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Invited Commentary
March 2018

The Prematurity of Recommending Particular Polyunsaturated Fatty Acid Supplements for Retinopathy of Prematurity

Author Affiliations
  • 1Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City
JAMA Ophthalmol. 2018;136(3):277-278. doi:10.1001/jamaophthalmol.2017.6657

The Donna Mega Study1 in Gothenburg, Sweden, was a randomized, open-label, single-site clinical trial that compared 2 parenteral emulsions, 1 with 15% fish oil and rich in ω-3 fatty acids (SMOFlipid) and another based on olive oil (Clinoleic), on retinopathy of prematurity (ROP), other morbidities of prematurity, and postnatal growth. Löfqvist et al2 report another analysis of serum levels of long-chain polyunsaturated fatty acids (PUFAs) measured in a sample of 90 of 138 preterm infants in the Donna Mega Study, all of whom were born less than 28 weeks’ gestational age and 78 of whom survived for the final ROP examination. The study had previously reported1 that infants receiving SMOFlipid, compared to those on clinioleic, had reduced ratios of arachidonic acid (ω-6 20:4) to docosahexaenoic acid (DHA; ω-3 22:6) from 1 week after birth until 32 weeks’ postmenstrual age, and that there were no differences in the prevalence of morbidities between the 2 groups, including ROP or severe ROP. The goal of the current report2 was to examine the association between ROP and serum levels of the 2 most prevalent PUFAs in the brain and retinas of these infants, DHA (ω-3 22:6) and arachidonic acid (ω-6 20:4). The finding of an association between a reduced area under the curve of arachidonic acid at 1 month of life and the prevalence of ROP and severe ROP was somewhat unexpected, given experimental data3 that found neuroprotection and reduced retinopathy with forms of DHA.

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