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Updated: Nov 24, 2025
Author Spotlight: Studying the Impact of Maternal Dietary Deficiencies on Long-Term Offspring Health Outcomes
Published on: June 28, 2024
Randomized Controlled Trial of Early Docosahexaenoic Acid and Arachidonic Acid Enteral Supplementation in Very Low
Brandy L Frost1, Aloka L Patel2, Daniel T Robinson3
1Department of Pediatrics, NorthShore University HealthSystem, Evanston, IL; Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL.
Insights
Supplementing very low birth weight infants with long-chain polyunsaturated fatty acids (LCPUFA) supports higher blood docosahexaenoic acid (DHA) levels. A higher dose of LCPUFA (360 mg) is needed to maintain and increase arachidonic acid (ARA) and DHA levels.
Area of Science:
- Neonatal nutrition
- Biochemistry
- Pediatric research
Background:
- Very low birth weight infants have unique nutritional needs.
- Long-chain polyunsaturated fatty acids (LCPUFA) are crucial for infant development.
- Assessing the impact of LCPUFA supplementation in this vulnerable population is important.
Purpose of the Study:
- To evaluate the feasibility of administering a concentrated emulsified LCPUFA supplement to very low birth weight infants.
- To measure blood LCPUFA concentrations at 2 and 8 weeks of supplementation.
- To determine optimal LCPUFA dosing for neonatal nutrition.
Main Methods:
- Prospective, randomized, double-blind, placebo-controlled trial.
- Infants received either LCPUFA-120, LCPUFA-360, or sunflower oil (placebo) for 8 weeks.
- Whole blood LCPUFA levels (DHA and ARA) were measured at baseline, 2, and 8 weeks.
Main Results:
- At 2 weeks, significant differences in blood DHA and ARA changes from baseline were observed across groups (P < .003).
- The LCPUFA-360 group showed increases in DHA and ARA, while the placebo group showed decreases.
- Significant differences in DHA and ARA changes persisted at 8 weeks (P < .02).
Conclusions:
- Enteral LCPUFA supplementation is feasible and supports increased blood DHA by 2 weeks.
- Supplementation with 360 mg/kg/day of combined DHA and ARA is likely necessary to prevent declines and promote increases in blood LCPUFA concentrations.
- Optimized LCPUFA intake is critical for very low birth weight infants during early life.
Objective:
To determine feasibility of providing a concentrated emulsified long-chain polyunsaturated fatty acids (LCPUFA) supplement to very low birth weight infants, and to evaluate blood LCPUFA concentrations at 2 and 8 weeks of study supplementation.
Study Design:
This prospective, randomized, double-blind, placebo-controlled trial randomized infants to receive (1) LCPUFA-120 (a supplement of 40 mg/kg/day docosahexaenoic acid [DHA] and 80 mg/kg/day arachidonic acid [ARA]; DHA:ARA at 1:2 ratio), (2) LCPUFA-360 (a supplement of 120 mg/kg/day DHA and 240 mg/kg/day ARA), or (3) sunflower oil (placebo control). Infants received supplement daily for 8 weeks or until discharge, whichever came first. Whole blood LCPUFA levels (wt%; g/100 g) were measured at baseline, 2 weeks, and 8 weeks.
Results:
Infants were 28 weeks of gestation (IQR, 27-30 weeks of gestation) and weighed 1040 g (IQR, 910-1245 g). At 2 weeks, the change in blood DHA (wt%) from baseline differed significantly among groups (sunflower oil, n = 6; -0.63 [IQR, -0.96 to -0.55]; LCPUFA-120: n = 12; -0.14 [IQR, -0.72 to -0.26]; LCPUFA-360, n = 12; 0.46 [IQR, 0.17-0.81]; P = .002 across groups). Change in blood ARA (wt%) also differed by group (sunflower oil: -2.2 [IQR, -3.9 to -1.7]; LCPUFA-120: 0.1 [IQR, -2.1 to 1.1] vs LCPUFA-360: 2.9 IQR, 1.5 to 4.5]; P = .0002). Change from baseline to 8 weeks significantly differed between groups for DHA (P = .02) and ARA (P = .003).
Conclusions:
Enteral LCPUFA supplementation supported higher blood DHA by 2 weeks. LCPUFA supplementation at 360 mg of combined DHA and ARA is likely necessary to reduce declines as well as allow increases in whole blood concentrations in the first 8 weeks of life.
Trial Registration:
Clinicaltrials.gov: NCT03192839.
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