Targeting inflammation in the preterm infant: The role of the omega-3 fatty acid docosahexaenoic acid

• DHA has been shown to exert an anti-inflammatory effect in adults and animals.
• Clinical trials suggests that DHA is safe and likely beneficial in preterm infants.
• Decreased DHA levels have been associated with an increase in neonatal morbidities.
• It is not known which immune targets DHA interacts with in a preterm infant.
• Short and long-term effects of DHA on the immune system remain to be assessed.

Long-chain polyunsaturated fatty acids are critical for the normal growth and development of preterm infants. Interest in these compounds rests in their anti-inflammatory properties. Clinical conditions with an inflammatory component such as bronchopulmonary dysplasia, necrotising enterocolitis and sepsis are risks to the survival of these infants. Dysregulation of inflammatory responses plays a central role in the aetiology of many of these neonatal disorders. There is evidence to suggest that the omega-3 long chain polyunsaturated fatty acid docosahexaenoic acid (DHA) can down-regulate local and systemic inflammation in adults and animal models; however, very little is known about its protective effects in infants, especially preterm infants. Due to their immunological immaturity, preterm infants are particularly sensitive to diseases with an inflammatory aetiology in the early postnatal period. This makes DHA supplementation immediately after birth to combat neonatal inflammation an attractive therapy. Mechanistic data for DHA use in preterm infants are lacking and results from adult and animal studies may not be relevant to this population because of fundamental immune system differences. While there is increasing evidence from randomised controlled trials to support a beneficial effect of DHA for the preterm infant, more evidence is required to establish short and long-term effects of DHA on the immune status of preterm infants.