Effect of arachidonic and docosahexaenoic acid supplementation on respiratory outcomes and neonatal morbidities in preterm infants.

Double-blind randomized controlled trial conducted at Oslo University Hospital, Norway. Very preterm infants born at <29 weeks gestational age were randomized to receive either ARA:DHA supplementation (n=60) or isocaloric MCT oil control (n=60). Exclusions included congenital malformations, chromosomal abnormalities, or critical illness with short life expectancy. Informed parental consent obtained within 48 hours after birth.

ARA:DHA group: daily enteral supplement containing arachidonic acid (ARA) 100 mg/kg and docosahexaenoic acid (DHA) 50 mg/kg, given as a daily bolus via feeding tube from day 2 to 36 weeks postmenstrual age; starting volume 0.2 mL/kg on day 2, increased to 0.4 mL/kg from day 4 onward; weekly weight-based adjustments to deliver 100 mg/kg ARA and 50 mg/kg DHA total. Control group: daily enteral supplement with medium-chain triglyceride oil (MCT oil) at the same schedule; does not contain ARA or DHA.

Compared with control, the ARA:DHA group had fewer days requiring respiratory support (63.4 vs 80.6 days; p=0.03) and lower oxygen needs (FiO2 0.26 vs 0.29; p=0.03). There were no clinically important differences in bronchopulmonary dysplasia (BPD) or other major morbidities. Blood DHA concentrations were higher at 36 weeks PMA in the ARA:DHA group; ARA concentrations did not differ significantly. The intervention appeared safe with similar adverse events across groups. The authors concluded that ARA and DHA supplementation in preterm infants was safe and might have beneficial effects on short-term respiratory outcomes.

Not powered for respiratory outcomes or neonatal morbidities; single-center trial with a small sample; baseline imbalances (antenatal steroids and 5-minute Apgar) may confound results; post-hoc sensitivity analyses attenuated significance; lung-function testing performed only in infants not requiring respiratory support at 36 weeks PMA; limited generalizability.