Docosahexaenoic Acid and Bronchopulmonary Dysplasia in Preterm Infants
Collins CT, Makrides M, McPhee AJ, Sullivan TR, Davis PG, Thio M, Simmer K, Rajadurai VS, Travadi J, Berry MJ, Liley HG, Opie GF, Tan K, Lui K, Morris SA, Stack J, Stark MJ, Chua MC, Jayagobi PA, Holberton J, Bolisetty S, Callander IR, Harris DL, Gibson RA
The New England journal of medicine · 140 citations
How it was studied
- Design
- Randomized controlled trial (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Independent funding
- Government
- Medical Research Council
Based on 1 listed funder(s).
Publication
- Published
- 2017-03-29 · N Engl J Med · vol. 376 · issue 13 · pp. 1245–1255
- Publisher
- Massachusetts Medical Society
- Cited
- 176 citations · more than 99% of similar papers · 10.7× the field average
- Impact
- Top 10% most cited in its field
- References
- 32 works
- Access
- Paywalled
- Research areas
- Neonatal Respiratory Health Research · Infant Nutrition and Health · Fatty Acid Research and Health
- Keywords
- Bronchopulmonary dysplasia, Medicine, Enteral administration, Gestational age, Retinopathy of prematurity, Necrotizing enterocolitis, Pediatrics, Randomized controlled trial, Confidence interval, Relative risk, Docosahexaenoic acid, Birth weight, Gestation, Respiratory distress, Parenteral nutrition, Internal medicine, Polyunsaturated fatty acid, Surgery, Pregnancy, Fatty acid
- MeSH
- humans, bronchopulmonary dysplasia, docosahexaenoic acids, emulsions, regression analysis, double-blind method, gestational age, infant, newborn, infant, premature, female, male
24 authors
From AU, GB, SG, NZ, US
- Carmel T CollinsSouth Australian Health and Medical Research Institute
- Maria MakridesSouth Australian Health and Medical Research Institute
- Andrew J McPheeSouth Australian Health and Medical Research Institute; The University of Adelaide
- Thomas SullivanFaculty of Public Health
- Peter Graham DavisRoyal Women's Hospital; The University of Melbourne; Flinders University
- Marta ThióRoyal Women's Hospital; The University of Melbourne; Flinders University; Murdoch Children's Research Institute
Abstract
Background
Studies in animals and in humans have suggested that docosahexaenoic acid (DHA), an n-3 long-chain polyunsaturated fatty acid, might reduce the risk of bronchopulmonary dysplasia, but appropriately designed trials are lacking.
Methods
We randomly assigned 1273 infants born before 29 weeks of gestation (stratified according to sex, gestational age [<27 weeks or 27 to <29 weeks], and center) within 3 days after their first enteral feeding to receive either an enteral emulsion providing DHA at a dose of 60 mg per kilogram of body weight per day or a control (soy) emulsion without DHA until 36 weeks of postmenstrual age. The primary outcome was bronchopulmonary dysplasia, defined on a physiological basis (with the use of oxygen-saturation monitoring in selected infants), at 36 weeks of postmenstrual age or discharge home, whichever occurred first.
Results
A total of 1205 infants survived to the primary outcome assessment. Of the 592 infants assigned to the DHA group, 291 (49.1% by multiple imputation) were classified as having physiological bronchopulmonary dysplasia, as compared with 269 (43.9%) of the 613 infants assigned to the control group (relative risk adjusted for randomization strata, 1.13; 95% confidence interval [CI], 1.02 to 1.25; P=0.02). The composite outcome of physiological bronchopulmonary dysplasia or death before 36 weeks of postmenstrual age occurred in 52.3% of the infants in the DHA group and in 46.4% of the infants in the control group (adjusted relative risk, 1.11; 95% CI, 1.00 to 1.23; P=0.045). There were no significant differences between the two groups in the rates of death or any other neonatal illnesses. Bronchopulmonary dysplasia based on a clinical definition occurred in 53.2% of the infants in the DHA group and in 49.7% of the infants in the control group (P=0.06).
Conclusions
Enteral DHA supplementation at a dose of 60 mg per kilogram per day did not result in a lower risk of physiological bronchopulmonary dysplasia than a control emulsion among preterm infants born before 29 weeks of gestation and may have resulted in a greater risk. (Funded by the Australian National Health and Medical Research Council and others; Australian New Zealand Clinical Trials Registry number, ACTRN12612000503820 .).
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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