Introduction
BPD
BRONCHOPULMONARY DYSPLASIA (BPD)
Children born at less than 29 weeks’ gestation are at high risk of bronchopulmonary dysplasia (BPD) and have an IQ a mean 12 points lower than children born at term.Findings from the N3RO trial may create a dilemma for clinicians in the neonatal unit concerning how best to balance perceived risks and benefits associated with high-dose DHA supplementation. BPD occurs among approximately half of children born at less than 29 weeks’ gestation and is a major challenge for clinical practice. However, high-dose DHA supplementation provides one of the few treatments in the neonatal unit found to improve IQ and potentially minimize the longer-term burden facing these children. Such a benefit is particularly compelling given that cognitive outcomes of children born at less than 29 weeks’ gestation have had little improvement over the last 30 years.In this cohort study, we conducted an exploratory mediation analysis of results from the N3RO trial with the aim of untangling the opposing outcomes associated with DHA supplementation for BPD and IQ in children born at less than 29 weeks’ gestation. In particular, we sought to quantify the indirect effect the DHA-related increase in BPD risk had on the IQ benefit and the direct effect of DHA supplementation on IQ independent of earlier effects on BPD risk.