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High dose arachidonic and docosahexaenoic acid in very preterm infants and neurodevelopment at 2 years - A
Gunnthorunn Gunnarsdottir1, Madelaine Eloranta Rossholt2, Tone Nordvik3
1Department of Pediatric Neurology, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
Insights
Supplementing very preterm infants with arachidonic acid (ARA) and docosahexaenoic acid (DHA) did not improve neurodevelopmental outcomes. However, factors like maternal education and faster growth were linked to better results in these vulnerable infants.
Area of Science:
- Neonatal nutrition
- Neurodevelopmental pediatrics
- Clinical trial research
Background:
- Preterm infants have lower levels of essential fatty acids arachidonic acid (ARA) and docosahexaenoic acid (DHA) due to reduced in-utero accumulation.
- These fatty acids are crucial for neural tissue development, particularly in the third trimester.
Purpose of the Study:
- To assess the impact of ARA and DHA supplementation on neurodevelopmental outcomes in very preterm infants at two years corrected age.
- To investigate the influence of in-hospital growth, socioeconomic factors, and other variables on neurodevelopment in this population.
Main Methods:
- Follow-up of the ImNuT-trial (NCT03555019), a randomized controlled trial involving 120 infants born before 29 weeks gestational age.
- Infants received either ARA and DHA enteral supplements or medium-chain triglycerides (control) from day 2 of life until 36 weeks postmenstrual age.
- Neurodevelopmental assessments were conducted at two years corrected age using the Bayley Scales of Infant and Toddler Development (BSID-III) and Peabody Developmental Motor Scales (PDMS-2).
Main Results:
- No significant differences in neurodevelopmental outcomes were observed between the ARA/DHA supplemented group and the control group.
- Multivariable regression indicated positive associations between female sex and motor scores, and maternal education level and language scores.
- Faster linear growth between 28 weeks and 36 weeks postmenstrual age correlated with higher cognitive scores. Non-Scandinavian family language was negatively associated with BSID scores.
Conclusions:
- ARA and DHA supplementation did not significantly alter neurodevelopmental outcomes in very preterm infants at two years corrected age.
- Predictive factors for better neurodevelopmental outcomes included higher maternal education, being female, faster linear growth during hospitalization, and Scandinavian family language.
Background And Aims:
The fatty acids arachidonic acid (ARA) and docosahexaenoic acid (DHA) accumulate in neural tissue in the last trimester, thus preterm infants have lower levels compared to their term-born peers. Our aim was to evaluate the impact of ARA and DHA supplementation in very preterm infants on neurodevelopmental outcomes at two years corrected age (CA). We also wanted to study the effect of in-hospital growth, socioeconomic factors and other possible covariates on neurodevelopmental outcomes for the entire study population.
Methods:
This is a follow-up study of the ImNuT-trial (NCT03555019); a randomized controlled trial (RCT), where 120 infants born before 29 weeks of gestational age (GA) were randomized to receive an enteral supplement of both ARA and DHA (ARA:DHA group) or medium chain triglycerides (control group). The infants received supplementation from the second day of life until 36 weeks postmenstrual age (PMA). At two years CA, the children underwent neurodevelopmental assessment using Bayley Scales of Infant and Toddler Development, third edition (BSID-III) and Peabody Developmental Motor Scales second edition (PDMS-2).
Results:
Mean (SD) GA at birth was 26.4 (1.7) weeks. The mean (SD) corrected age at follow-up was 24 months + 7 days (17 days). There were no significant differences in neurodevelopmental outcomes between the treatment groups. The multivariable regression model showed a positive association between female sex and motor scores as well as maternal education level and language scores. Faster linear growth from day 28-36 weeks PMA was associated with higher cognitive scores. Non-Scandinavian family language was negatively associated with all three BSID-scores.
Conclusion:
Supplementation with ARA and DHA in very preterm children did not result in significant differences in neurodevelopmental outcomes assessed with BSID-III and PDMS-2 at 2 years corrected age. Higher maternal education level, female sex, faster linear growth during hospitalization and Scandinavian family language were predictive of neurodevelopmental outcome.
Trial Registration:
Clinicaltrials.gov ID NCT03555019.
