Early treatment with the corticosteroid dexamethasone, even at moderate doses, doesn’t help prevent chronic lung disease or mortality in extremely low birth weight infants and is associated with serious complications in premature babies.

This was the conclusion of a study which randomly assigned 220 low birth weight infants to receive either steroid or placebo. The study was stopped early because of an increased incidence of intestinal perforation during the first 14 days of therapy in babies exposed to dexamethasone (13 per cent vs 4 per cent with placebo).

The dexamethasone was given within 24 hours of birth at a dose of 0.15 mg/kg for three days, which was tapered over the next seven days. While those receiving dexamethasone were less likely than controls to receive supplemental oxygen or open label dexamethasone at 28 days after birth, they were more likely to have hypertension and to receive insulin for hyperglycaemia. Compared with infants receiving placebo, those receiving dexamethasone had no increased risk of death or developing chronic lung disease (N Engl J Med, 2001; 344: 95-101).

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