Neonatal supplementation of omega-3 fatty acid improves intelligence scores in preterm infants: NEJM.

Australia: A recent study published in the New England Journal of Medicine has concluded that omega-3 fatty acid supplementation in  first few months of life to preterm infants born before 29 weeks gestation appeared to modestly boost IQ scores at 5 years of age.

Supplementation of enteral emulsion of Docosahexaenoic Acid at 60 mg/kg per day given to infants born before 29 weeks of gestation improves FSIQ scores at five years of age which is comparatively higher compared to the control feeding.

Docosahexaenoic acid (DHA) is a neural tissue component, and its accumulation is most significant during the final trimester of pregnancy into the brain. Those infants born prematurely, before 29 weeks of gestation, are deprived of a transplacental supply of DHA.

Due to a lack of the normal supply of DHA, preterm children are at risk of lower cognitive scores. The relationship between a higher amount of DHA supplementation and improved cognition function remains unclear. Current practice implements 20 mg of DHA per kg of body weight per day, which is lower than the estimated in-utero requirement of 60 mg per kg per day.

Based on the above background, a study was conducted by Gould JF et al. with a team of researchers to determine the effect of an enteral emulsion of DHA (60 mg per kilogram per day) or a control emulsion beginning in the first three days of enteral feeds until either 36 weeks of postmenstrual age or discharge.

The key points of the study are:

• A total of 1273 infants were randomized in the original trial.

• 656 surviving children randomized at the centers were included in the follow-up study.

• In 323 infants, 60 mg/kg/day DHA emulsion was given.

• In 333 infants, a control emulsion was given.

• The full-scale intelligence quotient (FSIQ) score was the primary outcome measured.

• Secondary outcomes included Wechsler Preschool and Primary Scale of Intelligence (WPPSI).

• FSIQ of 480 children (73 %) was available, 241 in the DHA group and 239 in the control group at five years of age.

• The mean (±SD) FSIQ scores in the DHA and control group was 95.4±17.3 and 91.9±19.1, respectively. The adjusted difference was 3.45. The P value was 0.03.

• The results for secondary outcomes were not supportive of what was obtained for the primary outcome.

• In the two groups, adverse events were similar.

The researcher wrote, "We assessed general intelligence in children enrolled in neonatal DHA supplementation trial to prevent bronchopulmonary dysplasia." They wrote, "The mean FSIQ score was modestly higher in the DHA group than the control group."

The researchers mentioned the study's limitations, such as higher than expected attrition rate due to COVID-19 pandemic restriction, and the assessment of the age range was broader as 4 to 7.5 years which was different from what was planned originally.

The Australian National Health and Medical Research Council and Nu-Mega Ingredients funded the study.

Further reading:

Neonatal Docosahexaenoic Acid in Preterm Infants and Intelligence at 5 Years. Jacqueline F. Gould, Ph.D et al.October 27, 2022N Engl J Med 2022; 387:1579-1588

DOI: 10.1056/NEJMoa2206868