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Published on: November 29, 2013
Early docosahexaenoic and arachidonic acid supplementation in extremely-low-birth-weight infants
Daniel T Robinson1, Michael Caplan2, Susan E Carlson3
1Ann & Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Insights
Daily buccal docosahexaenoic acid (DHA) and arachidonic acid (ARA) drops did not increase blood levels in extremely-low-birth-weight (ELBW) infants. This study found no significant changes in fatty acid levels with this supplementation method.
Area of Science:
- Neonatal nutrition
- Pediatric fatty acid metabolism
- Infant supplementation
Background:
- Extremely-low-birth-weight (ELBW) infants often have significant deficits in docosahexaenoic acid (DHA) and arachidonic acid (ARA).
- Improved strategies are needed to enhance DHA and ARA levels in these vulnerable infants.
- Buccal administration of DHA and ARA was investigated as a novel supplementation approach.
Purpose of the Study:
- To determine if daily buccal administration of DHA and ARA supplements can increase blood levels in ELBW infants.
- To evaluate the efficacy of buccal DHA+ARA drops in improving docosahexaenoic acid and arachidonic acid status.
Main Methods:
- A randomized controlled trial involving 30 ELBW infants was conducted.
- Infants received daily DHA and ARA drops via buccal mucosa or placebo for 8 weeks.
- Red blood cell phospholipid levels of DHA and ARA were measured at 2 and 8 weeks of age.
Main Results:
- Twenty-eight infants completed the study.
- No significant differences in red blood cell DHA or ARA levels were observed between the DHA+ARA supplemented groups and the placebo group at 2 or 8 weeks.
- While DHA levels showed a trend of increase from 2 to 8 weeks, ARA levels did not change significantly over time.
Conclusions:
- Daily buccal administration of DHA and ARA supplements did not effectively increase blood fatty acid levels in ELBW infants.
- The buccal route may not be an efficient method for supplementing DHA and ARA in this population.
- Further research into alternative or optimized supplementation strategies for ELBW infants is warranted.
Background:
Extremely-low-birth-weight (ELBW) infants accrue large deficits in docosahexaenoic acid (DHA) and arachidonic acid (ARA) and require improved supplementation strategies. We hypothesized that once daily DHA+ARA drops applied to buccal mucosa will increase blood levels.
Methods:
Thirty ELBW infants were randomized to receive DHA 20 mg/kg/d + ARA 40 or 60 mg/kg/d + ARA 120 mg/kg/d or placebo within 72 h of age for 8 wk duration. Red blood cell phospholipid levels of DHA (primary) and ARA (secondary) were measured at 2 and 8 wk of age.
Results:
Twenty-eight survivors with a median birth weight of 806 g completed dosing and sampling. Red blood cell levels were similar between the three groups at 2 wk (DHA: 4.62 wt% (interquartile range (IQR) 4.1-5.5) for all, P = 0.29 between groups; ARA: 21.1 wt% (IQR 18.78-22.6) for all, P = 0.41 between groups) and 8 wk (DHA: 6.0 wt% (IQR 5.1-7.1) for all, P = 0.57 between groups; ARA: 20.1 wt% (IQR 18.3-23.1) for all, P = 0.63 between groups). DHA in all infants showed a median increase of 31% from 2 to 8 wk (P < 0.04). ARA levels did not significantly change over time (P > 0.6).
Conclusion:
Daily buccal DHA and ARA supplements did not affect fatty acid levels in ELBW infants.
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