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The inadequacy of the essential fatty acid content of present preterm feeds
M A Crawford1, K Costeloe, K Ghebremeskel
1The Institute of Brain Chemistry and Human Nutrition, University of North London, UK. michael@macrawf.demon.co.uk
Insights
Preterm infants have low levels of essential fatty acids like arachidonic acid (AA) and docosahexaenoic acid (DHA). Current infant nutrition formulas further deplete these vital nutrients, potentially harming development.
Area of Science:
- Biochemistry and Neonatal Nutrition
- Cell Membrane Physiology
- Oxidative Stress in Preterm Infants
Background:
- Arachidonic acid (AA) and docosahexaenoic acid (DHA) are crucial for endothelial, pulmonary, and neuro-visual cell membranes.
- Preterm infants are born with potential deficits in AA and DHA and immature antioxidant enzyme systems.
- Postnatal exposure to higher oxygen levels exacerbates oxidative stress in preterm neonates.
Purpose of the Study:
- To evaluate the essential fatty acid (EFA) composition of enteral and parenteral nutrition for preterm infants.
- To assess the impact of current feeding practices on plasma EFA levels in preterm neonates.
- To highlight potential biochemical consequences of inadequate EFA provision for preterm infant growth and development.
Main Methods:
- Biochemical analysis of plasma phosphoglycerides.
- Comparison of EFA proportions in preterm infants with intrauterine expectations.
- Assessment of antioxidant enzyme activity (superoxide dismutase).
Main Results:
- Enteral and parenteral feeds lead to a significant drop in plasma AA and DHA proportions in preterm infants.
- Proportions of AA and DHA fall to one-quarter or one-third of intrauterine expectations post-birth.
- Linoleic acid (LA) proportion increases four-fold, limiting the availability of AA precursor for rapid growth needs.
Conclusions:
- Current enteral and parenteral nutrition formulations for preterm infants are inadequately supplied with essential fatty acids.
- This deficiency may result in fragile cell membranes, leakage, and peroxidation, leading to inflammatory agents.
- Optimizing EFA content in preterm infant nutrition is critical for supporting healthy development and preventing complications.
Unlabelled:
Arachidonic (AA) and docosahexaenoic (DHA) acids are major components of endothelial, pulmonary and neuro-visual cell membranes. Preterm babies may be born with deficits of both AA and DHA. There is evidence that their endogenous anti-oxidant enzymes defence systems have only reached half the activity expected at term. Yet they are exposed to an oxygen tension greater than physiologically anticipated at this time, and the superoxide dismutase shows no evidence of significant catch-up. After birth, present enteral and parenteral feeds for the preterm baby result in a further drop of AA and DHA plasma proportions to a quarter or third of the intra-uterine expectation. At the same time, the proportion of linoleic acid (LA), the precursor for AA, rises in the plasma phosphoglycerides four-fold, thus denying the preterm infant the provision with which the placenta would have perfused the fetus to meet the very rapid demand for endothelial and neural growth. From the biochemistry it is predictable that this situation could lead to fragile cell membranes, leakage, rupture with peroxidation resulting in the formation of inflammatory and vasoconstrictive agents.
Conclusion:
The essential fatty acid content of current enteral and parenteral feeds for preterm infants is incorrectly formulated.