Enteral Lipid Supplement Reduces Severe Retinopathy Risk in Preterm Infants

By Lisa Rapaport

February 04, 2021

(Reuters Health) - Extremely premature infants who receive enteral lipid supplementation starting within three days of birth have a lower risk of severe retinopathy of prematurity than without supplementation, a clinical trial suggests.

Researchers randomly selected 206 infants born at less than 27 weeks' gestation to receive no supplementation or to initiate supplementation with an enteral oil containing arachidonic acid (AA, 100 mg/kg/day) and docosahexaenoic acid (DHA, 50 mg/kg/day). Those in the supplement group continued this intervention until they reached 40 weeks postmenstrual age.

Severe retinopathy of prematurity (ROP) was half as common with supplementation (16 of 101, 15.8%) as without supplementation (35 of 105, 33.3%), researchers report in JAMA Pediatrics.

"It is likely that these essential fatty acids allow the retina and retinal vessels to develop better (more like they do in utero) which will prevent retinopathy of prematurity," said lead study author Dr. Ann Hellstrom of the University of Gothenburg and Sahlgrenska University Hospital in Sweden.

"It should be stressed that it seems as if the ratio between AA and DHA is important for optimal action," Dr. Hellstrom said by email. "The optimal ratio might differ in different gestational ages and may depend on gender, so there is still more to learn."

Mean gestational age in the study population was 25.5 weeks.

Babies with supplementation had higher levels of DHA and AA in serum phospholipids (overall mean difference 0.82 mol%) than in the control group (overall mean difference 0.13 mol%).

Rates of bronchopulmonary dysplasia were similar with supplementation (47.5%) and without it (47.5%), a difference that wasn't significant. There also wasn't a significant difference in any grade of intraventricular hemorrhage between the supplement group (42.6%) and the control group (40.0%).

Sepsis was less common in the supplement group (41.6%) than the control group (50.5%).

Serious adverse events were similar with supplementation (25.7%) and without it (24.8%), as were mortality rates (15.8% vs 12.3%).

Limitations of the study include the lack of a placebo to mask supplementation to the caregivers treating the preterm infants in the study. It's also possible that ingredients in the supplement other than DHA or AA influenced the outcomes, the researchers note.

In addition, most infants who developed retinopathy of prematurity in the study were born at less than 26 weeks gestation, so results might not be generalizable to infants born later in pregnancy, said Dr. Mary Elizabeth Hartnett, a professor of ophthalmology and visual sciences at the John A. Moran Eye Center at the University of Utah in Salt Lake City.

However, the investigators found a reduction in severe ROP in infants of 27 weeks GA or younger following enteral lipid solution with AA to DHA ratio of 2:1, and the emulsion appeared safe without an increase in adverse effects, Dr. Hartnett, who wasn't involved in the study, said by email.

"Regulatory agencies have recommended supplementation with only DHA in order to reduce the potential of inflammation that has been ascribed to omega-6 PUFAs, such as AA," Dr. Hartnett said. "However, this study provides evidence of the importance of a balance between DHA and AA."

SOURCE: https://bit.ly/2MUdSxL JAMA Pediatrics, online February 1, 2021.