Postnatal dexamethasone in preterm infants

Is potentially lifesaving, but follow up studies are urgently needed

Clinical research must determine whether treatments enhance lives, make little difference, cause significant harm, or do several of these things. This is well illustrated by the epidemic of blindness due to retrolental fibroplasia that affected thousands of preterm babies in the 1950s.1 Although oxygen was accepted as lifesaving in severe respiratory distress syndrome, randomised controlled trials showed that its unrestricted use could also cause permanent visual impairment. The risk is minimised with modern oxygen therapy, which is strictly controlled. The lesson is that new treatments need to be tested with randomised trials that are large enough and with follow ups long enough to provide robust data on all clinically important endpoints 12 Dexamethasone for chronic lung disease in preterm infants may be a similar case where we need better data from larger trials with longer follow up.