Postnatal glucocorticosteroid therapy for treatment and prevention of neonatal chronic lung disease

Neonatal chronic lung disease (CLD) is a persistent complication, primarily of premature infants. Postnatal glucocorticoid therapy is widely used in t he treatment and prevention of CLD. Most studies reveal acute improvement i n the pulmonary status of infants treated with postnatal glucocorticoid the rapy. Recent studies of 'earlier' intervention (< 14 days of age) demonstra ted a reduction in mortality and in the occurrence of CLD between 28 days o f age and 36 weeks postmenstrual age. Great concern remains, however, regar ding the potential adverse outcomes, including growth inhibition, infection , catastrophic GI complications and CNS injury. Therefore, the use of postn atal glucocorticoid therapy remains controversial with respect to the clini cal indications for initiating therapy, the dose, duration, onset and route of administration, as well as potential benefits and risks. Inhaled glucoc orticoid therapy is increasingly used to treat and prevent CLD in order to avoid adverse effects of high dose systemic glucocorticoid therapy. Recent studies with inhaled glucocorticoid therapy show promise. Further work, how ever, for improving aerosol delivery and deposition, will be needed to refi ne their role in the prevention and treatment of CLD. Future studies enabli ng early, accurate identification of infants at greatest risk for CLD, coup led with a more comprehensive understanding of the different pathogeneses, will provide information regarding appropriate timing of onset, dosing, rou te of therapy and duration of intervention.