Fish oil may reduce retinopathy of prematurity

Day 1 NICU

Retinopathy of prematurity (ROP) is a disorder involving the abnormal growth of blood vessels in the retina. The abnormal blood vessels are fragile and can break, causing bleeding. They can also grow in a disordered fashion and pull on the retina, causing it to detach from the inside of the eye. Both the bleeding and retinal detachment can cause serious vision problems. ROP affects 15,000 preemies a year: approximately 500-1,000 will be blind and many more will have some vision impairment. Babies who weigh < 1,000 g are at greatest risk.

A study published this month in Pediatrics looked at preemies needing nutrition in the intravenous. Many preemies < 1,500 g can only receive intravenous nutrition as it takes a while for the bowel to be mature enough to tolerate and digest even breastmilk. Traditionally the fat source (lipid) in IV nutrition is made from soybean and olive oil: rich in omega-6 fatty acids but no omega-3 fatty acids. However, the rods and cones (the actual structures in the retina that process light) have membranes that contain docosahexaenoic acid (DHA), an omega-3 fatty acid.

In this study, 40 preemies who weighed less than 1,250 g received IV nutrition made from fish oil, soybean oil, and olive oil (containing both omega-3′s and omega-6′s) were compared to 44 infants who had received IV nutrition containing only omegaa-6′s. The babies who received the fish oil/omega-3 enriched nutrition were 75% less likely to receive laser surgery for ROP. Also, none of these infants had gallbladder problems, which can be a consequence of getting lipids by IV, while 5 preemies who got the traditional IV lipids developed gallbladder issues.

This study is very exciting and should prompt more research. Omegaven is an IV lipid formulation made form fish, soybean, and olive oil and contains both omega 3′s and omega-6 fatty acids. It is used for children who are at risk for developing liver disease from prolonged IV nutrition (bypassing the bowel by giving food in the IV can eventually cause problems).

The weaknesses of the study are that it is small, there is no long-term follow up, and it is an observational study, meaning the group of babies who received the omega-3 fatty acids were compared to babies who previously received the older formulation. There may be other aspects of care that changed and so it is not possible to know if the reduction in ROP is only due to the different lipid formulation or due to some other factor.

This study adds to the growing body of evidence that preemies probably need omega-3 fatty acids and a study where the omega-3 formulation is compared head-to-head with the older omega-6 only formulation is definitely needed.

Can my baby get Omegaven? It is not FDA approved, meaning it can only be used in research studies or by compassionate use (must be approved by the FDA on a case by cases basis, this link explains the steps). There are several studies looking at Omegaven for preventing liver damage with IV nutrition and once it is actually FDA approved for something, it will be much easier to get. Unless there are unknown long-term complications from using an omega-3 formulation (hard to see how, then again, no one thought high concentrations of oxygen would cause damage and now we know it causes ROP), I imagine it will eventually become the standard of care for

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