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Platelet characteristics in extremely preterm infants after fatty acid supplementation: a randomized controlled trial
Pia Lundgren1,2, Aldina Pivodic3,4, Anders K Nilsson3
1The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. pia.lundgren@gu.se.
Insights
Supplementing extremely preterm infants with arachidonic acid (AA) and docosahexaenoic acid (DHA) may reduce severe retinopathy of prematurity (ROP) in those with thrombocytopenia. This intervention may modulate platelet activation and angiogenesis-related proteins, impacting ROP risk.
Area of Science:
- Neonatal Medicine
- Perinatal Research
- Ophthalmology
Background:
- Severe retinopathy of prematurity (ROP) is a significant concern in extremely preterm infants.
- Thrombocytopenia and low levels of arachidonic acid (AA) and docosahexaenoic acid (DHA) are known risk factors for severe ROP.
- The link between these risk factors has not been previously established.
Purpose of the Study:
- To investigate the association between AA/DHA supplementation and severe ROP in extremely preterm infants.
- To determine if AA/DHA supplementation affects thrombocytopenia and related platelet proteins.
- To explore the potential mechanisms linking AA/DHA, thrombocytopenia, and ROP.
Main Methods:
- Randomized controlled trial involving infants born < 28 weeks gestational age.
- Infants received either enteral AA/DHA supplementation or standard care.
- Evaluated levels of AA, DHA, platelet counts, and platelet-related proteins in the first four postnatal weeks.
Main Results:
- No significant difference in thrombocytopenia rates between supplemented (20.2%) and control (27.7%) groups.
- In infants with thrombocytopenia, AA/DHA supplementation was associated with a significantly lower incidence of severe ROP (29.4% vs. 65.4%, p=0.031).
- Thrombocytopenia and AA/DHA levels correlated with angiogenesis-related proteins like PDGF and VEGF.
Conclusions:
- Postnatal enteral AA/DHA supplementation is associated with reduced severe ROP in extremely preterm infants with thrombocytopenia.
- The protective effect may be mediated by altered platelet activation and function.
- AA/DHA supplementation might modulate platelet-related proteins involved in angiogenesis, impacting ROP development.
Background:
Two risk factors for severe retinopathy of prematurity (ROP) in extremely preterm infants are thrombocytopenia and low levels of arachidonic acid (AA) and docosahexaenoic acid (DHA). To date, these risk factors have not been linked.
Method:
Infants born < 28 weeks gestational age (GA) from 2016 to 2019 were randomized to postnatal enteral AA/DHA supplementation or standard care (controls). Levels of AA and DHA, platelet counts ( < 100 × 109/L defined as thrombocytopenia) and platelet-related proteins in the infants' first four weeks of life were evaluated for their association with severe ROP.
Results:
The mean birthweight of 178 included infants was 806 ± 200 grams, and the mean GA was 25.6 ± 1.4 weeks. During the first four postnatal weeks, 20.2% of AA/DHA-supplemented infants had thrombocytopenia versus 27.7% of controls (p = 0.29). In infants with thrombocytopenia, fewer AA/DHA-supplemented infants developed severe ROP than non-supplemented controls, 29.4% (5/17) versus 65.4% (17/26) (p = 0.031). Thrombocytopenia and serum levels of AA and DHA correlated with several platelet-related proteins involved in angiogenesis and ROP, such as platelet-derived growth factor subunits A and B and vascular endothelial growth factor.
Conclusions:
AA and DHA supplementation is associated with less severe ROP in thrombocytopenic infants, possibly by modulating platelet activation and function.
Impact:
Postnatal enteral supplementation with arachidonic acid (AA) and docosahexaenoic acid (DHA) to extremely preterm infants reduces the risk of severe retinopathy of prematurity (ROP) in infants with thrombocytopenia. The impact of AA and DHA might be, at least in part, mediated through altered platelet activation. We found that AA and DHA may reduce the risk of severe ROP, possibly by modulating platelet-related proteins involved in angiogenesis. Our findings strongly support that supplementing AA and DHA to extremely preterm infants is crucial and can significantly impact their health.
