Abstract
OBJECTIVES: To investigate the evidence for the effect of omega 3 fatty acids via enteral nutrition on identified outcomes in the very low birthweight preterm infant population. METHODS: A literature search was conducted in EMBASE, CINAHL, Cochrane Central, PubMed databases for the period of January 1980-November 2017 for all peer-reviewed articles examining preterm infant nutrition. A multidisciplinary volunteer expert Workgroup and staff screened articles according to defined inclusion criteria (randomized controlled trials, enteral fed preterm infants < 1500 gm, economically developed nations). Data was extracted and risk of bias was evaluated for each included article using the Academy's Quality Criteria Checklist and Cochrane's Risk of Bias Tool. Data was summarized and conclusion statements were developed and graded for each identified outcome using the GRADE framework and Academy methodology. RESULTS: The search identified in 25,264 articles, and six studies published in 13 articles were included. Two included studies had low risk of bias. Remaining studies had bias in the following Cochrane domains: attrition (2), detection (3), selection (2), performance (2), and reporting (1). Eleven conclusion statements were developed, 4 were graded as good, 2 as fair, 5 as limited. Though evidence quality describing the effect of 64mg of omega 3s daily on mortality and retinopathy of prematurity was good, there were no significant effects reported [RR (95% CI) was 1.31 (0.88 to 1.96) and 0.96 (0.61, 1.50), respectively]. Similarly, there were no significant effects found for type of fat intake by VLBW infants on bronchopulmonary disease, atopy, necrotizing enterocolitis, anthropometrics, neuro- or visual development or gastrointestinal health. CONCLUSIONS: This systematic review revealed high heterogeneity amongst interventions, including in feeding types (formula, formula or human milk, or human milk), mode of supplementation, and amount and composition of supplement (DHA, EPA, ARA, MCT). FUNDING SOURCES: Academy of Nutrition and Dietetics.