***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Dexamethasone was compared with placebo in a double-blind , crossover , r and omised study of infants with severe bronchopulmonary dysplasia who had required mechanical ventilation for at least four weeks , despite treatment with diuretics , methylxanthines , bronchodilators , fluid restriction , nutritional supplementation , and ligation of the patent ductus arteriosus when indicated . Gestational age ranged from 27 to 33 weeks and birth weight from 800 to 1730 g. Patients received dexamethasone ( 0 . 5 mg/kg/day ) or normal saline for the first 3 days , then treatment was crossed over for the next 3 days . The study was terminated when sequential analysis showed that all six patients had improved during dexamethasone therapy . Significant improvements were seen in ventilator-determined respiratory rate , peak inspiratory pressure , fractional inspired oxygen concentration , and alveolar arterial oxygen gradients ( p less than 0 . 05 ) . Although dexamethasone hastened weaning from mechanical ventilation , infection occurred in a substantial proportion of patients BACKGROUND . Low cortisol concentrations in premature infants have been correlated with increased severity of illness , hypotension , mortality , and development of bronchopulmonary dysplasia . A total of 360 mechanically ventilated infants with a birth weight of 500 to 999 g were enrolled in a r and omized , multicenter trial of prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia . Mortality and bronchopulmonary dysplasia were decreased in the hydrocortisone-treated  patients exposed to chorioamnionitis .  We now report outcomes at 18 to 22 months ' corrected age . PATIENTS AND METHODS . Surviving infants were evaluated with st and ardized neurologic examination and Bayley Scales of Infant Development-II . Neurodevelopmental impairment was defined as a Mental Developmental Index or Psychomotor Developmental Index of < 70 , cerebral palsy , blindness or deafness . RESULTS . A total of 252 ( 87 % ) of 291 survivors were evaluated .  Cerebral palsy was diagnosed in 13 % of hydrocortisone-treated versus 14 % of placebo-treated infants . Fewer hydrocortisone-treated infants had a Mental Development Index < 70 , and more of the hydrocortisone-treated infants showed evidence of awareness of object permanence . Incidence of neurodevelopmental impairment was not different ( 39 % [ hydrocortisone ] vs 44 % [ placebo ] ) . There were no differences in physical growth measures . Chorioamnionitis-exposed infants treated with hydrocortisone were shorter and weighed less than controls but had no evidence of neurodevelopmental impairment . Among infants not exposed to chorioamnionitis , hydrocortisone-treated patients were less likely to have a Mental Development Index of < 70 or to be receiving glucocorticoids at follow-up . CONCLUSIONS . Early , low-dose hydrocortisone treatment was not associated with increased cerebral palsy . Treated infants had indicators of improved developmental outcome . Together with the short-term benefit previously reported , these data support additional studies of hydrocortisone treatment of adrenal insufficiency in extremely premature infants OBJECTIVE There is increasing concern in regard to the possible long-term adverse effects of postnatal dexamethasone treatment in preterm infants . The purpose of this study was to assess growth and neurodevelopmental outcome in preterm infants at high risk of chronic lung disease ( CLD ) , treated with early ( < 96 hours ) postnatal dexamethasone .  DESIGN Three-year follow-up data of physical growth and neurodevelopmental outcome of preterm infants enrolled in a controlled trial to study the effectiveness of early postnatal dexamethasone administration for the prevention of CLD were review ed . The original trial included 25 treated neonates who received dexamethasone intravenously from the fourth day of life for 7 days ( 0.5 mg/kg/d for the first 3 days , 0.25 mg/kg/d the next 3 days , and 0.125 mg/kg/d on the seventh day ) , and 25 untreated neonates as controls . Forty-five surviving infants ( 22 untreated and 23 treated ) completed the 3-year follow-up . RESULTS At the end of follow-up , infants pertaining to both study groups had similar values for body weight , height , and head circumference , and a similar incidence of infants with anthropometrics data below the third percentile . Moreover , no differences were detected between the groups in regard to incidence of major cranial ultrasound abnormalities , cerebral palsy , major neurosensory impairment or IQ scores , and distribution . CONCLUSIONS Early ( < 96 hours ) postnatal dexamethasone administration at the doses employed in this study did not impair physical or neurodevelopmental outcome in preterm infants at high risk of CLD . However , the small sample size of our study was not tailored to look for long-term outcomes and our results are not in agreement with those of larger trials and systematic review s. The real risks of postnatal dexamethasone administration could be definitely assessed only when more well- design ed trials using long-term neurodevelopmental assessment as the primary outcome will be reported Objective . To assess the effect on duration of ventilator dependency of a 42-day tapering course of dexamethasone in very low birth weight neonates . Methods . Infants ( N = 118 ) were assigned r and omly , within birth weight/gender strata , to treatment with either a 42-day tapering course of dexamethasone or an equal volume of saline as placebo .  Entry criteria were 1 ) birth weight < 1501 g ; 2 ) age between 15 and 25 days ; 3 ) < 10 % decrease in ventilator setting s for 24 hours and Fio 2 ≥0.3 ; 4 ) absence of patent ductus arteriosus , sepsis , major congenital malformation , congenital heart disease ; and 5 ) no evidence of maternal HIV or hepatitis B infection . The dosage schedule was 0.25 mg/kg bid for 3 days , then 0.15 mg/kg bid for 3 days , then a 10 % reduction in the dose every 3 days until a dose of 0.1 mg/kg had been given for 3 days , from which time a dose of 0.1 mg/kg qod was continued until 42 days after entry . The primary endpoint was the number of days on assisted ventilation after study entry . Secondary outcomes of interest included days on supplemental oxygen , days of hospitalization , and potential adverse effects , such as infection , gastrointestinal bleeding , left ventricular hypertrophy , and severe retinopathy of prematurity . Results . Infants in the dexamethasone- and placebo-treated groups were similar in terms of baseline attributes , including birth weight , gestational age , gender , race , and ventilator setting s at entry . Infants treated with dexamethasone were on assisted ventilation and supplemental oxygen for fewer days after study entry ( median days on ventilator , 5th and 95th percentiles , 13 [ 1–64 ] vs 25 [ 6–104 ] ; days on oxygen , 59 [ 6–247 ] vs 100 [ 11–346 ] ) . No differences were found in risk of death , infection , or severe retinopathy . In subgroup analyses , the association of dexamethasone  with more rapid weaning from the ventilator was weaker among infants enrolled before the 16th day of life , infants with chest radiographs showing cystic changes and /or hyperinflation , and infants requiring an Fio 2 ≥0.7 or a peak inspiratory pressure ≥19 at study entry . Conclusions . A 42-day tapering course of dexamethasone decreases the duration of ventilator and oxygen dependency in very low birth weight infants and is not associated with an increased risk of short-term adverse effects OBJECTIVES To test the cortisol response to adrenocorticotrophic hormone ( ACTH ) in a population of very low birth weight newborns at the end of the first week of life , and to evaluate the relationship of this response to the subsequent development of bronchopulmonary dysplasia and to the total length of oxygen dependence . METHODS Appropriate for gestational age newborns < 1500 g birth weight were enrolled prospect ively . Response to ACTH stimulation was tested on days 5 , 6 , or 7 . Baseline cortisol , stimulated cortisol , and magnitude of response were compared between babies who developed bronchopulmonary dysplasia ( BPD ) , defined as oxygen dependence at 28 days , and those who recovered without BPD . RESULTS In this population , the cortisol response to ATCH increased with increasing birth weight ( P < .001 ) . Using birth weight as a cofactor , analysis of variance showed that patients who developed BPD ( n = 34 , BW 974 + /- 192 g , mean + /- S.D. ) had significantly reduced responses to ACTH at 5 to 7 days of age compared to those who recovered ( n = 25 , BW 1251 + /- 194 g ) , P = .006 . Additionally , 84 % of patients who recovered without BPD , but only 26 % of BPD patients , achieved a prospect ively defined positive cortisol response to ACTH ( > or = 9 micrograms/dL ; P < .005 ) . Supplemental oxygen was discontinued at a younger postconceptional age in babies with a positive cortisol response to ACTH ( P < .01 ) and fewer of those babies were on supplemental oxygen at 36-week postconceptional age ( P < .01 ) . CONCLUSIONS At the end of the first week of life , infants who subsequently developed BPD and prolonged oxygen dependence had significantly lower cortisol secretion in response to ACTH than infants who recovered without BPD . We speculate that these babies may be unable to secrete adequate amounts of cortisol in a setting of increased stress , leaving them vulnerable to continuing lung injury The potential induction of cardiac effects by high-dose dexamethasone therapy was evaluated prospect ively in 13 respirator-dependent infants with bronchopulmonary dysplasia by means of two-dimensional and M-mode echocardiography . The initial divided dose of dexamethasone was 500 micrograms/kg per day , tapered progressively for as long as 6 weeks . Evaluations were made before treatment and at 3 , 7 , 14 , 21 , 28 , 35 , and 42 days after the start of dexamethasone therapy . This regimen was associated with a significant ( p less than 0.01 ) increase in thickness of the interventricular septum ( 2.60 + /- 0.09 to 4.00 + /- 0.16 mm ) , diastolic left ventricular free wall ( 2.80 + /- 0.13 to 4.06 + /- 0.20 mm ) , and diastolic right ventricular free wall ( 1.55 + /- 0.08 to 2.02 + /- 0.12 mm ) . In addition , seven dexamethasone-treated infants but no control infants had systolic anterior motion of the mitral valve ( p less than 0.001 ) . These effects were transient , reached their maximal degree by the third week of treatment , and approached pretreatment conditions by the sixth week of treatment . Ejection fraction was not affected ; heart rate and mean arterial pressure were transiently increased during dexamethasone therapy . We conclude that a transient absolute myocardial hypertrophy is associated with dexamethasone therapy in infants with bronchopulmonary dysplasia . The mechanism or mechanisms through which this hypertrophy arises and the cardiopulmonary implication s are unclear BACKGROUND We studied the outcomes at school age in children who had participated in a double-blind , placebo-controlled trial of early postnatal dexamethasone therapy ( initiated within 12 hours after birth ) for the prevention of chronic lung disease of prematurity . METHODS Of the 262 children included in the initial study , 159 lived to school age . Of these children , 146 ( 72 in the dexamethasone group and 74 in the control group ) were included in our study . All the infants had had severe respiratory distress syndrome requiring mechanical ventilation shortly after birth . In the dexamethasone group , 0.25 mg of dexamethasone per kilogram of body weight was given intravenously every 12 hours for one week , and then the dose was tapered . We evaluated the children 's growth , neurologic and motor function , cognition , and school performance . RESULTS Children in the dexamethasone group were significantly shorter than the controls ( P=0.03 for boys , P=0.01 for girls , and P=0.03 for all children ) and had a significantly smaller head circumference ( P=0.04 ) . Children in the dexamethasone group had significantly poorer motor skills ( P<0.001 ) , motor coordination ( P<0.001 ) , and visual-motor integration ( P=0.02 ) . As compared with the controls , children in the dexamethasone group also had significantly lower full IQ scores ( mean [ + 
    Output:
    
There were no significant differences in the rates of neonatal or subsequent mortality , infection , severe IVH , PVL , NEC or pulmonary haemorrhage .
Gastrointestinal bleeding and intestinal perforation were important adverse effects and the risks of hyperglycaemia , hypertension , hypertrophic cardiomyopathy and growth failure were also increased .
In the twelve trials that reported late outcomes , several adverse neurological effects were found at follow-up examinations including developmental delay ( not defined ) , cerebral palsy and abnormal neurological examination .
Moreover , the rates of the combined outcomes of death or cerebral palsy , or of death or major neurosensory disability were not significantly increased .
AUTHORS ' CONCLUSIONS The benefits of early postnatal corticosteroid treatment ( < /= 7 days ) , particularly dexamethasone , may not outweigh the known or potential adverse effects of this treatment .
Although early corticosteroid treatment facilitates extubation and reduces the risk of chronic lung disease and patent ductus arteriosus , it causes short-term adverse effects including gastrointestinal bleeding , intestinal perforation , hyperglycaemia , hypertension , hypertrophic cardiomyopathy and growth failure .
Long-term follow-up studies report an increased risk of abnormal neurological examination and cerebral palsy .
Hydrocortisone in the doses and regimens used in the reported RCTs has few beneficial or harmful effects and can not be recommended for prevention of CLD