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Bronchoalveolar dysplasia (BPD) is a common complication of premature infants, affecting more than 50% of babies
born before 28 weeks' gestational age (GA).
BPD is mainly caused by stunted lung development and persistent postpartum inflammation, and arachidonic acid (ARA) and docosahexaenoic acid (DHA) in long-chain polyunsaturated fatty acids (LCPUFAs) are important lipid structures in cell membranes, but they also act as signaling molecules to attenuate the inflammatory cascade
.
At the beginning of the third trimester, the concentration of 14 ARAs in the fetal plasma is physiologically higher, of which 15 ARA: DHA ratio is about 3: 1
.
Babies born before 29 weeks' gestation have reduced levels of LCPUFA in the fetus during the third trimester and a rapid deficiency of ARA and DHA
after birth.
After birth, preterm infants rely on an exogenous supply of ARA and DHA because of their low ability to endogenously synthesize from linoleic acid and alpha-19 linolenic acid, breast milk provides ARA and DHA in a 2:1 ratio, and low postnatal DHA concentrations are associated with
an increased risk of BPD.
The aim of this study was to investigate the effects
of arachidonic acid (ARA) and DHA supplementation on short-term respiratory outcomes and neonatal morbidity in very preterm infants.
This study is a secondary analysis of data from the ImNuT (Immature Nutritional Therapy) study, a randomized, double-blind clinical trial
.
Infants with gestational age less than 29 weeks were randomized to receive daily oral supplementation with ARA 100 mg/kg and DHA 50 mg/kg (intervention group) or medium-chain triglyceride (MCT) oil (control group) from the second day of birth to age after 36 years of age
.
Study observations included duration of respiratory support, incidence of BPD, and other major complications
associated with preterm birth.
The results showed that 120 infants with a mean gestational age of 26.
4 weeks were randomized to either intervention or control
.
Supplementation with ARA and DHA significantly reduced days of respiratory support (mean (95% CI) 63.
4 (56.
6 to 71.
3) VS 80.
6 (72.
4 to 88.
8); p=0.
03) and lower oxygen demand (FiO2) (mean (95% CI) 0.
26 (0.
25-0.
28) VS 0.
29 (0.
27-0.
30); p=0.
03)
。 However, there were no clinically important differences
in the incidence of BPD and other major conditions between treatment groups.
This study confirms that supplementation with ARA and DHA in preterm infants is safe and may have beneficial effects on
respiratory outcomes.
Original source:
S.
KristinaWendel.
et al.
Effect of arachidonic and docosahexaenoic acid supplementation on respiratory outcomes and neonatal morbidities in preterm infants.
Clinical Nutrition.
2022.