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Maternal high-dose docosahexaenoic acid supplementation and neurodevelopment at 5 Years of preterm children
Sara-Pier Paquet1, Etienne Pronovost1, David Simonyan2
1Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, 2705 Boulevard Laurier, G1V 4G2, Québec, Canada.
Insights
High-dose docosahexaenoic acid (DHA) supplementation in very preterm infants did not improve behavioral functioning at age 5. Omega-3 fatty acid intake showed no significant benefits for child behavior in this vulnerable population.
Area of Science:
- Neuroscience
- Pediatrics
- Nutritional Science
Background:
- Docosahexaenoic acid (DHA), an omega-3 fatty acid crucial for brain development, is accumulated by the fetal brain during the third trimester.
- Very preterm infants may have altered DHA accretion due to premature birth, potentially impacting neurodevelopment.
- Investigating the effects of neonatal DHA supplementation on long-term behavioral outcomes is important for optimizing infant care.
Purpose of the Study:
- To determine if high-dose DHA supplementation during the neonatal period improves behavioral functioning at 5 years corrected age in children born very preterm.
- To assess the impact of DHA on secondary neurodevelopmental outcomes, including executive functions and global development.
Main Methods:
- A follow-up study of a multicenter randomized controlled trial involving very preterm infants.
- Participants received high-dose DHA or placebo via maternal breastmilk until 36 weeks postmenstrual age.
- Behavioral functioning was assessed at 5 years corrected age using the Strengths and Difficulties Questionnaire (SDQ); secondary outcomes included executive functions and global development.
Main Results:
- No significant difference in the Total Difficulties Score (primary outcome) was observed between the DHA and placebo groups.
- Secondary neurodevelopmental outcomes also did not differ significantly between the groups.
- While no overall treatment effect was found, significant interactions between treatment and sex or gestational age were noted for some secondary outcomes.
Conclusions:
- High-dose DHA supplementation during the neonatal period does not improve behavioral functioning at 5 years in children born very preterm.
- The findings suggest that neonatal DHA supplementation, under these conditions, does not confer long-term behavioral benefits.
- Further research may explore specific subgroups or alternative DHA administration strategies.
Background & Aims:
Docosahexaenoic acid (DHA) is the most abundant omega-3 fatty acid in the brain and is accumulated by the fetal brain during the last trimester of pregnancy. Our objective was to determine whether high-dose DHA supplementation during the neonatal period, vs. placebo, improves behavioral functioning at 5 years in children born very preterm.
Methods:
This is a follow-up at 5 years corrected age of a subset of children who participated in a multicenter randomized controlled trial. The participants received a high-dose DHA supplementation, or a placebo, through maternal breastmilk until 36 weeks' postmenstrual age. Primary outcome was child behavioral functioning, assessed by the Total Difficulties Score from the Strengths and Difficulties Questionnaire (SDQ). Secondary outcomes included behavioral scores from the SDQ, executive functions assessment and global developmental performance. Neurodevelopmental outcomes were assessed through interviews with parents. Mean differences between DHA and placebo groups were estimated using mixed linear models. Subgroup analyses were conducted for sex and gestational age (GA) at birth.
Results:
Among 177 eligible children, 132 (74.6 %) completed neurodevelopmental assessment at 5 years (DHA, N = 64, placebo, N = 68). Total Difficulties Score did not differ between the DHA and placebo groups (mean differences, -0.9 [95 % confidence interval, -2.7 to 0.8], P = 0.30), nor any of the secondary outcomes. There was no significant interaction between treatment groups and sex, nor GA, for the primary outcome. However, significant interactions between treatment groups and sex or GA were found for some secondary outcomes.
Conclusions:
In very preterm infants, high-dose DHA supplementation did not improve behavioral functioning at 5 years.
Clinical Trial Registration:
ClinicalTrials.gov, NCT02371460, https://clinicaltrials.gov/study/NCT02371460.
