Evaluation of hypothalamic-pituitary-adrenal axis in premature infants treated with dexamethasone

Results of a national survey of the current use of steroids in newborns in 1993 showed that 95% of the neonatologists in the United Stales have used dexamethasone for neonates at risk for chronic lung disease. Dexamethasone therapy for a period of a week or longer is associated with suppression of the hypothalamic-pituitary-adrenal axis (HPAA) in a substantial number of premature infants. A review of our current understanding of the biochemical tests evaluating HPAA function in premature infants and suggested guidelines for HPAA evaluation and management following dexamethasone therapy are presented.