Maternal and Neonatal Polyunsaturated Fatty Acid Intake and Risk of Neurodevelopmental Impairment in Premature Infants

Abstract

The N3 and N6 long chain polyunsaturated fatty acids (LCPUFA) docosahexaenoic acid (DHA) and arachidonic acid (AA) are essential for proper neurodevelopment in early life. These fatty acids are passed from mother to infant via the placenta, accreting into fetal tissues such as brain and adipose tissue. Placental transfer of LCPUFA is highest in the final trimester, but this transfer is abruptly severed with premature birth. As such, efforts have been made to supplement the post-natal feed of premature infants with LCPUFA to improve neurodevelopmental outcomes. This narrative review analyzes the current body of evidence pertinent to neurodevelopmental outcomes after LCPUFA supplementation in prematurely born infants, which was identified via the reference lists of systematic and narrative reviews and PubMed search engine results. This review finds that, while the evidence is weakened by heterogeneity, it may be seen that feed comprising 0.3% DHA and 0.6% AA is associated with more positive neurodevelopmental outcomes than LCPUFA-deplete feed. While no new RCTs have been performed since the most recent Cochrane meta-analysis in 2016, this narrative review provides a wider commentary; the wider effects of LCPUFA supplementation in prematurely born infants, the physiology of LCPUFA accretion into preterm tissues, and the physiological effects of LCPUFA that affect neurodevelopment. We also discuss the roles of maternal LCPUFA status as a modifiable factor affecting the risk of preterm birth and infant neurodevelopmental outcomes. To better understand the role of LCPUFAs in infant neurodevelopment, future study designs must consider absolute and relative availabilities of all LCPUFA species and incorporate the LCPUFA status of both mother and infant in pre- and postnatal periods.

Randomized controlled trial of early arachidonic acid and docosahexaenoic acid enteral supplementation in very preterm infants

“…Additionally, it has been demonstrated that human milk ARA levels are higher with increased ARA supplementation ( 41 ). Although several studies in very preterm infants have shown a decrease in LCPUFA levels compared to term infants ( 3 , 42 ) and existing evidence supports LCPUFAs supplementation in these infants ( 43 ), doses, the route of administration, and the choice of better LCPUFA supplementation remain unknown. According to our data, 120:60 ARA:DHA supplementation increased DHA metabolite levels compared to lower doses (80:40 ARA:DHA), without a significant increase in DHA plasma levels.…”

Fats in Human Milk: 2022 Updates on Chemical Composition

“…109 In the first week after birth, the levels of DHA and AA might drop due to the lack of adipose reserves and insufficient FA intake by the mother. 110 The LC-PUFA content in HM in the United States, Europe, and Africa is similar, except for higher amounts of ω-3 LC-PUFAs in the milk of women whose diets contain a large quantity of fish. 111,112 Arachidonic acid (C20:4 ω-6) is an important LC-PUFA in HM.…”

Research Progress in Bronchopulmonary Dysplasia: A Narrative Review by Etiology

“…Consequently, preterm neonates should be maintained within this range during the postnatal period. Moreover, substantial reductions in mean DHA levels in preterm neonates were seen during the first postnatal week and remained for three weeks, and decreased postnatal DHA levels in premature infants were associated with an in-creased risk of BPD [59]. A post-hoc study of the Trial to Improve Neurodevelopmental Outcomes (2001 to 2005) found that giving DHA supplements to pregnant mothers reduced supplementary oxygen requirements in newborns weighing less than 1250 g at birth 36 weeks after menopause [60].…”