Symposium: neonatologySteroids on the neonatal unit

Corticosteroids are a potent class of drugs that, since their discovery, have become a cornerstone of therapy in many areas of medical practice. Their range of anti-inflammatory and immune modulating actions make them an attractive option, however their use has to be balanced against a significant side effect profile which is well known in children and adults but has not been so extensively studied in preterm infants. Currently antenatal steroid therapy in expectant preterm deliveries has been shown to reduce neonatal morbidity and mortality and is recommended as standard therapy. Postnatal steroids on the neonatal unit have mainly been used in the treatment of hypotension and in the prevention/treatment of chronic lung disease. Despite evidence confirming that postnatal treatment with dexamethasone reduced the incidence of chronic lung disease major concerns about long-term neurological outcomes persist, resulting in a need for careful balancing of the risks and benefits. Systematic reviews and meta-analyses have looked at the evidence to clarify the most effective steroid; timing of administration; dose and route to further guide their safe and effective use. This article aims to provide a summary of the currently available evidence regarding the risks and benefits of steroid use in the neonatal intensive care unit and offer guidance for paediatricians.