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Neonatal Docosahexaenoic Acid in Preterm Infants and Intelligence at 5 Years

Jacqueline F Gould1, Maria Makrides1, Robert A Gibson1

  • 1From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia.

The New England Journal of Medicine
|October 27, 2022
PubMed

Insights

Neonatal docosahexaenoic acid (DHA) supplementation in premature infants may improve cognitive development. This study found higher intelligence scores at age five in children who received DHA, suggesting benefits for preterm infant neurodevelopment.

Area of Science:

  • Neuroscience
  • Pediatrics
  • Nutritional Science

Background:

  • Docosahexaenoic acid (DHA) is crucial for neural tissue development, with significant accretion in the third trimester.
  • Infants born before 29 weeks' gestation miss this critical period of DHA accretion, potentially impacting cognitive development.
  • The long-term effects of this deficiency on cognitive outcomes remain incompletely understood.

Purpose of the Study:

  • To assess the effect of neonatal docosahexaenoic acid (DHA) supplementation on general intelligence at 5 years of corrected age.
  • To evaluate cognitive outcomes in extremely preterm infants following a trial of DHA supplementation initiated in the neonatal period.

Main Methods:

  • Children born before 29 weeks' gestation, enrolled in a neonatal DHA supplementation trial, were assessed at 5 years.
  • Participants received either an enteral DHA emulsion (60 mg/kg/day) or a control emulsion until 36 weeks postmenstrual age or discharge.
  • General intelligence was measured using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), with full-scale IQ (FSIQ) as the primary outcome.

Main Results:

  • Of 656 eligible survivors, 480 (73%) had FSIQ scores at 5 years (241 DHA group, 239 control group).
  • The mean FSIQ score was modestly higher in the DHA group (95.4 ± 17.3) compared to the control group (91.9 ± 19.1).
  • The adjusted difference in FSIQ was 3.45 (95% CI, 0.38 to 6.53; P = 0.03), indicating a statistically significant improvement.

Conclusions:

  • Enteral DHA emulsion supplementation in extremely preterm infants was associated with modestly higher full-scale intelligence quotient (FSIQ) scores at 5 years of age.
  • These findings suggest a potential benefit of neonatal DHA supplementation for cognitive development in infants born before 29 weeks' gestation.
  • Adverse events were similar between the DHA and control groups, indicating a favorable safety profile.
Abstract

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