Dexamethasone, survival, and neurological impairment
- Westmead Hospital and The Children's Hospital at Westmead
- University of Sydney, Australia
- lwd{at}unimelb.edu.au
Editor,—Professor Pharoah questions whether the increased rate of cerebral palsy among newborn infants who were randomly allocated early postnatal dexamethasone therapy in the trial by Shinwell et al 1 might be because dexamethasone increased survival of infants who were impaired before birth, and not because dexamethasone caused cerebral impairment.
However, two recent systematic reviews of randomised trials of postnatal dexamethasone therapy in infants at risk of chronic lung disease do not support this hypothesis. Halliday and Ehrenkrantz found no difference in survival in trials of dexamethasone given within 96 hours of birth.2 Doyle and Davis found no difference in survival, overall or in any subgroups, in trials of dexamethasone therapy at any time after birth.3 Both reviews concluded that postnatal dexamethasone may cause neurological dysfunction and called for further trials with appropriate follow up.
Professor Doyle is currently co-ordinating such a trial in infants under 1000 g or less than 29 weeks who are ventilated after 7 days from birth (the DART study, Dexamethasone in tiny infants—a Randomised Trial). Those interested in participating in this important study are very welcome to contact him at l.doyle{at}obgyn-rwh.unimelb.edu.au.
Notice of duplicate publication
Rushforth H, Bliss A, Burge D, Glasper E. A pilot randomised controlled trial of medical versus nurse clerking for minor surgery. Archives of Disease in Childhood2000;83: 223–6.
Rushforth H, Bliss A, Burge D, Glasper E. Nurse led pre-operative assessment: a study of appropriateness.Paediatric Nursing2000;12(5):15–20.
The same data, resulting from a single pilot study were reported in the two above papers. The authors have apologised, explaining that they had not intended to flaunt accepted academic standards, rather that they wished to bring their findings to the attention of two separate readerships—namely paediatricians and nurses. However, we would not wish compilers of systematic reviews to include these data twice and therefore we give notice of duplicate publication and withdraw the article published inArchives of Disease in Childhood.
