We read with interest the recent article on this subjects(1) and have the following comments to offer:

(i) Figures 1 and 2 are inconsistent with the text, i.e.. trends in A_a DO₂ as shown in Figure 1 and trends in FIO₂ as shown in Figure 2 in control and dexa groups, respectively are in reverse order.

(ii) HMO is mainly due to the deficiency of surfactants. In addition, there are inflammatory exudates secondarily to the denuded alveolar epithelium(2). No doubt, dexamethasone helps in the synthesis of surfactants but at the same time, it is having an anti-inflammatory role also. The comparatively higher decline in values of AaDO₂ and FIO₂ in study groups may be due to the combined effects of steroids. Since the assay of the surfactants have not been done by the routinely available methods, i.e., lecithin levels, L:S ratio and bubble stability test, etc. both prior to and after the trial in either of the two groups, it is quite difficult to say whether the improvement is due to anti-inflammatory effect of steroids or its role in surfactant synthesis.
 

K.K. Locham,
Professor,
Meenakshi Dhawan,
Resident,
Department of Pediatrics,
Government Medical College,
Rajendra Hospital,
Patiala 147 001, India.
 

1. Mukhopadhyay K, Kumar P, Narang A. Role of early postnatal dexamethasone in respiratory distress syndrome. Indian Pediatr 1998; 35: 117-122.

2. Groneck P, Reuss D, Goetze-Super 8, Speer CP. Effects of dexamethasone on chemotatic activity and inflammatory mediators in tracheobronchial aspirates of preterm infants at risk for chronic lung disease. J Pediatr 1993; 122: 938-944.