Long-Chain Polyunsaturated Fatty Acids and Clinical Outcomes of Preterm Infants

Abstract

Long-chain polyunsaturated fatty acids (LCPUFAs) play specific roles during the perinatal period and are very important nutrients to consider. The possible effects of LCPUFAs, particularly docosahexaenoic acid (DHA), on various clinical outcomes of preterm infants are discussed in this paper. Since DHA accumulates in the central nervous system during development, a lot of attention has focused on the effects of DHA on neurodevelopment. Experimental studies as well as recent clinical trials show that providing larger amounts of DHA than currently and routinely provided is associated with better neurological outcomes at 18 months to 2 years. This early advantage, however, does not seem to translate into detectable change in visual and neurodevelopmental outcomes or behavior when assessed in childhood. There is growing evidence that, in addition to effects on development, omega-3 LCPUFAs may reduce the incidence or severity of neonatal morbidities by affecting different steps of the immune and anti-inflammatory response. Studies in preterm infants suggest that the omega-3 LCPUFAs may play a significant role by reducing the risk of bronchopulmonary dysplasia, necrotizing enterocolitis and possibly retinopathy of prematurity and sepsis. Overall, evidence is increasing to support the benefits of high-dose DHA for various health outcomes of preterm infants. These findings are of major clinical relevance mainly because infants born preterm are at particularly high risk for a nutritional deficit in omega-3 fatty acids, predisposing to adverse neonatal outcomes. Further studies are warranted to address these issues as well as to more precisely determine the LCPUFA requirement in order to favor the best possible outcomes of preterm infants.

Effects of a lipid emulsion containing fish oil on polyunsaturated fatty acid profiles, growth and morbidities in extremely premature infants: A randomized controlled trial

“…Very preterm infants develop a large deficit in DHA as well as in the omega-6 LCPUFA arachidonic acid (AA) during parenteral nutrition with commonly used soybean- [ 7 ] and olive oil-based lipid emulsions [ 8 ] as well as during enteral nutrition even with breastfeeding [ 9 , 10 ]. Lapillonne et al have estimated that an infant born at gestational age (GA) 27 weeks weighing 1000 g will have a DHA deficit of 600 mg/kg at age 4 weeks [ 11 ] which is thought to contribute to preterm morbidities such as bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC) and white matter injury and sepsis [ 12 ]. Supplementation of omega-3 LCPUFA to preterm children was recently reviewed by Zhang et al [ 13 ].…”

Influence of Human Milk and Parenteral Lipid Emulsions on Serum Fatty Acid Profiles in Extremely Preterm Infants

“…These and other LC‐PUFAs serve as precursors of potent signaling molecules, including prostaglandins, thromboxanes, leukotrienes, and resolvins, with well‐documented roles in inflammation and immune functions . DHA and AA deficiency in neonates has been associated with an altered growth rate, manifestations of allergy, reduced intellectual development, and increased risk of several morbidities commonly associated with prematurity . Preterm infants are capable, to a certain extent, of de novo synthesis of DHA and AA from their shorter‐chain precursors ALA and LA, respectively .…”

A More Comprehensive Approach to the Neuroprotective Potential of Long-Chain Polyunsaturated Fatty Acids in Preterm Infants Is Needed—Should We Consider Maternal Diet and the n-6:n-3 Fatty Acid Ratio?

“…Although the most recent Cochrane review did not show any significant effect of LCPUFA supplementation (42), two other recent systematic reviews, Shulkin et al (133) and Wang et al (134) concluded that LCPUFA supplementation in preterm infants has short term neurodevelopmental benefits. Lapillone and Moltu also concluded that there is evidence of short term benefit with a high dose DHA supplement and their review focused on several areas of benefit in preterm development (135). Smith and Rouse published a narrative review in 2017 focused on the role of DHA in preterm infants (136), and Laurizen et al have written an interesting commentary on AA (137).…”