Postnatal steroids for chronic lung disease

Chronic lung disease (CLD) remains a major problem in neonatal intensive care units. Steroids given either soon after birth to prevent CLD, or later to reduce its severity, are effective, but there are acute and long-term adverse effects. When steroids are given early (first 4 days) there is an increased risk of cerebral palsy in surviving infants which precludes their use at this time. Dexamethasone may be effective in far lower doses than used in most of the randomised trials to date. There are probably situations where its use is associated with more benefit than harm. There is no convincing evidence that inhaled steroids alter the course of CLD. More research is needed into ways of preventing or reducing CLD in at risk preterm infants.