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PEDIATRICS Vol. 109 No. 4 April 2002, pp. 716-717

Meta-analysis of Postnatal Steroid Use Challenged

To the Editor—

We read with interest the recent commentary by Barrington1 and the relevant published meta-analysis.2 Dexamethasone has been widely used to prevent, treat, or reduce the severity of chronic lung disease in ventilated preterm infants. However, there have been growing concerns regarding the short- and long-term complications associated with its use. The author has performed a meta-analysis of the randomized trials of glucocorticoid therapy that report long-term neurodevelopmental outcome. He reports increases in the rates of cerebral palsy and neurodevelopmental impairment with steroid treatment and recommends that treatment of preterm infants with postnatal steroids be abandoned. Although we agree that caution should be exercised when considering prescribing dexamethasone to preterm infants, we feel that this meta-analysis is insufficient to justify the conclusions reached or the strength of the recommendations issued.

Meta-analyses are considered to be at the highest level in the evidence-generating hierarchy. However, for a meta-analysis to be valid, several steps are essential. The study question must be clear and focused, the search strategy must be thorough, the studies must each be critically assessed for methodologic rigor, and the . . . [Full Text of this Article]




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