Determining the limits of viability and long term outcome of ELBW infants are foremost concerns for perinatal medicine and society. We documented improved survival of ELBW infants following the introduction of surfactant(Pediatrics, 1996). We now compare outcomes of ELBW for three time periods: 1982-88, pre-surfactant; 1990-92, surfactant; 1993-95, surfactant plus increased use of antenatal steroids. Between `90-'92 and `93-'95 antenatal steroid use among survivors increased from 10% to 53% (p<0.001), and postnatal steroid use from 43% to 84% (p<0.001). Table There has been no improvement in outcome of ELBW infants despite more aggressive delivery room resuscitation and increased use of antenatal and postnatal steroids. The trend to poorer neurodevelopmental outcome is disturbing. Are steroids potentially harmful for ELBW?

Table 1 No caption available.
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