Omega-3 Long-Chain Polyunsaturated Fatty Acids for Extremely Preterm Infants: A Systematic Review
What this study found
Overall, omega-3 long-chain polyunsaturated fatty acid supplementation did not significantly reduce bronchopulmonary dysplasia in preterm infants. Across 12 RCTs, pooled BPD risk was RR 0.97, 95% CI 0.82-1.13, in 2809 infants; in the subgroup born at 32 weeks or less, BPD risk was RR 0.88, 95% CI 0.74-1.05, in 1156 infants. Necrotizing enterocolitis in that subgroup showed a non-significant trend toward benefit, RR 0.50, 95% CI 0.23-1.10, in 900 infants. Other key outcomes were also not significantly improved, including neonatal death RR 0.76, 95% CI 0.42-1.38, retinopathy of prematurity RR…
- Study & population
- Systematic review of trials in preterm infants, with the main population focused on extremely preterm infants born at less than 29 weeks' gestation and some analyses restricted to infants born at 32 weeks or less.
- Intervention
- Omega-3 long-chain polyunsaturated fatty acid exposure was delivered through several regimens, including enteral formulas or human milk supplementation with DHA and ARA, maternal DHA supplementation affecting breast milk composition, and parenteral lipid emulsions containing fish oil or other omega-3 sources.
- Key limitation
- Trials used heterogeneous omega-3 sources, doses, routes, and co-nutrients, making the intervention difficult to compare across studies.
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Open PDFOriginal abstract
BACKGROUND AND OBJECTIVE: Omega-3 long chain polyunsaturated fatty acid (LCPUFA) exposure can be associated with reduced neonatal morbidities. We systematically review the evidence for the benefits of omega-3 LCPUFAs for reducing neonatal morbidities in extremely preterm infants. METHODS: Data sources were PubMed, Embase, Center for Reviews and Dissemination, and the Cochrane Register of Controlled Trials. Original studies were selected that included infants born at <29 weeks’ gestation, those published until May 2013, and those that evaluated the relationship between omega-3 LCPUFA supplementation and major adverse neonatal outcomes. Data were extracted on study design and outcome. Effect estimates were pooled. RESULTS: Of the 1876 studies identified, 18 randomized controlled trials (RCTs) and 6 observational studies met the defined criteria. No RCT specifically targeted a population of extremely preterm infants. Based on RCTs, omega-3 LCPUFA was not associated with a decreased risk of bronchopulmonary dysplasia in infants overall (pooled risk ratio [RR] 0.97, 95% confidence interval [CI] 0.82–1.13], 12 studies, n = 2809 infants); however, when considering RCTs that include only infants born at ≤32 weeks’ gestation, a trend toward a reduction in the risk of bronchopulmonary dysplasia (pooled RR 0.88, 95% CI 0.74–1.05, 7 studies, n = 1156 infants) and a reduction in the risk of necrotizing enterocolitis (pooled RR 0.50, 95% CI 0.23–1.10, 5 studies, n = 900 infants) was observed with LCPUFA. CONCLUSIONS: Large-scale interventional studies are required to determine the clinical benefits of omega-3 LCPUFA, specifically in extremely preterm infants, during the neonatal period.