Premature Conclusions on Postnatal Steroid Effects

To the Editor.—

We read with interest the recent joint statement of the AAP, Committee on the Fetus and Newborn and the Canadian Paediatric Society, Fetus and Newborn Committee,¹ the recent letter to the editor by Taylor et al,² and the response by Dr Barrington³ on the topic of postnatal glucocorticoids for chronic lung disease in the neonate. The use of steroids, dexamethasone in particular, to treat or prevent chronic lung disease (CLD) is controversial. Although we applaud the efforts of the Academy to bring some sense to this quagmire, we have serious reservations about some of the conclusions and recommendations.

Our major concern is that conclusions in the AAP report relating to neurodevelopmental outcome after glucocorticoid treatment were based largely on 2 published meta-analyses performed on 5⁴ and 8 studies⁵ that appear to be seriously flawed. In a comment on the latter paper, Taylor et al² discussed the impropriety of combining 8 heterogeneous studies that differed in age at initiation of glucocorticoid therapy, dose and duration of therapy, and tests (and timing of these tests) used to determine neurodevelopmental outcome. Their succinct and valid arguments apply equally well to the meta-analysis of 5 studies,⁴ and need not be repeated. It was disappointing to note that the AAP report accepted the findings of these 2 analyses without any stated reservations and then went on to recommend restrictive conditions for using postnatal glucocorticoids.

Review of the 11 studies listed in the AAP report reveals that in 5, glucocorticoid therapy was initiated in the first 4 days after birth and in the remaining 6, therapy was begun at 7 days’ postnatal age or later. Another way to look at the published data is to …