Decreased Postnatal Docosahexaenoic and Arachidonic Acid Blood Levels in Premature Infants are Associated with Neonatal Morbidities

Abstract

Objective To measure the changes in whole blood fatty acid levels in premature infants and evaluate their association with neonatal morbidities. Study design Retrospective cohort study of 88 infants born at < 30 weeks of gestation. Serial fatty acid profiles during the first postnatal month and infant outcomes, including chronic lung disease (CLD), retinopathy of prematurity (ROP), and late-onset sepsis, were analyzed. Regression modeling was applied to determine the association between fatty acid levels and neonatal morbidities. Results DHA and AA levels declined rapidly in the first postnatal week with a concomitant increase in linoleic acid (LA) levels. Decreased DHA levels were associated with an increased risk of CLD (OR 2.5; 95% CI 1.3 – 5.0). Decreased AA levels were associated with an increased risk of late-onset sepsis (hazard ratio 1.4; 95% CI 1.1 – 1.7). The balance between fatty acids was also a predictor of CLD and late-onset sepsis. An increased LA:DHA ratio was associated with an increased risk of CLD (OR 8.6; 95% CI 1.4 – 53.1) and late-onset sepsis (hazard ratio 4.6; 95% CI 1.5 – 14.1). Conclusion Altered postnatal fatty acid levels in premature infants are associated with an increased risk of CLD and late-onset sepsis.

Omega-3 Long-Chain Polyunsaturated Fatty Acids for Extremely Preterm Infants: A Systematic Review

“…56 In extremely preterm infants, reduced serum DHA during the first postnatal month was associated with increased need for supplemental oxygen at 36 weeks PMA (odds ratio 2.5, 95% CI 1.3-5.0). 8 The ratio of n6-linoleic acid to n3-DHA in these infants was highly predictive of lung disease, confirming the importance of balanced ratios of LCPUFA and potential selective role of DHA in protecting against BPD. 8 A balanced LCPUFA ratio was also protective against late-onset infections, providing an additional protective mechanism against adverse neonatal outcomes.…”

“…These results also are in accordance with observational studies, indicating an association between DHA levels and adverse neonatal outcomes in very preterm infants. 8,30,33 Preterm infants are nutritionally deficient in DHA. Daily nutritional DHA requirements of extremely preterm infants are estimated at the range of 40 to 60 mg/kg.…”

“…Eighteen of these studies were RCTs. [11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Among nonrandomized studies, 4 were interventional studies with a control group [30][31][32][33] and the remaining 2 studies 8,34 did not test an intervention because they examined the association of BPD with LCPUFA concentrations in blood or in tracheal aspirates. Fifteen RCTs presented dichotomous outcomes.…”

“…Only a few studies reported other relevant neonatal outcomes, such as number of days of ventilation, or the use or duration of supplementation oxygen, 13,20,22,27,28 patent ductus arteriosus, 12,20,23,[30][31][32] cholestasis, 31,32 or number of days of hospital admission. 8,11,13,18,31,32 Effect Estimates for Dichotomous Neonatal Outcomes…”

“…6,7 Therefore, it is possible that supplementing the diet of extremely preterm infants with DHA could reduce inflammation that predisposes to BPD and other major neonatal diseases. [8][9][10] Establishing a causal link between exposure to omega-3 lipids and neonatal outcomes in high-risk preterm infants has important clinical implications in neonatal care. Recent studies have investigated associations between reduced nutritional omega-3 during the perinatal or neonatal period and adverse neonatal outcomes, with the hope that supplementation may improve those outcomes.…”