Student Laval University Université Laval Quebec, Quebec, Canada
Background: To diversify lipid intakes in very preterm infants, traditional lipid emulsions (LE) based on pure soybean oil have been substituted by a multi-source, docosahexaenoic acid (DHA)-rich LE (SMOF-LE) in some neonatal intensive care units (NICU) in Canada. Although DHA could modulate inflammation, which is involved in the development of bronchopulmonary dysplasia (BPD), two recent large randomized clinical trials (RCT) did not confirm the superiority of an omega-3 DHA oral supplementation in decreasing BPD and even suggested an increased risk.
Objective: To assess whether parenteral administration of SMOF-LE during the neonatal period would be associated with BPD-free survival at 36 weeks’ postmenstrual age in very preterm infants.
Design/Methods: Prospective ancillary cohort study of a randomized clinical trial conducted in 16 Canadian NICUs between 2015 and 2018 to investigate the effect of a maternal DHA supplementation on BPD-free survival in breastfed, very preterm infants (NCT02371460). Preterm infants received intravenous SMOF-LE during the neonatal period according to sites’ routine care. Primary outcome was BPD-free survival at 36 weeks postmenstrual age. Relative risks (RR) were estimated using a working Poisson regression models with generalized estimating equations taking into account sites and multiple births. Models were adjusted for maternal supplementation, birth weight, sex and gestational age after interaction between these variables and SMOF-LE tested negative.
Results: Among 528 infants (mean gestational age, 26.5 weeks [SD, 1.6]), 272 received SMOF (median age at first administration, 1.0 day [IQR, 0.0-5.0], median duration, 19.0 days [IQR, 10.0-29.5]). Overall, 153 of 270 infants (56.7%) in the SMOF group and 151 of 253 infants (59.7%) in the Non-SMOF group survived without BPD (RR, 0.76 [95% CI, 0.62 to 0.94], P=0.010; adjusted RR, 0.94 [95% CI, 0.77 to 1.14], P=0.51). BPD rates were 39.3% in the SMOF group vs 34.1% in the Non-SMOF group (RR, 1.62 [95% CI, 1.17 to 2.25], P=0.004; adjusted RR, 1.10 [95% CI, 0.82 to 1.47], P=0.53). Severe BPD rates were 31.8% in the SMOF group vs 28.8% in the Non-SMOF group (P=0.006; adjusted P=0.59). Mortality was not significantly different between the SMOF (6.7%) and Non-SMOF group (9.5%) (P=0.84; adjusted P=0.40). Conclusion(s): In very preterm infants, administration of intravenous DHA rich SMOF-LE during the neonatal period is not associated with BPD-free survival (Grant MOP-136964 from The Canadian Institutes of Health research).
Effect of DHA-rich SMOF lipids on BPD-free survival, BPD and its severity and death before 36 weeks PMA
Authors/Institutions: Aissatou B. Ndiaye, Université Laval, Quebec, Quebec, Canada; Pascal M. Lavoie, University of Calgary, Calgary, Alberta, Canada; Ibrahim Mohamed, University of Montreal, Montreal, Quebec, Canada; Etienne Pronovost, Université Laval, Quebec, Quebec, Canada; Bruno Piedboeuf, Université Laval, Quebec, Quebec, Canada; David Simonyan, CHU de Québec-Université Laval, Québec, Quebec, Canada; Georgina Angoa, Université Laval, Quebec, Quebec, Canada; Thierry Ducruet, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada; William Fraser, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Anne Monique Nuyt, University of Montreal, Montreal, Quebec, Canada; Brigitte Lemyre, University of Ottawa, Ottawa, Ontario, Canada; Mosarrat Qureshi, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Jehier Afifi, Dalhousie University, Halifax, Nova Scotia, Canada; Kamran Yusuf, University of Calgary, Calgary, Alberta, Canada; Benoît Mâsse, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada; Thierry Lacaze-Masmonteil, University of Calgary, Calgary, Alberta, Canada; Isabelle Marc, Université Laval, Quebec, Quebec, Canada