COMMENTARY |
Vascular Anomalies Center and Department of Plastic Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
Abbreviations: VLBW, very low birth weight
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Many practitioners are hesitant to give corticosteroids to preterm infants because of data suggesting that corticosteroids may increase the child's risk for cerebral palsy; however, randomized, prospective trials and meta-analyses have shown that only dexamethasone administered within 96 hours after birth to very low birth weight infants (VLBW; <1250 g) increases the frequency of cerebral palsy.1–3 Corticosteroids' effect on neurodevelopment depends on the (1) age of the infant, (2) timing of administration, and (3) type of corticosteroid.
In contrast to VLBW infants, corticosteroids that are given to older preterm infants does not affect neurodevelopment.4,5 Even in VLBW children, dexamethasone started after 1 week of age is not associated with cerebral palsy.3,6,7 In fact, dexamethasone given after 2 weeks of age may improve neurodevelopment in these high-risk infants.8 Compared with dexamethasone, early treatment of VLBW infants with other types of corticosteroid (hydrocortisone, methylprednisolone) does not cause cognitive impairment and reduces the rate of cystic periventricular leukomalacia, a risk
Address correspondence to Arin K. Greene, MD, MMSc, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115. E-mail: arin.greene@childrens.harvard.edu