Docosahexaenoic Acid and Arachidonic Acid Levels Are Associated with Early Systemic Inflammation in Extremely Preterm Infants

Abstract

<jats:p>Fetal and early postnatal inflammation have been associated with increased morbidity in extremely preterm infants. This study aimed to demonstrate if postpartum levels of docosahexaenoic acid (DHA) and arachidonic acid (AA) were associated with early inflammation. In a cohort of 90 extremely preterm infants, DHA and AA in cord blood, on the first postnatal day and on postnatal day 7 were examined in relation to early systemic inflammation, defined as elevated C-reactive protein (CRP) and/or interleukin-6 (IL-6) within 72 h from birth, with or without positive blood culture. Median serum level of DHA was 0.5 mol% (95% CI (confidence interval) 0.2–0.9, P = 0.006) lower than the first postnatal day in infants with early systemic inflammation, compared to infants without signs of inflammation, whereas levels of AA were not statistically different between infants with and without signs of inflammation. In cord blood, lower serum levels of both DHA (correlation coefficient −0.40; P = 0.010) and AA (correlation coefficient −0.54; p &lt; 0.001) correlated with higher levels of IL-6. Levels of DHA or AA did not differ between infants with and without histological signs of chorioamnionitis or fetal inflammation. In conclusion, serum levels of DHA at birth were associated with the inflammatory response during the early postnatal period in extremely preterm infants.</jats:p>

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

“…In humans, mothers whose blood content of AA + DHA was <1.6% of total blood fatty acids had 10-fold higher risk of premature birth in comparison to mothers with LCPUFA levels >1.8% [ 39 ]. A recent study showed that the DHA and AA status of cord blood correlates with levels of the inflammatory markers CRP and IL-6 of prematurely born infants [ 40 ], while inflammation in the fetal and early post-natal periods are linked with increased morbidity in later life [ 41 , 42 ].…”

“…It is apparent that LCPUFA availability has differential effects upon the development of specific organs. Although postnatal supplementation of DHA and AA seem to be beneficial for neurodevelopment and retinal development in preterm infants [ 16 , 32 ], recent studies have indicated a potentially opposing effect in pulmonary development, with no benefit on rates of—and a potentially increased risk for—bronchopulmonary dysplasia (BPD) in infants supplemented with LCPUFA [ 35 , 36 , 40 ]. This is despite pre-clinical evidence and observational studies showing that lower postnatal levels of DHA are associated with increased risk of chronic lung disease [ 34 , 81 ].…”

Maternal n-3 Polyunsaturated Fatty Acid Enriched Diet Commands Fatty Acid Composition in Postnatal Brain and Protects from Neonatal Arterial Focal Stroke

“…Both n-3 and n-6 long-chain (LC) PUFA are essential components of cell membranes but are also precursors to bioactive lipid mediators. In extremely preterm infants, lower serum levels of DHA at birth are associated with inflammatory responses postnatally [5]. DHA is a precursor of several metabolites that regulate resolution of inflammation [6], while n-6 metabolites are considered mostly proinflammatory [7].…”

Lipid Metabolism in Inflammation and Immune Function

“…In contrast, Hellström et al [ 6 ] examined the relationship between blood DHA and AA levels and systemic inflammatory markers in 90 extremely preterm infants (<28 weeks gestational age) with or without early systemic inflammation, defined by elevated C-reactive protein (>20 mg/L) and IL-6 (>1000 pg/mL) levels within 72 h of birth regardless of whether the infants’ blood culture was positive for bacteria or fungus, which would be indicative of sepsis. DHA levels in cord blood and postnatal day 1 were lower in extremely preterm infants with early systemic inflammation compared to infants with early systemic inflammation, whereas no differences in AA were observed.…”

“…While many studies investigating the role of lipids in regulating immune function and inflammation target acute and chronic diseases in adults, two studies within this Special Issue highlight the important biological roles of lipids in early life. Accordingly, Yakah et al [ 5 ] and Hellström et al [ 6 ] investigated the association between fatty acid profiles and inflammatory markers in preterm animal models and infants, respectively, and provide evidence that underscores the importance of balancing AA:DHA ratios to optimize health outcomes in infancy.…”