1. This systematic review did not find an association between omega-3 fatty acid supplementation and decreased incidence of bronchopulmonary dysplasia (BPD) among neonates.
2. In a subset of extremely premature infants, effects of omega-3 fatty acid supplementation were still non-significant, but trended towards a lower risk of BPD and necrotizing enterocolitis.
Evidence Rating Level: 2 (Good)
Study Rundown: Bronchopulmonary dysplasia (BPD) is a common and significant complication of premature birth, resulting in long-term respiratory difficulties and the need for supplemental oxygen. Long-chain polyunsaturated fatty acids (LCPUFAs), including omega-3 fatty acids, have been previously implicated in inflammatory modulation. Dysregulation in the inflammatory cascade is postulated as a contributor to BPD, and research has indicated that premature infants are LCPUFA-deficient. As such, this systematic review gathered multiple studies analyzing the effects of omega-3 fatty acid supplementation on neonates. Researchers found that omega-3 fatty acid supplementation was not associated with decreased BPD in neonates overall, but may show a benefit for BPD and nectrotizing enterocolitis in extremely premature infants. This systematic review was greatly limited by homogeneity amongst included studies, including a lack of randomized control trials directly comparing supplementation to placebo in extremely premature infants. The review however, indicated no adverse effects to supplementation, and sets up a platform for future trials of LCPUFA supplementation in neonates.
In-Depth [systematic review]: This systematic review included 18 randomized control trials and 6 observational studies analyzing the effects of omega-3 LCPUFA supplementation in neonates; individual trials comprised of a range of gestational age, omega-3 derivative (fish, algae, eggs), and route of administration in addition to differences in study design. Overall, omega-3 fatty acid supplementation was not associated with a decreased risk of BPD (n = 2809, pooled RR = 0.97, 95% CI: 0.82 – 1.13). In extremely preterm infants ≤ 32 weeks gestational age, effects of omega-3 fatty acid supplementation were still non-significant, but trended towards reduced risk for both BPD (n= 1156, pooled RR = 0.88, 95% CI: 0.74 – 1.05,) and necrotizing enterocolitis (n = 900, pooled RR = 0.50, 95% CI: 0.23 – 1.10).
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