Docosahexaenoic acid supplementation does not reduce risk of necrotizing enterocolitis among preterm infants

1. In preterm infants admitted to the neonatal intensive care unit (NICU), docosahexaenoic acid (DHA) supplementation did not significantly reduce the risk of necrotizing enterocolitis (NEC) compared to control.

Evidence Rating Level: 1 (Excellent)

NEC primarily affects premature infants and is associated with dysregulated immune responses. Long-chain polyunsaturated fatty acids (LCPUFAs) have been shown to be important for fetal and neonatal development of the gut and immune system. Previous studies have found preterm infants to be at risk for LCPUFA deficiencies. Despite this, it is unclear which LCPUFAs should be supplemented to prevent NEC, and in what ratio. This randomized clinical trial included infants admitted to the NICU born at a gestational age of less than 34 weeks. 62 infants were randomised to receive standard care (control group; n = 33; mean [SD] gestational age, 32.45 [1.47] weeks; 57.6% female) or 60 mg DHA/kg once daily for three consecutive days (DHA group; n = 29; mean [SD] gestational age, 33.18 [0.99] weeks; 44.8% female). There was no significant difference in NEC rates between the control and DHA groups (15/33, 45.5% vs. 7/29, 24.1%; RR 0.53; 95% CI 0.25 to 1.12; p = 0.112). No infants required NEC-related surgery. There were no significant differences in mortality (5/33 vs. 1/29; p = 0.201). Patients receiving DHA had a significantly higher risk of neutropenia compared to the control group (6/29, 20.7% vs. 0/33, 0.0%; p = 0.008). Overall, DHA supplementation did not significantly reduce NEC risk compared to control in premature infants admitted to the NICU, but it did significantly increase the risk of neutropenia.

Click here to read this study in BMC Pediatrics

Citation: Sabzevari F, Parvaz A, Rezaei M, Bijari BB, Jamali Z, Nikvarz M, et al. Docosahexaenoic acid in preventing necrotizing enterocolitis in preterm infants: a randomized clinical trial. BMC Pediatr. 2026 Oct 29. doi: 10.1186/s12887-026-07968-z. Epub ahead of print.

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