Abstract
The amount, composition, and sources of nutrition support provided to preterm infants is critical for normal growth and development, and particularly for structural and functional neurodevelopment. Although omega-3 long chain polyunsaturated fatty acids (LC-PUFA), and particularly docosahexanoic acid (DHA), are considered of particular importance, results from clinical trials with preterm infants have been inconclusive because of ethical limitations and confounding variables. A translational large animal model is needed to understand the structural and functional responses to DHA. Neurodevelopment of preterm pigs was evaluated in response to feeding formulas to term-equivalent age supplemented with DHA attached to phosphatidylserine (PS-DHA) or sunflower oil as the placebo. Newborn term pigs were used as a control for normal in utero neurodevelopment. Supplementing formula with PS-DHA increased weight of the brain, and particularly the cerebellum, at term-equivalent age compared with placebo preterm pigs (P’s < 0.10 and 0.05 respectively), with a higher degree of myelination in all regions of the brain examined (all p < 0.06). Brains of pigs provided PS-DHA were similar in weight to newborn term pigs. Event-related brain potentials and performance in a novel object recognition test indicated the PS-DHA supplement accelerated development of sensory pathways and recognition memory compared with placebo preterm pigs. The PS-DHA did not increase weight gain, but was associated with higher survival. The benefits of PS-DHA include improving neurodevelopment and possibly improvement of survival, and justify further studies to define dose-response relations, compare benefits associated with other sources of DHA, and understand the mechanisms underlying the benefits and influences on the development of other tissues and organ systems.
Highlights
Normal growth and development of the preterm infant is dependent on adequate nutrition support
The c-sections provided a total of 77 preterm pigs with 65 surviving the initial 24 h of parenteral nutrition (PN)
The mortality rate of preterm pigs exceeds that for preterm infants born at similar stages of development, reflecting the challenges associated with providing intensive care to entire litters
Summary
Normal growth and development of the preterm infant is dependent on adequate nutrition support. The specific needs and sources of nutrition remain uncertain and many preterm infants suffer ex utero growth retardation that compromises structural and functional development [1]. All organs are at risk with the brain considered sensitive to inadequacies of the amount and composition of nutrition [2] as brain development in the third trimester and early neonatal period is rapid and dramatic [3]. The lack of consistency in findings has been attributed to differences in when and how assessments are performed, the dose and source of supplementation, fatty acid composition of the test formulas, and the gestational age, health status, and postnatal environment of the preterm infants
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