Journal of Pediatric Medicine and Child Health

ABSTRACT

Background

Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness, particularly in low- and middle-income countries. Omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) play a critical role in retinal vascular and neuronal development and may influence the severity of ROP.

Objective

To evaluate the effect of enteral omega-3 LCPUFA supplementation on the incidence and severity of ROP in preterm low-birth-weight infants.

Methods

This randomized controlled trial was conducted at a tertiary care neonatal unit in Bangladesh between June to November 2023. Preterm neonates with gestational age >28 to <34 weeks and birth weight <1800 g were randomized to receive either enteral omega-3 supplementation (40 mg/kg/day of DHA) initiated within 48 hours of starting enteral feeds and continued for four weeks, or standard care without supplementation. ROP screening was performed according to national guidelines. Outcomes included overall ROP incidence, progression to severe or treatment-requiring ROP, and spontaneous regression.

Statistical analysis

Data were analyzed by Statistical Package for Social Science (SPSS 27.0 IBM Corporation, New York, USA).

Result

Among 76 enrolled infants, 71 completed follow-up (35 in the omega-3 group and 36 controls). Baseline neonatal and maternal characteristics were comparable between groups. The overall incidence of ROP did not differ significantly between the omega-3 and control groups (37.1% vs 41.7%, p=0.69). However, among infants who developed ROP, progression to severe ROP was significantly lower in the omega-3 group compared with controls (23.1% vs 60.0%, p=0.049), while spontaneous regression was significantly higher (76.9% vs 40.0%, p=0.049).

Conclusion

Enteral omega-3 supplementation does not reduce the overall incidence of ROP but significantly lowers the risk of severe, treatment-requiring disease and promotes spontaneous regression. Omega-3 LCPUFAs may serve as a supportive nutritional strategy to modulate ROP severity in preterm infants. Further multicenter studies are needed to determine optimal dosing and long-term outcomes.

Keywords: Retinopathy of Prematurity; Omega-3 Fatty Acids; Preterm Infants; Neonatal Nutrition