Randomized Controlled Trial of Early Docosahexaenoic Acid and Arachidonic Acid Enteral Supplementation in Very Low Birth Weight Infants

Abstract

To determine feasibility of providing a concentrated emulsified long-chain polyunsaturated fatty acids (LCPUFA) supplement to very low birth weight infants, and to evaluate blood LCPUFA concentrations at 2 and 8weeks of study supplementation. This prospective, randomized, double-blind, placebo-controlled trial randomized infants to receive (1) LCPUFA-120 (a supplement of 40mg/kg/day docosahexaenoic acid [DHA] and 80mg/kg/day arachidonic acid [ARA]; DHA:ARA at 1:2 ratio), (2) LCPUFA-360 (a supplement of 120mg/kg/day DHA and 240mg/kg/day ARA), or (3) sunflower oil (placebo control). Infants received supplement daily for 8weeks or until discharge, whichever came first. Whole blood LCPUFA levels (wt%; g/100g) were measured at baseline, 2weeks, and 8weeks. Infants were 28weeks of gestation (IQR, 27-30weeks of gestation) and weighed 1040g (IQR, 910-1245g). At 2weeks, the change in blood DHA (wt%) from baseline differed significantly among groups (sunflower oil, n=6; -0.63 [IQR, -0.96 to -0.55]; LCPUFA-120: n=12; -0.14 [IQR, -0.72 to -0.26]; LCPUFA-360, n=12; 0.46 [IQR, 0.17-0.81]; P=.002 across groups). Change in blood ARA (wt%) also differed by group (sunflower oil: -2.2 [IQR, -3.9 to -1.7]; LCPUFA-120: 0.1 [IQR, -2.1 to 1.1] vs LCPUFA-360: 2.9 IQR, 1.5 to 4.5]; P=.0002). Change from baseline to 8weeks significantly differed between groups for DHA (P=.02) and ARA (P=.003). Enteral LCPUFA supplementation supported higher blood DHA by 2weeks. LCPUFA supplementation at 360mg of combined DHA and ARA is likely necessary to reduce declines as well as allow increases in whole blood concentrations in the first 8weeks of life. Clinicaltrials.gov: NCT03192839.