Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm, Sweden; Division of Neonatology, Department of Pediatrics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Prostaglandins Leukot Essent Fatty Acids. 2024 Feb;201:102613. doi: 10.1016/j.plefa.2024.102613. Epub 2024 Feb 15.
Enteral supplementation with arachidonic acid (AA) and docosahexaenoic acid (DHA) in extremely preterm infants has shown beneficial effects on retinopathy of prematurity and pulmonary outcome whereas exclusive DHA supplementation has been associated with increased pulmonary morbidity. This secondary analysis evaluates pulmonary outcome in 204 extremely preterm infants, randomized to receive AA (100 mg/kg/day) and DHA (50 mg/kg/day) enterally from birth until term age or standard care. Pulmonary morbidity was primarily assessed based on severity of bronchopulmonary dysplasia (BPD). Serum levels of AA and DHA during the first 28 days were analysed in relation to BPD. Supplementation with AA:DHA was not associated with increased BPD severity, adjusted OR 1.48 (95 % CI 0.85-2.61), nor with increased need for respiratory support at post menstrual age 36 weeks or duration of oxygen supplementation. Every 1 % increase in AA was associated with a reduction of BPD severity, adjusted OR 0.73 (95 % CI 0.58-0.92). In conclusion, in this study, with limited statistical power, enteral supplementation with AA:DHA was not associated with an increased risk of pulmonary morbidity, but higher levels of AA were associated with less severe BPD. Whether AA or the combination of AA and DHA have beneficial roles in the immature lung needs further research.
肠内补充花生四烯酸（AA）和二十二碳六烯酸（DHA）可使极早产儿的视网膜病变和肺结局受益，而单独补充 DHA 与肺发病率增加有关。这项二次分析评估了 204 名极早产儿的肺结局，他们随机接受 AA（100mg/kg/天）和 DHA（50mg/kg/天）从出生到足月年龄或标准护理的肠内补充。肺发病率主要根据支气管肺发育不良（BPD）的严重程度进行评估。分析了前 28 天内血清 AA 和 DHA 水平与 BPD 的关系。AA：DHA 的补充与 BPD 严重程度的增加无关，调整后的 OR 为 1.48（95 % CI 0.85-2.61），也与出生后月经年龄 36 周时呼吸支持的需求或氧补充的持续时间无关。AA 每增加 1 %，BPD 严重程度降低，调整后的 OR 为 0.73（95 % CI 0.58-0.92）。总之，在这项研究中，由于统计能力有限，AA：DHA 的肠内补充与肺发病率的增加无关，但 AA 水平较高与 BPD 较轻有关。AA 或 AA 和 DHA 的组合是否对未成熟的肺有有益作用需要进一步研究。
