Early treatment of premature infants with steroids: neurological sequelae.

(1) For more than 30 years premature infants with respiratory disorders have been routinely prescribed a steroid during the first days of life. (2) A number of immediate adverse effects have been described, and studies in which infants were monitored until they were 3 years old have raised concerns about neurological sequelae. (3) 146 children who participated in a randomised placebo-controlled trial of systemic steroid therapy in the early postnatal period were monitored until they were eight years old. (4) Mean height was lower in the dexamethasone group than among placebo-treated controls (121 cm to 122 cm, depending on gender, versus 124 cm to 126 cm), and mean cranial circumference was also smaller (49.8 cm versus 50.6 cm). (5) Scores for various motor and cognitive tests, as well as some school examinations, were lower in children exposed to dexamethasone. (6) Disabilities were more frequent in the group exposed to dexamethasone (28 of 72 children versus 16 of 74 controls; p <0.05). (7) These data confirm the neurological adverse effects of prolonged treatment of premature infants with systemic steroids in the early postnatal period. Such steroid regimen should no longer be used in this setting.