Postnatal steroids to treat or prevent chronic lung disease in preterm infants.

To the Editor .— The recommendations from the American Academy of Pediatrics Committee on Fetus and Newborn concerning use of postnatal steroids to prevent chronic lung disease in premature infants1 is a wonderful review and synopsis of the literature. In general, I applaud the spirit of the recommendation that, in essence, we restrict the use of this drug to a population of infants much sicker than those treated historically. However, I feel that, as was done in the past, we as neonatologists may be taking this to another extreme and may cause more harm by not administering steroids than we presently do. I concur that neonatologists jumped on the dexamethasone bandwagon with both feet and without thinking through the potential complications clearly. I attended a Neonatal Pharmacology Conference in 1995 where a leader in the field stated, “If you are going to use steroids, use them early.” Obviously, many infants who were only moderately ill received steroids, and we need to curtail this practice. However, steroids have probably been life-saving in some infants and should be strongly considered for patients with severe pulmonary disease. For instance, in the study by Kothadia et al,2 at first glance one would assume that the enrolled patients were quite ill, with an average oxygen requirement at entry of Fio2 (fraction of inspired oxygen) of 0.60. However, the …