Dexamethasone treatment in the first week of life for preventing bronchopulmonary dysplasia in preterm infants: a systematic review.

BACKGROUND: Dexamethasone treatment started soon after birth is controversial.
OBJECTIVES: To determine if postnatal dexamethasone treatment during the first week of life is beneficial in preventing bronchopulmonary dysplasia (BPD) in preterm infants.
METHODS: Randomised controlled trials of postnatal dexamethasone therapy started in the first week of life in infants at risk of BPD were sought using methods of the Cochrane Collaboration. Data regarding clinical outcomes including mortality, BPD, death or BPD, complications during the primary hospitalisation, and long-term outcome were abstracted and analysed using RevMan 5.
RESULTS: 20 randomised controlled trials enrolling a total of 2,860 participants were eligible for inclusion. Meta-analysis of these trials demonstrated significant benefits as regards earlier extubation and decreased risks of BPD at both 28 days' and 36 weeks' postmenstrual age (PMA), death or BPD at 28 days' and 36 weeks' PMA, patent ductus arteriosus and severe retinopathy of prematurity. Gastrointestinal bleeding and intestinal perforation were important adverse effects, and the risks of hyperglycaemia and hypertension were also increased. In the seven trials (921 infants) that reported late outcomes, cerebral palsy and the combined outcome of death or cerebral palsy were significantly more common in those treated with dexamethasone.
CONCLUSIONS: The benefits of early dexamethasone treatment (≤7 days) to prevent BPD do not outweigh the known or potential adverse effects of this treatment, and it cannot be recommended for routine clinical practice.