Prostanoid Formation during Feeding of a Preterm Formula with Long-Chain Polyunsaturated Fatty Acids in Healthy Preterm Infants during the First Weeks of Life

Abstract

The objective of this study was to evaluate the effect of conventional and long-chain polyunsaturated fatty acids (LCP)-enriched preterm formula on prostanoid formation in preterm infants during their first weeks of life. In a prospective, randomized, double-blind study, healthy infants received either formula enriched with LCP (n = 10), standard preterm formula (n = 10), or (expressed) breast milk (n = 10). Urine was sampled, and anthropometric measurements were taken at study entry and after the study period of 3 wk. In vivo formation of prostaglandin E2, thromboxane A2, and prostacyclin was evaluated by measuring the urinary excretion of the respective index metabolities by gas chromatography-mass spectrometry. There were no significant differences in urinary prostanoid excretion and anthropometric data between the groups at the end of the study period. We conclude that neither conventional formula nor supplementation of a preterm formula with LCP for a period of 3 wk substantially influence prostanoid formation in healthy preterm infants.

Randomized trials with polyunsaturated fatty acid interventions in preterm and term infants: Functional and clinical outcomes

“…All trials involved healthy preterm infants fed preterm formula, and 8 of 11 trials had a breast-fed reference group (1,(11)(12)(13)15,(19)(20)(21). Only one (15,16) of these trials reported adequate concealment of allocation, and 9 of 11 trials were either unclear regarding losses to follow-up or failed to follow up ≥20% of infants randomly allocated to treatment groups.…”

Specific requirements for n‐3 and n‐6 long‐chain polyunsaturated fatty acids for preterm and term infantš

“…Most recent trials have attempted to add AA with n-3 LC-PUFA to avoid the decline in plasma and erythrocyte AA caused by fish oil supplementation. The five trials [17,19,20,24,25] that added both n-3 and n-6 LC-PUFA reported no adverse effects on growth.…”

“…We are aware of 12 RCTs reported in at least 19 separate papers [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. These trials were designed to test the efficacy and safety of varying levels of eicosapentaenoic acid (EPA, C20:5n-3), docosahexaenoic acid (DHA, C22:6n-3) and arachidonic acid (AA, C20:4n-6) in the diets of preterm infants.…”

“…The trials largely involved healthy preterm infants fed preterm formula and 9 of 12 trials had a reference group receiving breast milk [9,[17][18][19][20][24][25][26][27]. Few trials reported adequate concealment of allocation [20,21] or losses to follow-up.…”

“…More recent studies [15,23] have avoided the addition of excessive EPA by using fish oils high in DHA such as tuna oil, egg phospholipids [17,25] or fungal and algal oil [20,21,24]. It is doubtful whether the source of LC-PUFA has much effect on LC-PUFA status of the infant [28].…”