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Docosahexaenoic Acid and Bronchopulmonary Dysplasia in Preterm Infants

Carmel T Collins1, Maria Makrides1, Andrew J McPhee1

  • 1From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore.

The New England Journal of Medicine
|March 30, 2017
PubMed

Insights

Docosahexaenoic acid (DHA) supplementation did not reduce bronchopulmonary dysplasia risk in very preterm infants. This study suggests DHA may increase the risk of this serious lung condition in vulnerable newborns.

Area of Science:

  • Neonatology
  • Nutritional Science
  • Pediatric Pulmonology

Background:

  • Docosahexaenoic acid (DHA), an omega-3 fatty acid, has been investigated for its potential to reduce bronchopulmonary dysplasia (BPD) risk.
  • Previous studies suggested a possible protective effect, but lacked rigorous trial designs.

Purpose of the Study:

  • To evaluate the efficacy of enteral DHA supplementation in preventing physiological bronchopulmonary dysplasia in extremely preterm infants.
  • To determine if DHA administration impacts the risk of BPD or death in this population.

Main Methods:

  • A randomized controlled trial involving 1273 infants born before 29 weeks gestation.
  • Infants received either DHA (60 mg/kg/day) or a control (soy) emulsion enterally.
  • The primary outcome was physiological bronchopulmonary dysplasia at 36 weeks postmenstrual age or discharge.

Main Results:

  • Enteral DHA supplementation did not lower the risk of physiological bronchopulmonary dysplasia (49.1% vs. 43.9%, RR 1.13, P=0.02).
  • The composite outcome of BPD or death before 36 weeks was higher in the DHA group (52.3% vs. 46.4%, RR 1.11, P=0.045).
  • No significant differences were observed in mortality or other neonatal morbidities.

Conclusions:

  • Enteral DHA supplementation at 60 mg/kg/day did not reduce the risk of physiological bronchopulmonary dysplasia in preterm infants.
  • The findings suggest a potential increase in BPD risk with DHA supplementation in this vulnerable group.
Abstract

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