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Daily Enteral DHA Supplementation Alleviates Deficiency in Premature Infants

  • Original Article
  • Published:
Lipids

Abstract

Docosahexaenoic acid (DHA) is an essential fatty acid (FA) important for health and neurodevelopment. Premature infants are at risk of DHA deficiency and circulating levels directly correlate with health outcomes. Most supplementation strategies have focused on increasing DHA content in mother’s milk or infant formula. However, extremely premature infants may not reach full feedings for weeks and commercially available parenteral lipid emulsions do not contain preformed DHA, so blood levels decline rapidly after birth. Our objective was to develop a DHA supplementation strategy to overcome these barriers. This double-blind, randomized, controlled trial determined feasibility, tolerability and efficacy of daily enteral DHA supplementation (50 mg/day) in addition to standard nutrition for preterm infants (24–34 weeks gestational age) beginning in the first week of life. Blood FA levels were analyzed at baseline, full feedings and near discharge in DHA (n = 31) or placebo supplemented (n = 29) preterm infants. Term peers (n = 30) were analyzed for comparison. Preterm infants had lower baseline DHA levels (p < 0.0001). Those receiving DHA had a progressive increase in circulating DHA over time (from 3.33 to 4.09 wt% or 2.88 to 3.55 mol%, p < 0.0001) while placebo-supplemented infants (receiving standard neonatal nutrition) had no increase over time (from 3.35 to 3.32 wt% or 2.91 to 2.87 mol%). Although levels increased with additional DHA supplementation, preterm infants still had lower blood DHA levels than term peers (4.97 wt% or 4.31 mol%) at discharge (p = 0.0002). No differences in adverse events were observed between the groups. Overall, daily enteral DHA supplementation is feasible and alleviates deficiency in premature infants.

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Abbreviations

ALA:

α-Linolenic acid

ARA:

Arachidonic acid

BPD:

Bronchopulmonary dysplasia

DSMB:

Data safety and monitoring board

DHA:

Docosahexaenoic acid

EPA:

Eicosapentaenoic acid

FA:

Fatty acid(s)

GA:

Gestational age

IUGR:

Intrauterine growth restriction

LNA:

Linoleic acid

LCPUFA:

Long chain polyunsaturated fatty acid(s)

NEC:

Necrotizing enterocolitis

NICU:

Neonatal intensive care unit

ROP:

Retinopathy of prematurity

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Acknowledgments

We gratefully acknowledges our exceptional study team (Von “Mimi” Chau, Diane Hahn, Katherine Burgess, Dawn Hansen, Jessica Howard, Carmen Sandman, Melissa Hemenway), DSMB members (Pam Koepsell, Dr. Lisa Jaton, Dr. Paul Thompson, Dr. Dennis Stevens, Michele Sturdevant, and Dr. Amanda Jensen), NICU staff nurses, pharmacy staff (Linda Oyen), neonatologists, and especially our NICU babies and their families—it is such a privilege to care for you. Funding for this study was provided by a Sanford Health Seed Grant, a Gerber Foundation Pediatric Nutrition Grant (PN12-005-1372-3069), and Sanford Research. Dr. Baack also receives support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (K08HD078504) and an NIH Center of Biomedical Research Excellence (COBRE) Grant (P20 GM103620-01A1). Further information about this trial and ongoing efforts may be found at ClinicalTrials.gov (NCT01908907).

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Authors and Affiliations

  1. Sanford Research, Children’s Health Research Center, 2301 E. 60th Street North, Sioux Falls, SD, 57104, USA

    Michelle L. Baack, Susan E. Puumala, Stephen E. Messier & William S. Harris

  2. Sanford School of Medicine, University of South Dakota, 1400 W. 22nd St., Sioux Falls, SD, 57105, USA

    Michelle L. Baack, Susan E. Puumala & William S. Harris

  3. Boekelheide Neonatal Intensive Care Unit, Sanford Children’s Hospital, 1600 W. 22nd St., PO Box 5039, Sioux Falls, SD, USA

    Michelle L. Baack, Stephen E. Messier & Deborah K. Pritchett

  4. OmegaQuant Analytics, LLC, 5009 W. 12th St, Ste 8, Sioux Falls, SD, 57106, USA

    William S. Harris

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  1. Michelle L. Baack
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  2. Susan E. Puumala
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  5. William S. Harris
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Correspondence to Michelle L. Baack.

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Conflict of interest

Dr. William S. Harris who serves as a senior mentor to Dr. Baack, is the Founder and President of OmegaQuant, LLC, but has no foreseen financial gain from publication of this work. Additional authors declare no conflict of interest. Funding sponsors had no role in study design, implementation, data collection, analyses, interpretation or publication.

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Baack, M.L., Puumala, S.E., Messier, S.E. et al. Daily Enteral DHA Supplementation Alleviates Deficiency in Premature Infants. Lipids 51, 423–433 (2016). https://doi.org/10.1007/s11745-016-4130-4

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