Postnatal corticosteroids and bronchopulmonary dysplasia: balancing pulmonary and neurologic effects to enable individualized decision-making

Current evidence supports the use of medium dose systemic dexamethasone - preferably between days 8 and 14 in ventilator-dependent infants at >50-70% risk of developing BPD. While more NDI follow-up data are needed, this regimen is proven to reduce BPD risk and may also reduce NDI risk, considering PNC effects on BPD reduction appear stronger than any direct NDI toxicity. Practical suggestions are provided to enable transition from the current prevalent use of late initiated (>3-4 weeks of age), low dose dexamethasone to moderately early, medium dose dexamethasone to reduce the ongoing high rates of BPD in very preterm infants.