The effect of postnatal steroids on growth and development.

Single courses of prenatal corticosteroids have many beneficial effects including reduction in respiratory distress syndrome, intraventricular hemorrhage and neonatal mortality. Postnatal corticosteroids, however, have both beneficial and harmful effects. The beneficial effects include shortened time on the ventilator and a reduction in chronic lung disease. Dexamethasone treatment started within the first 4 days of life is associated with an increased risk of abnormal neurodevelopment including cerebral palsy. Other adverse effects include metabolic disturbances, cardiac hypertrophy, reduced growth and gastrointestinal perforation. The risks of early dexamethasone treatment in currently used doses outweigh the benefits. Further research is needed to determine the optimal corticosteroid drug, its dose and timing of administration to maximize benefit and reduce risk to a minimum. Other non-drug interventions should be used to minimize the risk of chronic lung disease in very preterm infants.