilated after 7 days from
birth (the DART study, Dexamethasone in tiny infants - a Randomised
Trial). Those interested in participating in this important study are
very welcome to contact him at firstname.lastname@example.org.
Professor of Neonatal Medicine
Westmead Hospital and The Children's Hospital at Westmead
University of Sydney, Australia
(1) Shinwell ES, Karplus M, Reich D et al. Early postnatal
dexamethasone treatment and incidence of cerebral palsy. Arch Dis Child Fetal Neonatal Ed 2000;83:F177-81.
(2) Halliday HL, Ehrenkranz RA. Early postnatal (<96 hours) corticosteroids for preventing chronic lung disease in preterm infants. (Cochrane Review). In: Cochrane Library, Issue 1, 2001. Oxford: Update Software.
(3) Doyle L, Davis P. Postnatal corticosteroids in preterm infants: systematic review of effects on mortality and motor function. J Paediatr Child Health 2000;36:101-7.