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Effects of different arachidonic acid supplementation on psychomotor development in very preterm infants; a
Ayham Alshweki1, Alejandro Pérez Muñuzuri2, Ana M Baña3
1Neonatology Unit, Department of Paediatrics, University Clinical Hospital of Santiago de Compostela. IDIS, CIBERER, Travesia Choupana, 15706, Santiago de Compostela, Spain. drayham@live.com.
Insights
A 2:1 omega-6 to omega-3 ratio in formula milk improved essential fatty acid levels and psychomotor development in very preterm infants. This ratio is recommended for optimal neurodevelopment in high-risk newborns.
Area of Science:
- Neonatal Nutrition
- Neurodevelopmental Pediatrics
- Clinical Nutrition
Background:
- Polyunsaturated fatty acids (PUFAs) are crucial for preterm infant neurodevelopment.
- The optimal omega-6/omega-3 fatty acid ratio in infant formula is not well-established.
- Arachidonic acid (AA) plays a key role in brain development.
Purpose of the Study:
- To investigate the effect of different omega-6/omega-3 ratios in formula on very preterm infants.
- To determine if a balanced contribution of arachidonic acid influences neurodevelopment.
- To assess psychomotor development and biochemical markers in response to formula composition.
Main Methods:
- Randomized trial involving very preterm newborns (<1500g or <32 weeks gestational age).
- Two formula groups: Group A (2:1 ω-6/ω-3 ratio) and Group B (1:1 ω-6/ω-3 ratio).
- Two-year follow-up assessing growth, evoked potentials, plasma fatty acids, and psychomotor development (Brunet Lézine scale).
Main Results:
- Group A showed significantly higher arachidonic acid and total PUFA levels at 12 months.
- Group A achieved a significantly higher average psychomotor development score (Brunet Lézine) at 24 months compared to Group B.
- No significant differences in growth or evoked potentials were observed between the formula groups.
Conclusions:
- A 2:1 ω-6/ω-3 ratio in formula milk supports higher essential fatty acid levels in very preterm infants.
- This ratio is associated with enhanced psychomotor development compared to a 1:1 ratio.
- Formula with AA levels double that of docosahexaenoic acid warrants consideration for very preterm infant feeding.
Background & Aims:
Nutritional supplementation with polyunsaturated fatty acids is important in preterm infants neurodevelopment, but it is not known if the omega-6/omega-3 ratio affects this process. This study was designed to determine the effects of a balanced contribution of arachidonic acid in very preterm newborns fed with formula milk.
Methods:
This was a randomized trial, in which newborns <1500 g and/or <32 weeks gestational age were assigned to one of two groups, based on the milk formula they would receive during the first year of life. Initially, 60 newborns entered the study, but ultimately, group A was composed of 24 newborns, who were given formula milk with an ω-6/ω-3 ratio of 2/1, and Group B was composed of 21 newborns, given formula milk with an ω-6/ω-3 ratio of 1/1. The infants were followed up for two years: growth, visual-evoked potentials, brainstem auditory-evoked potentials, and plasma fatty acids were periodically measured, and psychomotor development was assessed using the Brunet Lézine scale at 24 months corrected age. A control group, for comparison of Brunet Lézine score, was made up of 25 newborns from the SEN1500 project, who were fed exclusively with breast milk.
Results:
At 12 months, arachidonic acid values were significantly higher in group A than in group B (6.95 ± 1.55% vs. 4.55 ± 0.78%), as were polyunsaturated fatty acids (41.02 ± 2.09% vs. 38.08 ± 2.32%) achieved a higher average. Group A achieved a higher average Brunet Lézine score at 24 months than group B (99.9 ± 9 vs. 90.8 ± 11, p =0.028). The Brunet Lézine results from group A were compared with the control group results, with very similar scores registered between the two groups (99.9 ± 9 vs. 100.5 ± 7). There were no significant differences in growth or evoked potentials between the two formula groups.
Conclusions:
Very preterm infants who received formula with an ω-6/ω-3 ratio of 2/1 had higher blood levels of essential fatty acids during the first year of life, and better psychomotor development, compared with very preterm newborns who consumed formula with an ω-6/ω-3 of 1/1. Therefore, formula milk with an arachidonic acid quantity double that of docosahexaenoic acid should be considered for feeding very preterm infants.
Trial Registration:
ClinicalTrials.gov Identifier NCT02503020.
