{"title":"Effect of enteral supplementation of DHA with or without ARA in preterm infants: a meta-analysis.","authors":"Dan Dang, Zhongyu Gao, Chuan Zhang, Xin Mu, Xiaoming Lv, Hui Wu","doi":"10.1136/archdischild-2024-327606","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess whether additional enteral docosahexaenoic acid (DHA) supplementation, with or without arachidonic acid (ARA), influences morbidities diagnosed in the neonatal intensive care unit among preterm infants, excluding administration via formula or parenteral nutrition.</p><p><strong>Design and setting: </strong>This meta-analysis involved a comprehensive search of the PubMed, Embase, Web of Science and Cochrane Library databases from their inception to 9 June 2024.</p><p><strong>Patients and interventions: </strong>Randomised controlled trials focusing on the effects of enteral DHA with or without ARA in preterm infants born at ≤34 weeks gestational age or a birth weight ≤2000 g were included.</p><p><strong>Main outcomes and measures: </strong>The main outcomes included in-hospital mortality, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotising enterocolitis (NEC), sepsis, intraventricular haemorrhage (IVH) and periventricular leukomalacia (PVL).</p><p><strong>Results: </strong>Eleven trials evaluating distinct adverse outcomes in preterm infants were incorporated. Of these, nine trials assessing enteral DHA supplementation with or without ARA indicated an increased risk of BPD with a relative risk of 1.11 (95% CI 1.00 to 1.22). Additionally, five trials assessing DHA supplementation without ARA showed an increased risk of BPD with a relative risk of 1.15 (95% CI 1.03 to 1.28). No significant effects were observed on the incidence of ROP, NEC, sepsis, IVH, PVL or in-hospital mortality.</p><p><strong>Conclusions and relevance: </strong>Enteral supplementation of DHA with or without ARA did not demonstrate protective effects against major complications in preterm infants and even increased the risk of BPD. Further research is warranted to evaluate the necessity of DHA and ARA supplementation in this population.</p><p><strong>Prospero registration number: </strong>CRD42024552578.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9000,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Disease in Childhood - Fetal and Neonatal Edition","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/archdischild-2024-327606","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: This study aimed to assess whether additional enteral docosahexaenoic acid (DHA) supplementation, with or without arachidonic acid (ARA), influences morbidities diagnosed in the neonatal intensive care unit among preterm infants, excluding administration via formula or parenteral nutrition.
Design and setting: This meta-analysis involved a comprehensive search of the PubMed, Embase, Web of Science and Cochrane Library databases from their inception to 9 June 2024.
Patients and interventions: Randomised controlled trials focusing on the effects of enteral DHA with or without ARA in preterm infants born at ≤34 weeks gestational age or a birth weight ≤2000 g were included.
Main outcomes and measures: The main outcomes included in-hospital mortality, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotising enterocolitis (NEC), sepsis, intraventricular haemorrhage (IVH) and periventricular leukomalacia (PVL).
Results: Eleven trials evaluating distinct adverse outcomes in preterm infants were incorporated. Of these, nine trials assessing enteral DHA supplementation with or without ARA indicated an increased risk of BPD with a relative risk of 1.11 (95% CI 1.00 to 1.22). Additionally, five trials assessing DHA supplementation without ARA showed an increased risk of BPD with a relative risk of 1.15 (95% CI 1.03 to 1.28). No significant effects were observed on the incidence of ROP, NEC, sepsis, IVH, PVL or in-hospital mortality.
Conclusions and relevance: Enteral supplementation of DHA with or without ARA did not demonstrate protective effects against major complications in preterm infants and even increased the risk of BPD. Further research is warranted to evaluate the necessity of DHA and ARA supplementation in this population.
目的：本研究旨在评估添加或不添加花生四烯酸（ARA）的额外肠内二十二碳六烯酸（DHA）是否会影响新生儿重症监护病房诊断的早产儿发病率，不包括通过配方奶粉或肠外营养给药。设计和背景：这项荟萃分析包括对PubMed、Embase、Web of Science和Cochrane图书馆数据库从建立到2024年6月9日的全面搜索。患者和干预措施：纳入了随机对照试验，重点关注肠内DHA合并或不合并ARA对≤34孕周或出生体重≤2000 g的早产儿的影响。主要结局和指标：主要结局包括住院死亡率、支气管肺发育不良（BPD）、早产儿视网膜病变（ROP）、坏死性小肠结肠炎（NEC）、败血症、脑室内出血（IVH）和脑室周围白质软化（PVL）。结果：纳入了11项评估早产儿不同不良结局的试验。其中，评估肠内DHA补充加或不加ARA的9项试验表明，BPD的相对风险增加1.11 （95% CI 1.00 - 1.22）。此外，5项评估补充DHA而不服用ARA的试验显示BPD的风险增加，相对风险为1.15 （95% CI 1.03 - 1.28）。对ROP、NEC、败血症、IVH、PVL的发生率和院内死亡率均无显著影响。结论和相关性：肠内补充DHA合并ARA或不合并ARA并没有显示出对早产儿主要并发症的保护作用，甚至增加了BPD的风险。需要进一步的研究来评估DHA和ARA补充在这一人群中的必要性。普洛斯彼罗注册号：CRD42024552578。
期刊介绍：
Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.
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