Enteral supplementation of DHA and ARA effective in very Low Birth Weight Infants

The study is published in the Journal of Pediatrics.

Brandy L. Frost and colleagues from the NorthShore University Health System, Evanston conducted this prospective, randomized, double-blind, placebo-controlled trial to determine feasibility of providing a concentrated emulsified long-chain polyunsaturated fatty acids (LCPUFA) supplement to very low birth weight infants, and to evaluate blood LCPUFA concentrations at 2 and 8 weeks of study supplementation.

This trial randomized infants to receive (1) LCPUFA-120 (a supplement of 40 mg/kg/day docosahexaenoic acid [DHA] and 80 mg/kg/day arachidonic acid [ARA]; DHA:ARA at 1:2 ratio), (2) LCPUFA-360 (a supplement of 120 mg/kg/day DHA and 240 mg/kg/day ARA), or (3) sunflower oil (placebo control).

Infants were 28 weeks of gestation (IQR, 27-30 weeks of gestation) and weighed 1040 g (IQR, 910-1245 g).

Infants received supplement daily for 8 weeks or until discharge, whichever came first. Whole blood LCPUFA levels (wt%; g/100 g) were measured at baseline, 2 weeks, and 8 weeks.

The key findings highlighted in this trial include-

1. At 2 weeks, the change in blood DHA (wt%) from baseline differed significantly among groups (sunflower oil, n = 6; −0.63 [IQR, −0.96 to −0.55]; LCPUFA-120: n = 12; −0.14 [IQR, −0.72 to −0.26]; LCPUFA-360, n = 12; 0.46 [IQR, 0.17-0.81];
   P = .002 across groups).
2. Change in blood ARA (wt%) also differed by group (sunflower oil: −2.2 [IQR, −3.9 to −1.7]; LCPUFA-120: 0.1 [IQR, −2.1 to 1.1] vs LCPUFA-360: 2.9 IQR, 1.5 to 4.5]; P = .0002).
3. Change from baseline to 8 weeks significantly differed between groups for DHA (P = .02) and ARA (P = .003).

Therefore, the authors concluded that "enteral LCPUFA supplementation supported higher blood DHA by 2 weeks. LCPUFA supplementation at 360 mg of combined DHA and ARA is likely necessary to reduce declines as well as allow increases in whole blood concentrations in the first 8 weeks of life."