Twenty-month outcome in ventilator-dependent, very low birth weight infants born during the early years of dexamethasone therapy L. Furman, MD, M. Hack, MB,ChB, C. Watts, MD, E. Borawski-Clark, PhD, J. Baley, MD, S. Amini, PhD, and B. Hook, MD From the Departments of Pediatrics and Epidemiology, Case Western Reserve University, Cleveland, Ohio We sought to examine the effect of the introduction of dexamethasone therapy on health, growth, and neurodevelopmental outcome in very low birth weight (VLBW) infants at 20 months of age. We compared outcomes in all 86 VLBW in- fants (mean birth weight 871 gm, mean gestational age 26.4 weeks) who were ventilator dependent on day 21 of life during the 2 years preceding October 1988 (period 1), when dexamethasone therapy became accepted clinical practice in our unit, with outcomes in all 124 infants (mean birth weight 891 gm, mean gestational age 26.9 weeks) with similar ventilator status during the subsequent 2 years (period 2). In addition, we compared outcomes in infants who received dexamethasone during period 2 with those in a concurrent cohort of less ill in- fants who were not given dexamethasone. There were no significant differences between periods 1 and 2 in mortality rates after 21 days (17% vs 21%), need for home oxygen (23% vs 25%), oxygen dependence at 20 months of corrected age (11% vs 10%), rate of neurosensory impairment (24% vs 25%), and mean Bayley Mental scores (81.5 vs 77.2) or Psychomotor Development Index (81.6 vs 71.1). In- fants who received dexamethasone during period 2 had significantly more se- vere lung disease and poorer respiratory, growth, and developmental out- comes. We conclude that VLBW infants with ventilator-dependent chronic lung disease have very poor outcomes, even when treated with dexamethasone. More information is needed from prospective, randomized trials before dexa- methasone can be accepted as routine therapy for chronic lung disease. (J PE- DIATR1995;126:434-40) The improved survival rates of very low birth weight infants in the late 1970s were accompanied by an increase in chronic lung disease. 1 Despite various ventilator modalities to prevent lung injury, 2 and the introduction of surfactant to prevent or treat respiratory distress syndrome, 3 there has Submitted for publication July 19, 1994; accepted Sept. 8, 1994. Reprint requests: Maureen Hack, MD, Division of Neonatology, Rainbow Babies and Childrens Hospital, University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH 44106. Copyright © 1995 by Mosby-Year Book, Inc. 0022-3476/95/$3.00 + 0 9/23/60453 been little change in the rate of chronic lung disease. Sev- eral pharmacologic strategies aimed at ameliorating chronic lung disease have been unsuccessful, 47 but dexamethasone therapy has improved short-term pulmonary mechanics and accelerated weaning from the ventilator. 812 Reports on I VLBW Very low birth weight, <1500 gm I outcomes in dexamethasone-treated infants have, with one exception, 8 not shown a significant decrease in duration of oxygen dependence, hospital stay, or later improvements in growth or development. 13-17 434