Further Considerations on Corticosteroid Use in Premature Infants—Reply

In Reply We thank Groenendaal and Raghuveer and Zackula for their interest in our article. We agree with Groenendaal that the different types of cerebral palsy (CP) have different pathologies, and we support his call that the types of CP should be reported in more detail in future publications of neonatal neurodevelopment. It was not possible to consider the different types of CP in this article because such details had not been reported in all of the 26 studies that we included. Groenendaal also suggests that dexamethasone is unlikely to be associated with unilateral CP caused by severe intraventricular hemorrhage (IVH) and unilateral venous infarction because such pathology occurs shortly after birth. However, it should be noted that 6 of the 26 studies included in our article started treatment within 24 hours after birth, and 10 by 48 hours after birth, which would precede the occurrence of some cases of severe IVH. Even if treatment started after the main pathology that might ultimately cause CP, corticosteroids could still alter the natural progression to ultimate motor deficit through their anti-inflammatory effects, and prevent the later diagnosis of CP in some cases. Alternatively, through their neurotoxic effects, corticosteroids could accelerate the path to CP in those with severe IVH.