The research, published in BMC Pediatrics by Genmiao Zhuang, Xiaohua Xie, and Jianan Chen of the First Affiliated Hospital of Xiamen University, examined 68 extremely preterm infants treated between March 2016 and January 2024. Of these, 41 received low-dose dexamethasone in addition to standard care, while 27 received standard respiratory support, nutritional support, anti-infection measures, and other conventional treatments alone. The team then asked a deceptively simple question: did the steroid change the odds of the worst outcomes, and did it trigger side effects that clinicians and parents have long worried about?

To understand why this question matters, it helps to know what dexamethasone actually does. It is a synthetic glucocorticoid, a powerful anti-inflammatory agent that mimics the stress hormones the body would normally produce. In the immature lung, inflammation driven by ventilation, oxygen toxicity, and infection is a central driver of BPD. By dampening that inflammatory cascade, steroids can in principle accelerate recovery, reduce the duration of mechanical ventilation, and give the lung a window in which to continue its development. Dexamethasone has been used for this purpose for decades, and early trials in the 1990s showed striking reductions in ventilator dependence. But those early successes came at a cost that changed neonatal practice almost overnight.

Follow-up studies of infants treated with early, high-dose dexamethasone revealed higher rates of cerebral palsy and impaired neurodevelopment, prompting professional bodies worldwide to warn against routine systemic steroid use in preterm infants. Since then, neonatologists have walked a tightrope: steroids remain one of the few interventions that can wean a ventilator-dependent baby off the machine, yet their safety profile, particularly at lower doses and later in the course of the disease, is still not fully mapped. The optimal dosage, treatment duration, and safety window remain subjects of genuine clinical uncertainty, which is precisely the gap the Xiamen team set out to address.

The study’s design was retrospective, meaning the researchers looked back at records of infants already treated rather than assigning treatments prospectively. That choice carries inherent limitations, since the decision to give dexamethasone was made by treating clinicians and may have been influenced by how sick each infant appeared. The researchers confronted this problem with statistical adjustment. Their primary analysis used multivariable binary logistic regression, controlling for three of the most important predictors of outcome in this population: gestational age at birth, birth weight, and the respiratory severity score, a measure of how much respiratory support an infant requires. By adjusting for these variables, the team attempted to disentangle the effect of the drug itself from the effect of being a sicker baby in the first place.

The results were striking. After adjustment, infants who received low-dose dexamethasone had substantially lower odds of reaching the study’s composite endpoint of severe BPD or in-hospital death, with an adjusted odds ratio of 0.26, meaning roughly a quarter of the odds compared with untreated infants, and a 95 percent confidence interval of 0.09 to 0.55 with a P value of 0.003. Among survivors, the odds of severe BPD specifically were similarly reduced, with an adjusted odds ratio of 0.27. Perhaps most clinically meaningful for day-to-day intensive care, the treated infants had nearly three times the odds of successful extubation, that is, of coming off the ventilator, with an adjusted odds ratio of 2.88 and a confidence interval of 1.20 to 7.57, reaching statistical significance at P equal to 0.024.

Then came the safety data, and here the picture grew more nuanced. Hyperglycaemia, or elevated blood sugar, a well-known metabolic side effect of glucocorticoids, occurred in 41.5 percent of the dexamethasone group compared with 18.5 percent of the control group. That is a substantial numerical difference, and one that any clinician would notice at the bedside, since steroid-induced hyperglycaemia often requires monitoring and sometimes insulin therapy in neonates. Yet when the researchers ran the adjusted analysis, the difference did not reach conventional statistical significance, yielding an adjusted odds ratio of 2.04 with a confidence interval of 0.82 to 4.97 and a P value of 0.121. The confidence interval spans the null value of one, which means the data cannot rule out either no effect or a meaningful increase in risk.

The authors are refreshingly candid about why that ambiguity persists. With only 68 infants in total, the study is small, and small studies have limited statistical power to detect differences in adverse events, particularly ones that are relatively uncommon or variable in presentation. The team also notes that long-term growth was not assessed, leaving open the question of whether the drug affects the infants’ development after discharge. And because the study was conducted at a single center, its findings may reflect local treatment protocols, patient demographics, and clinical judgment rather than universal patterns. In their conclusion, the researchers state plainly that clinically relevant increases in adverse events, particularly hyperglycaemia, cannot be excluded given the limited sample size, and that their findings require validation in larger multicenter prospective studies.

That caveat is not a dismissal; it is a roadmap. The field of neonatology has been burned before by premature enthusiasm for steroids, and the memory of high-dose dexamethasone’s neurodevelopmental toll still shapes every treatment decision. What this study adds is a carefully adjusted signal that low-dose regimens, used in extremely preterm infants with established respiratory disease, may substantially reduce the risk of severe BPD and death while improving the chances of successful ventilator weaning, all with a side-effect profile that, at least in this dataset, did not show statistically confirmed harm. The hyperglycaemia signal, though not statistically significant, is a reminder that the drug is pharmacologically active and metabolically consequential even at reduced doses, and that blood glucose monitoring should be an integral part of any treatment protocol.

For the families of the roughly one in ten babies born preterm worldwide, the stakes of this research are anything but abstract. Severe BPD can mean months in the neonatal intensive care unit, home oxygen therapy, and elevated risks of asthma-like symptoms throughout childhood. If larger, prospective, multicenter trials confirm what the Xiamen team observed, low-dose dexamethasone could take a more secure place in the standard of care, offering the sickest premature infants a better chance of breathing on their own. Until then, the study stands as a measured contribution to one of neonatal medicine’s longest-running debates: how to harness the anti-inflammatory power of steroids to protect fragile lungs without trading respiratory outcomes for developmental ones. The answer, the authors suggest, will come not from any single center’s records, but from the kind of rigorous, large-scale trials that only a coordinated research community can deliver.

Subject of Research: Safety and efficacy of low-dose dexamethasone for bronchopulmonary dysplasia in extremely premature infants

Article Title: Analysis of adverse reactions to low-dose dexamethasone in bronchopulmonary dysplasia of extremely premature infants: a retrospective study

Article References: Zhuang, G., Xie, X., & Chen, J. (2026). Analysis of adverse reactions to low-dose dexamethasone in bronchopulmonary dysplasia of extremely premature infants: a retrospective study. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07706-5

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07706-5

Keywords: dexamethasone, bronchopulmonary dysplasia, extremely preterm infants, neonatology, adverse drug reactions, hyperglycaemia, mechanical ventilation, retrospective study, corticosteroids, premature birth, respiratory severity score, neonatal intensive care

Dolutegravir was embraced worldwide for good reasons. The drug belongs to the integrase strand transfer inhibitor class, blocking the HIV enzyme that inserts viral DNA into the host genome. It offers a high genetic barrier to resistance, meaning the virus struggles to evolve escape mutations, and it is generally well tolerated, potent at low doses, and affordable in generic form. These properties made it the cornerstone of first-line therapy recommended by international guidelines and adopted enthusiastically across sub-Saharan Africa, where the majority of the world’s HIV infections are concentrated. However, as experience with the drug has accumulated, clinicians and researchers have reported a cluster of metabolic side effects, including abdominal obesity, hypertension, impaired glucose regulation, and abnormal lipid levels. These conditions do not occur in isolation; they tend to cluster together in the same patients, multiplying the long-term risk of cardiovascular disease and type 2 diabetes, the two conditions most likely to erode the survival gains that antiretroviral therapy has delivered.

The Zimbabwean study was designed as an exploratory, hypothesis-generating investigation to quantify this burden in a setting where such data had been scarce. Between 20 January and 13 February 2025, the researchers recruited 171 adults receiving first-line dolutegravir-based treatment at Parirenyatwa Group of Hospitals, one of Zimbabwe’s largest referral centres. Each participant completed a structured questionnaire covering demographics, lifestyle habits, and clinical history, and underwent anthropometric assessment including body mass index calculation. Blood pressure was measured with the participant at rest, and blood samples were drawn for laboratory analysis of glycated haemoglobin, fasting glucose, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. This combination of self-reported, physical, and biochemical measures allowed the team to build a reasonably complete metabolic picture of each patient in a single visit, a pragmatic approach suited to resource-constrained clinical settings.

The demographic profile of the cohort reflects the face of the HIV epidemic in Zimbabwe. Two-thirds of the participants, 67.8 percent, were female, and the median age was 42.1 years, with an interquartile range spanning 32.4 to 50.2 years. Most participants had at least a secondary education. Lifestyle risk factors were unevenly distributed: only nine participants were smokers, 23 percent reported alcohol use, and a substantial 62.2 percent reported engaging in no regular exercise. The physical measurements were already telling before any blood was analysed. More than half of the cohort, 57.9 percent, was overweight or obese, and 39.8 percent had elevated blood pressure meeting the threshold for hypertension. These figures suggest that the metabolic consequences of long-term HIV treatment in this population are not confined to laboratory values but are visible in body composition and vascular health.

The lipid results were the most dramatic finding. Dyslipidaemia, defined as one or more abnormal lipid values, affected 74.3 percent of participants. Breaking the pattern down, non-ideal high-density lipoprotein cholesterol, the so-called good cholesterol that protects arteries, was the most common abnormality at 50.5 percent, followed by raised low-density lipoprotein cholesterol at 33.3 percent, raised triglycerides at 16 percent, and hypercholesterolaemia, or elevated total cholesterol, at 10.3 percent. Low HDL cholesterol is a particularly insidious abnormality because it often produces no symptoms, yet it is strongly linked to atherosclerotic cardiovascular disease. The predominance of low HDL alongside elevated LDL mirrors the classic atherogenic lipid profile seen in metabolic syndrome and suggests that many patients on dolutegravir-based therapy are accumulating cardiovascular risk silently, years before any clinical event such as a heart attack or stroke might occur.

Glucose metabolism told a parallel story. While overt hyperglycaemia affected 13.4 percent of participants, insulin resistance was far more widespread at 56.1 percent. This gap matters clinically. Insulin resistance represents a state in which the body’s tissues respond poorly to insulin, forcing the pancreas to compensate by producing more of the hormone. This compensation can maintain normal blood sugar for years, but it is metabolically costly and often precedes frank diabetes by a decade or more. A screening strategy that measures only glucose would miss the majority of patients already on the diabetic pathway. The authors’ finding that more than half of a relatively young cohort showed insulin resistance raises the prospect of a future wave of type 2 diabetes among people living with HIV in Zimbabwe unless preventive interventions are introduced early.

To identify which factors independently predicted these metabolic abnormalities, the researchers performed multivariate analysis, a statistical technique that adjusts for the influence of multiple variables simultaneously. Two correlates emerged with statistical significance. Increasing age was independently associated with hyperglycaemia, with an adjusted odds ratio of 1.08 per year of age, a 95 percent confidence interval of 1.03 to 1.13, and a p-value of 0.002. This means that each additional year of life raised the odds of elevated blood sugar by roughly 8 percent after accounting for other factors. Meanwhile, elevated blood pressure was independently associated with dyslipidaemia, with an adjusted odds ratio of 2.64, a 95 percent confidence interval of 1.03 to 6.78, and a p-value of 0.043. Patients with high blood pressure were more than two and a half times as likely to have abnormal blood fats as those with normal readings. The co-occurrence of hypertension and dyslipidaemia is a hallmark of cardiometabolic syndrome and compounds vascular risk multiplicatively rather than additively.

The study’s cross-sectional design imposes important limits on interpretation. Because all measurements were taken at a single point in time, the analysis cannot establish whether dolutegravir itself caused the metabolic abnormalities, whether they predated treatment, or whether they stem from other contributors such as diet, physical inactivity, prior exposure to older antiretroviral drugs known to disrupt lipid metabolism, or background genetic and environmental factors in the Zimbabwean population. The authors explicitly frame the work as exploratory and hypothesis-generating rather than definitive. The modest sample size of 171, recruited from a single hospital, also means the confidence intervals around some estimates are wide, as seen with the blood pressure and dyslipidaemia association. Nevertheless, the consistency of the findings with reports from other countries where dolutegravir has been rolled out strengthens the case that metabolic monitoring deserves a central place in HIV care programmes throughout the region.

The clinical implications are nonetheless clear and actionable. As people living with HIV age on long-term dolutegravir-based therapy, the population is transitioning from a disease dominated by immune suppression to one where chronic, non-communicable conditions threaten the longevity that treatment has made possible. The authors conclude that routine, integrated screening of body mass index, blood pressure, glucose, and lipid profiles is essential to mitigate cardiometabolic risk and sustain the success of dolutegravir-based ART in Zimbabwe. Such screening is technically simple and inexpensive compared with the cost of treating advanced diabetes or cardiovascular disease, but it requires deliberate integration into HIV clinics, which have historically focused almost exclusively on viral suppression and CD4 counts. The Zimbabwean findings add to a growing body of evidence that the next frontier of HIV medicine lies not in controlling the virus, which modern therapy does remarkably well, but in managing the metabolic and cardiovascular consequences of decades of life with treated infection.

For the global HIV response, the study is a timely reminder that the success of a drug regimen must be measured not only in viral load suppression but in the long-term health of the people taking it. Dolutegravir has transformed treatment outcomes across Africa, and nothing in these findings argues for abandoning it. Instead, they argue for a broader model of care in which the HIV clinic doubles as a gateway for detecting and managing hypertension, diabetes risk, and dyslipidaemia. With 12.9 percent of Zimbabwean adults living with HIV and the vast majority now on dolutegravir-based regimens, the country has both an urgent need and a real opportunity to pioneer integrated cardiometabolic care within its antiretroviral programme. The alternative, allowing a silent epidemic of insulin resistance and abnormal blood fats to progress unchecked among a young and increasingly healthy HIV population, would squander much of the progress that antiretroviral therapy has achieved over the past two decades.

Subject of Research: Metabolic complications of dolutegravir-based antiretroviral therapy in Zimbabwean adults living with HIV

Article Title: Burden and determinants of hyperglycaemia and dyslipidaemia in Zimbabwean adults living with HIV on dolutegravir-based first-line antiretroviral therapy: A cross-sectional study

Article References: Chirimo, R., Zhou, D. T., Mudzviti, T., Ruredzo, I. M., Manasa, J., Maponga, C. C., Reginald Gomo, Z. A., Gomo, E., & Morse, G. D. (2026). Burden and determinants of hyperglycaemia and dyslipidaemia in Zimbabwean adults living with HIV on dolutegravir-based first-line antiretroviral therapy: A cross-sectional study. PLOS One, 21(10), e0359196. https://doi.org/10.1371/journal.pone.0359196

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0359196

Keywords: HIV, dolutegravir, dyslipidaemia, hyperglycaemia, insulin resistance, Zimbabwe, antiretroviral therapy, cardiovascular risk, hypertension, PLOS One, metabolic syndrome, cross-sectional study

The scale of the dataset is what gives the result its power. The National Family Health Survey, known as NFHS-5, visited households in every Indian state and union territory, collecting capillary blood samples with portable glucometers alongside detailed questionnaires on education, wealth, diet, body measurements and reproductive history. That combination allowed the researchers to estimate weighted national and state-level prevalence and then probe which individual characteristics tracked with elevated glucose. The survey’s blood glucose measurement is a single random reading rather than a fasting or oral glucose tolerance test, so the authors are careful to describe their outcome as screen-detected hyperglycaemia, a non-diagnostic signal that requires confirmatory clinical testing rather than a formal diabetes diagnosis.

Geography turned out to matter far more than many observers might expect. State-level prevalence ranged from 2.1 percent to 11.4 percent, a more than fivefold spread that maps onto India’s well-documented epidemiological transition. States in the southern peninsula and parts of the northeast and east have generally reported higher diabetes burdens in prior surveillance, and the new analysis confirms that this regional signature extends to women who have never been screened. Yet when the researchers decomposed the variation statistically, the picture became more nuanced: only 0.9 percent of the total variance in screen-detected hyperglycaemia was attributable to the state level, and 2.8 percent to the district level. In other words, where a woman lives matters, but the overwhelming majority of the variation reflects differences between individuals rather than fixed geographic context.

To untangle those individual differences, the team fitted multilevel logistic regression models, a technique suited to hierarchically nested survey data in which women are clustered within districts and districts within states. Multilevel models prevent the underestimation of uncertainty that occurs when clustered observations are treated as independent, and they allow predictors at the individual level to be estimated simultaneously with random effects for each geographic unit. The results were consistent across specifications. Older age carried substantially higher odds of screen-detected hyperglycaemia, as expected from decades of diabetes epidemiology, since insulin resistance and beta-cell decline accumulate over the life course. Higher adiposity, captured through body mass and related anthropometric measures, was likewise associated with elevated odds, reinforcing the central role of excess weight in glucose dysregulation even among women young enough to be bearing children.

One of the more striking findings concerned education. Women with higher educational attainment had lower odds of screen-detected hyperglycaemia than their less-educated peers, a protective gradient that the authors interpret in light of health literacy, occupational patterns and access to preventive care. Education is a classic upstream determinant: it shapes what people eat, how much they move, whether they seek screening and how they respond to health messaging. Intriguingly, however, the differences across urban versus rural residence and across the survey’s socioeconomic indices were described as modest. That relative flatness challenges a common assumption that undetected hyperglycaemia in India is primarily a problem of the urban affluent or, conversely, of the rural poor; instead, the analysis suggests the risk is distributed more broadly across the social spectrum than prevailing narratives imply.

Robustness checks strengthened the case that the signal is real rather than a statistical artefact. When the team repeated the analysis using a stricter threshold of 160 milligrams per decilitre for random capillary glucose, the pattern of associations held, indicating that the findings are not driven by borderline readings near the 140 milligram cutoff. This kind of sensitivity analysis matters because capillary glucometer readings are noisier than laboratory venous measurements, and a single random sample can fluctuate with recent meals, time of day and acute stress. The consistency of the age, adiposity and education gradients across thresholds suggests that the survey is capturing a genuine burden of dysglycaemia, even if the precise prevalence figure would shift under formal diagnostic protocols.

The clinical and public health implications are considerable. Diabetes is famously silent in its early years; international estimates have repeatedly suggested that a large fraction of people with diabetes worldwide, and roughly half or more in some low- and middle-income countries, remain undiagnosed until complications such as neuropathy, retinopathy or cardiovascular disease emerge. For women of reproductive age, the stakes extend across generations, because hyperglycaemia during pregnancy raises the risk of adverse obstetric outcomes and programmes the metabolic health of offspring. The authors argue that their findings make a direct case for strengthening opportunistic screening and early detection within India’s primary healthcare system, particularly through existing platforms such as antenatal care visits, where blood glucose testing could be integrated more systematically for women who would otherwise go unscreened.

The study’s design imposes important limits on interpretation, and the authors are explicit about them. A single random capillary glucose of 140 milligrams per decilitre or above is not diagnostic; clinical guidelines require confirmatory testing, typically fasting plasma glucose, glycated haemoglobin or an oral glucose tolerance test, before a diagnosis of diabetes or prediabetes can be made. Some of the women flagged in the survey may have had transient post-meal elevations, while others may genuinely have undiagnosed diabetes. The cross-sectional design also means the analysis identifies associations, not causes: older women differ from younger women in many ways beyond age, and body composition was measured at a single point in time. The authors caution that interpretations should be made cautiously given the non-diagnostic and cross-sectional nature of the data, a caveat that responsible coverage of this work should preserve.

Even with those caveats, the study adds a missing piece to India’s diabetes picture. Most national surveillance and burden estimates focus either on diagnosed diabetes or on adult populations as a whole, leaving a gap around women of reproductive age who have never been tested. By quantifying that gap at 6.3 percent nationally, with pockets exceeding 11 percent in some states, the analysis gives policymakers a concrete target population and a rationale for embedding glucose screening into routine primary care contacts rather than waiting for symptoms. The finding that individual-level factors, especially age, adiposity and education, dominate over geographic context also suggests that screening criteria can be refined: prioritising older women within the reproductive age band and those with higher body mass could yield efficient case-finding even in resource-constrained settings.

The broader lesson resonates well beyond India. Rapid urbanisation, dietary change and declining physical activity are driving diabetes epidemics across South Asia and much of the developing world, and young women sit at the intersection of these trends and the intergenerational transmission of metabolic risk. Large, nationally representative household surveys with biochemical measurement, of which NFHS-5 is among the world’s biggest, offer a template for other countries seeking to size their own hidden epidemics. What this study makes unmistakably clear is that the absence of a diagnosis is not the absence of disease. Millions of Indian women are walking through daily life with blood sugar levels that their bodies are already struggling to regulate, and the health systems around them have yet to notice. Closing that blind spot, the authors conclude, is one of the most achievable wins available in the global fight against non-communicable disease.

Subject of Research: Screen-detected undiagnosed hyperglycaemia among women of reproductive age in India

Article Title: Socioeconomic, demographic and anthropometric predictors and geographic variation of screen-detected hyperglycaemia among women in India

Article References: Rahaman, M., Rana, M. J., & Venkatesh, U. (2026). Socioeconomic, demographic and anthropometric predictors and geographic variation of screen-detected hyperglycaemia among women in India. Discover Social Science and Health, 6(1), Article 108. https://doi.org/10.1007/s44155-026-00443-1

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00443-1

Keywords: diabetes, hyperglycaemia, India, women's health, reproductive age, NFHS-5, screening, obesity, epidemiology, non-communicable diseases, public health, health survey