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Published on: November 29, 2013
Blood fatty acid changes in preterm infants in a trial of enteral DHA supplementation
Robert A Gibson1,2, Maria Makrides3,4, Jana M Bednarz3,5
1South Australian Health and Medical Research Institute, Adelaide, SA, Australia. robert.gibson@adelaide.edu.au.
Insights
High-dose docosahexaenoic acid (DHA) supplementation in preterm infants prevents DHA decline. However, it also modestly increases the decline in arachidonic acid (AA) levels, impacting neonatal nutrition strategies.
Area of Science:
- Neonatal nutrition and fatty acid metabolism.
Background:
- Very preterm infants miss crucial in-utero omega-3 docosahexaenoic acid (DHA) and omega-6 arachidonic acid (AA) supply.
- Postnatal intake of DHA and AA is often insufficient in extremely preterm neonates.
Purpose of the Study:
- To assess the effect of enteral DHA supplementation on DHA and AA concentrations in very preterm infants.
- To investigate the impact of DHA intervention on fatty acid levels at 36 weeks' postmenstrual age (PMA).
Main Methods:
- A randomized controlled trial involving 1077 infants born before 29 weeks' gestation.
- Infants received either 60 mg/kg/d of DHA or a soy oil placebo via enteral emulsion.
- Whole blood DHA and AA concentrations were measured before and after the intervention (at 36 weeks' PMA).
Main Results:
- Infants receiving DHA supplementation showed increased DHA levels (3.86%) compared to the control group (2.53%) at 36 weeks' PMA.
- Arachidonic acid (AA) levels decreased in both groups, with a marginally greater decrease observed in the DHA intervention group (8.11% vs. 8.84%).
- Fatty acid levels regressed towards a new diet-dependent mean at 36 weeks' PMA, irrespective of initial concentrations.
Conclusions:
- High-dose DHA supplementation effectively prevents the typical postnatal decline of DHA in very preterm infants.
- The intervention modestly exacerbated the decline in AA levels.
- Findings support optimizing neonatal nutrition for very preterm infants, considering the dual effects on DHA and AA.
Background:
Very preterm infants miss the peak in-utero supply of omega-3 docosahexaenoic acid (DHA) and omega-6 arachidonic acid (AA), and are thought to receive low amounts after birth.
Methods:
In a randomized controlled trial of 1077 babies born <29 weeks' gestation we assessed the DHA and AA concentrations in whole blood before and after (36 weeks' post menstrual age, PMA) enteral emulsion intervention with 60 mg/kg/d of DHA compared with no DHA soy oil.
Results:
Prior to the intervention, all infants had similar mean DHA (2.8% of total fatty acids) and mean AA (intervention 10.45%; control 10.42%) concentrations. By 36 weeks', mean DHA of intervention group infants increased to 3.86%, while it decreased to 2.53% in the control group (mean difference 1.33%, 95% CI 1.27 to 1.40, p < 0.0001). AA was lower at 36 weeks' than at enrolment, with the decrease marginally more pronounced in the intervention group (8.11%) compared with the control group (8.84%, mean difference -0.71%, 95% CI -0.86 to -0.57, p < 0.0001).
Conclusion:
All fatty acids regressed towards a new diet-dependent mean at 36 weeks regardless of the initial level. DHA supplementation successfully prevented the typical decline in DHA and modestly exacerbated the decline in AA.
Trial Registration:
The N3RO Trial is registered at the Australian New Zealand Clinical Trial Registry as ACTRN12612000503820 (anzctr.org.au), 9 May 2012.
Impact:
High-dose DHA supplementation in preterm infants prevents the typical postnatal decline in DHA. This study provides evidence from over 1000 infants across Australia, New Zealand, and Singapore. The findings have direct implications for optimizing neonatal nutrition in very preterm populations.
