Enteral Docosahexaenoic Acid and Retinopathy of Prematurity: A Randomized Clinical Trial
Enteral Docosahexaenoic Acid and Retinopathy of Prematurity: A Randomized Clinical Trial
复制标题
DOI：
10.1002/jpen.1497
复制
发表时间：
2019-09-01
影响因子：
3.4
通讯作者：
Cruz-Reynoso, Leonardo
中科院分区：
文献类型：
--
作者：
Bernabe-Garcia, Mariela;Villegas-Silva, Raul;Cruz-Reynoso, Leonardo
背景早产儿视网膜病变（ROP）是一种低出生体重早产儿视网膜疾病，可能导致失明。二十二碳六烯酸 (DHA) 在实验模型中具有保护作用，但将其作为肠外营养的一部分施用却显示出不一致的结果。我们测试肠内 DHA 对预防 ROP 和/或严重程度以及减少住院时间的效果。方法这是一项双盲平行临床试验。新生儿重症监护病房招募了出生体重为 1000 克的早产儿（n = 110；每组 55 例）。婴儿随机接受 75 mg DHA/kg/d（DHA 组）或高油酸葵花籽油（对照组）肠内喂养 14 天。评估 DHA 对 ROP 任何阶段、严重 ROP（阶段 >= 3）发生率和住院时间的影响。根据需要，使用相对风险 (RR) 和 95% 置信区间 (CI)、Fisher 精确检验、Student t 检验或 Mann-Whitney U 检验对各组进行比较。应用逻辑回归来调整混杂因素。结果 DHA 组和对照组之间的 ROP 风险没有差异（DHA 的 RR = 0.79；95% CI，0.49-1.27；P = 0.33）。然而，接受 DHA 治疗的患者出现 3 期 ROP 的风险较低（DHA 的 RR = 0.66；95% CI，0.44-0.99；P = 0.03）。调整混杂因素后，这种降低的风险仍然显着（调整后的比值比 = 0.10；95% CI，0.011-0.886；P = 0.04）。各组之间的住院时间相似。结论肠内DHA可降低3期ROP的发生率。
Background Retinopathy of prematurity (ROP) is a disorder of the retina of low-birth-weight preterm infants that potentially leads to blindness. Docosahexaenoic acid (DHA), is protective in experimental models, but its administration as part of parenteral nutrition has shown inconsistent results. We test the effect of enteral DHA to prevent ROP and/or severity and to reduce hospital stay. Methods This was a double-blind parallel clinical trial. Preterm infants (n = 110; 55 per group) with birth weight = 1000 g were recruited in a neonatal intensive care unit. Infants were randomized to receive 75 mg of DHA/kg/d (DHA group) or high oleic sunflower oil (control group) for 14 days by enteral feeding. The effect of DHA was evaluated on any stage of ROP, severe ROP (stage >= 3) incidence, and hospital stay. Groups were compared with relative risk (RR) and 95% confidence interval (CI), Fisher's exact test, Student's t-test, or Mann-Whitney U-test, as appropriate. Logistic regression was applied to adjust for confounders. Results There was no difference between the DHA and control groups in ROP risk (RR for DHA = 0.79; 95% CI, 0.49-1.27; P = 0.33). However, patients who received DHA showed lower risk for stage 3 ROP (RR for DHA = 0.66; 95% CI, 0.44-0.99; P = 0.03). After adjusting for confounders, this decreased risk remained significant (adjusted odds ratio = 0.10; 95% CI, 0.011-0.886; P = 0.04). Hospital stay was similar between groups. Conclusion Enteral DHA may reduce the incidence of stage 3 ROP.