In the last few years, several studies related to the benefit/risk balance of postnatal
corticosteroids administered to premature neonates for prevention or treatment of
bronchopulmonary dysplasia (BPD) have been published. These data encourage caution, given the risk of long-term adverse neurodevelopmental outcomes. In the meantime, the clinical profile of BPD has been altered based on the progress made in the pre- and
postnatal care of premature infants. In 2006, a survey conducted in France in neonatal centers showed that
corticosteroids were still frequently used (57% of the centers) following various protocols in very preterm-born infants for respiratory impairment. To promote safer practices and rational use of
corticosteroids in the prevention and treatment of BPD in preterm-born neonates, we reviewed the available data in order to establish recommendations. Systemic administration of
corticosteroids for prevention or treatment of BPD: (i) should not be used during the first 4 days of life; (ii) is not indicated in the first 3 weeks of life nor (iii) in extubated infants (nasal ventilation or
oxygen therapy). The systemic administration of
steroids can only be considered after the first 3 weeks of life in very preterm-born
ventilator-dependent infants to facilitate extubation (or prevent reintubation related to the severity of BPD). Postnatal
dexamethasone administration studied in several randomized clinical trials was shown to have an unfavorable benefit/risk profile, mainly because of the long-term adverse neurocognitive outcomes. Very few studies have been conducted with
betamethasone in the postnatal period. According to sparse data, this
drug might be as efficacious as
dexamethasone, but its long-term risk profile is unknown. It should be noted that following prenatal administration, the benefit/risk profile of
betamethasone is better than that of
dexamethasone, especially with regard to neurocognitive development. Intravenous
hydrocortisone administered at an early stage for the prevention of BPD is being evaluated and should not be administered in this indication, except within clinical trials approved by the ethics committee. No other
corticosteroids have been evaluated in the postnatal period in respiratory indications. In conclusion, in the situations described above for which systemic
corticosteroids could be justified, the use of
betamethasone (or
hydrocortisone) appears to be better. As usual, the lowest possible dose of
corticosteroids should be administered for the shortest possible duration. The
betamethasone-equivalent dose of 0.125 mg/kg/day for 3 days is deemed adequate. If inhaled,
corticosteroid therapy may facilitate extubation. Neither its efficacy in
respiratory diseases nor its long-term risk profile has been so far established.