Does supplementation with omega-3, and -6 fatty acids to extremely preterm infants improve visual acuity?

Pia Lundgren, University of Gothenburg, Gothenburg, Sweden, and colleagues investigated ophthalmological outcomes at 2.5 years of corrected age in children born extremely preterm (EPT) to assess the effects of postnatal enteral supplementation with ω-3 and ω-6 long-chain polyunsaturated fatty acids.

In the Mega Donna Mega clinical trial, extremely preterm children born at less than 28 weeks of gestation were included. They were randomized to receive an enteral supplementation of docosahexaenoic acid (DHA) and arachidonic acid (AA) from birth to 40 weeks postmenstrual age.

In the exploratory follow-up at 2.5 years of corrected age, the researchers assessed refraction, visual acuity, nystagmus, and manifest strabismus. Satisfactory VA was defined as ≥20/63. The issue of missing data was addressed using multiple imputation (MI).

The authors reported the following findings:

· Of 178 children in the trial, 115 (with median gestational age (GA) of 25 + 4/7 weeks and median birth weights of 790 g) were ophthalmologically assessed at a median corrected age of 2.7 years.

· VA assessment was missing in 42.1%, in 41.7% of the AA/DHA-supplemented infants, and 42.6% of the control infants.

· After MI and adjustments for GA, study centre, plurality, and corrected age at VA exam, no significant effect of AA/DHA supplementation was detected in VA outcome (≥20/63) (odds ratio 2.16).

"The study is the first to report a relatively long-term ophthalmological follow-up at 2.5 years of corrected age in a cohort of children born extremely preterm with a documented increase in both AA and DHA after receiving postnatal enteral lipid supplementation," the researchers wrote.

In this exploratory study, the researchers however could not conclude that postnatal supplementation with AA/DHA had a significant impact on VA outcome at 2.5 years of corrected age in EPT infants.

The authors note the need for additional studies due to the high loss to follow-up rate and the limited statistical power.

“We believe this study may inspire further research if postnatal fatty acid supplementation with AA and DHA to extremely preterm is beneficial for neural components in the visual system," the team concluded.

Reference:

“Visual outcome at 2.5 years of age in ω-3 and ω-6 long-chain polyunsaturated fatty acid supplemented preterm infants: a follow-up of a randomized controlled trial” by Pia Lundgren et al. Lancet Regional Health – Europe. DOI:https://doi.org/10.1016/j.lanepe.2023.100696.