We performed a systematic review of randomized controlled trials to determine whether the use of
dexamethasone therapy in the first 15 days of life is beneficial for prevention of chronic
lung disease is prematurely born infants. Studies were identified by conducting a literature search using the Medline database (1970-1997) and supplemented by a search of the Cochrane Library (1998, issue 4). Inclusion criteria were: 1) prospective randomized design with initiation of
dexamethasone therapy within the first 15 days of life; 2) report of outcome of interest; and 3) less than 20% cross-over between treatment and control group during the study period. Our primary outcomes were mortality at hospital discharge and the development of chronic
lung disease at 28 days of life and 36 weeks postconceptional age. The secondary outcomes were the presence of a
patent ductus arteriosus and treatment side effects. The overall baseline event rate in the control group and pooled risk ratio (RR) of event reduction with 95% confidence interval (CI) were calculated. With
dexamethasone therapy, chronic
lung disease was decreased by 26% at 28 days (RR, 0.74; 95% CI, 0.57-0.96) and 48% at 36 weeks postconceptional age (RR, 0.52; 95% CI, 0.33-0.81). These reductions were more significant when
dexamethasone was started in the first 72 h of life. The relative risk reduction of 24% in deaths was marginally significant (RR, 0.76; 95% CI, 0.56-1.04). The 27% decrease in
patent ductus arteriosus and 11% increase in
infection were not statistically significant, nor were any other changes. We conclude from this meta-analysis that systemic
dexamethasone given to at-risk infants soon after birth may have a beneficial effect in reducing the incidence of chronic
lung disease. We did not find evidence of significant short-term adverse side effects. New studies are needed to clarify long-term outcomes in prematurely born infants treated with
dexamethasone.