To the Editor.—

The study by Watterberg et al, published in the December 2004 issue of Pediatrics, does much to forward the debates surrounding prophylactic steroid use in extremely low birth weight infants. The long-term effect of dexamethasone on neurodevelopment has moved most neonatologists away from the belief that, if a little potency is good, a lot must be better. For some of us, that same concern exists for intestinal perforations. However, many of us had hoped that physiologic replacement of cortisol would prove to be a more biologically appropriate strategy to reduce the incidence of chronic lung disease while avoiding neurodevelopmental and intestinal complications. Others have suggested that the problem is not one of biology but of chemistry and that we have yet to test all the proper synthetic variants of glucocorticoids, one of which might avoid adversity. With regard to perforations, this now seems an...

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