Abstrakt
Effect of DHA on pro inflammatory cytokines including Platelets Activating Factor (PAF) and itâs role in prevention of necrotizing enterocolitis in preterm/very low birth weight neonates
Wafaa Osman Ahmed Osman, Hisham Abd El Samie Awad, Ola Galal Badr El-Deen, Noha Mokhtar Kamal Mahmoud, Sally Mohamed Hassan Mohamed
Background: Necrotizing enterocolitis (NEC) is a critical intestinal emergency condition, which mainly occurs in preterm low birth weight infants. Necrotizing enterocolitis (NEC) is the most devastating gastrointestinal disease in neonates. The pathogenesis of NEC is not well defined but evidence strongly suggests that it is multifactorial. Prematurity and enteral feeding are major risk factors for NEC.
Objectives: The purpose of this study is to determine whether DHA is effective in the prevention or reducing severity of necrotizing enterocolitis in preterm/low birth weight neonates.
Patients and Methods: We conducted an interventional two armed double blinded randomized control trial during the period from September 2017 to August 2020 in our tertiary level NICU. Our study recruited 80 neonates, they were divided blindly in to two groups (40 each) where; one group was labelled by yellow card and the other by red card. One color was assigned to receive DHA and the other receive the placebo;where their information were kept hidden and unknown till results of lab was received. The nurses were not informed by the type of the medication they give to patients.
Results: Our results showed a significant increase in the length of the neonates received DHA than those who received placebo (P=0.000). Additionally, although all other arthropometric measurements have been significantly increased in neonates of DHA at the follow-up evaluation, it was of no significant value when compared with the neonates of the opposite group. As regards the incidence of feeding intolerance, our results demonstrated a significant statistical improvement among neonates of DHA group; regarding abdominal girth, intestinal sound, gastric residual, passage of stool and modified NEC BELL’S criteria (P < 0.05). It was of most important to monitor the effect of DHA On sepsis and clinical laboratory including CBC. SNAP score for evaluation of sepsis was evaluated initially and 10 days later for both groups where, it increased from 9.6 to 19.2 among patients of group B and decreased from 14.4 to 8.3 among neonates of group A (P<0.001 and 0.001) respectively. This reflects the improvement of group A. Furthermore, the platelet count also decreased in group B from 199.3 to 123.1 while; it increased from 93.7 to 192.8 among neonates of group A, yielding a high significant difference at further evaluation and demonstrates the improvement occurred in the neonates taking DHA. These findings signify the possible role of DHA during sepsis in preterm infants.
Conclusion: DHA has not been used as unique intervention at a high but physiological dose; in addition, our previous results found an anti-inflammatory effect in neonates. Therefore, we expect that preterm infants may have a reduced bowel inflammatory response and lower NEC events and or severity.