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. 2021 Nov;29(11):1314-1322.
doi: 10.1016/j.jsps.2021.09.012. Epub 2021 Sep 25.

Impact of Docosahexaenoic acid supplementation on proinflammatory cytokines release and the development of Necrotizing enterocolitis in preterm Neonates: A randomized controlled study

Dina Khaled Abou El Fadl  1 , Marwa Adel Ahmed  2 , Yasmin Af Aly  3 , Ebtissam Abdel Ghaffar Darweesh  1 , Nagwa A Sabri  2
Affiliations

Impact of Docosahexaenoic acid supplementation on proinflammatory cytokines release and the development of Necrotizing enterocolitis in preterm Neonates: A randomized controlled study

Dina Khaled Abou El Fadl et al. Saudi Pharm J. 2021 Nov.

Abstract

Introduction: Preterm neonates have under-developed immune-regulatory system; consequently, there is a risk for developing chronic inflammation. Necrotizing enterocolitis (NEC) is an acute devastating neonatal intestinal inflammatory disorder. Due to the obscure multifactorial etiology, early diagnosis and effective treatment of NEC are limited. Consequently, effective strategies in the prevention of NEC, including nutritional approaches, are critically needed. The current study was conducted to assess the potential immunomodulatory effect of Docosahexaenoic Acid (DHA) supplementation in preterm neonates at neonatal intensive care unit (NICU) and subsequently its effect on preventing or reducing NEC incidence.

Methods: This was a prospective randomized controlled study. A total of 67 neonates, with gestational age equal or less than 32 weeks at birth and weight less than or equal 1500 g, were randomly assigned to either DHA group or the control group. Modified Bell's staging criteria for NEC was used as an objective tool for diagnosis and staging of NEC. Levels of Interleukin 1 beta (IL-1β) were measured at baseline and after 10 days. Mortality and NICU length of stay (LOS) were also monitored.

Results: Thirty neonates of each group completed the study. A statistically significant difference was observed between the two groups regarding diagnosis and staging of NEC (p = 0.0001). There was also a statistically significant difference between DHA group 22(73.3), 95% CI [55.9, 86.5] and the control group 8 (26.7), 95% CI [13.5, 44.1] in the percentage change in IL-1β levels (p = 0.0001).A statistically significant association was found between IL and 1 β change and NEC diagnosis (p = 0.001). NICU LOS was significantly lower among DHA group 21.63 ± 6.67 compared to the control group 25.07 ± 4.67 (p = 0.025). Mortality n (%) among the control group 4 (11.8) was higher than DHA group 3 (9.1), however, no significant difference was detected (p = 1.0).

Conclusion: Findings of this study suggest that enteral DHA supplementation can reduce NEC incidence in preterm neonates through its immunoregulatory effect that modulates production of regulatory cytokines.Trial registration: Registered at clinical trials.gov (NCT03700957), 6 October 2018.

Keywords: DHA, Docosahexaenoic acid; IL-1β, Interleukin 1 beta; Immunomodulation; Inflammation; Interleukin 1 beta; LOS, Length of stay; Long-chain polyunsaturated fatty acids; NEC, Necrotizing enterocolitis; NICU, Neonatal intensive care unit; Neonatal intensive care unit; Prematurity; n-3 LCPUFA, Omega-3 long-chain polyunsaturated.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Modified Bell’s Staging Criteria for NEC.
Fig. 2
Fig. 2
CONSORT flow chart diagram of study selection.
Fig. 3
Fig. 3
Diagnosis and staging of NEC on day 10 for both groups.
Fig. 4
Fig. 4
NICU length of stay.
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