The longitudinal investigation, which served as a follow-up to a comprehensive randomized clinical trial, sought to unravel the potential ramifications of docosahexaenoic acid (DHA) supplementation in infants born prematurely, specifically those delivered at less than 29 weeks’ gestation.
Carried out as part of a broader initiative encompassing 958 prematurely born infants in Australia spanning the period between June 2012 and September 2015, the study aimed to scrutinize whether meeting the neonatal DHA requirement through supplementation could manifest in improved behavioural functioning during childhood.Â
Docosahexaenoic acid, a vital fatty acid renowned for its integral roles in the structural and functional facets of brain development, takes centre stage in this exploration. Premature infants, born before completing 29 weeks of gestation, are particularly susceptible to behavioural challenges, potentially stemming from an inadequate transplacental supply of DHA.
In an endeavour to address this vulnerability, the study randomly allocated infants to receive a daily enteral emulsion furnishing 60 mg/kg/d of DHA or a soy-oil emulsion devoid of DHA. Commencing within the initial three days of enteral feeding, the supplementation persisted until either 36 weeks’ postmenstrual age or the point of discharge home, whichever transpired first.Â
The subsequent follow-up, spanning from August 2018 to May 2021, centered its focus on children who had not only survived but also remained actively participating in the original trial. Parents of these children were solicited to complete questionnaires at the juncture of their child reaching 5 years’ corrected age.
The primary metric for assessment was parent-rated behaviour and emotional functioning, gauged through the Total Difficulties score of the Strengths and Difficulties Questionnaire. Of the 958 surviving eligible children, primary outcome data were attainable for 731, representing a 76% participation rate.
Following the imputation process to account for missing data, the study yielded no substantive evidence supporting differences in the mean Total Difficulties score between the DHA supplementation cohort and the control group. The parity in the mean Total Difficulties score between both groups strongly indicated that neonatal DHA supplementation wielded no discernible influence on behavioural functioning at the 5-year corrected age mark.Â
Beyond the primary focus, the investigation delved into secondary outcomes encompassing behaviour, executive functioning, and overall health. Strikingly, no statistically significant differences emerged between the two groups across these secondary measures.
The overarching implication from these findings is that, within the parameters of this trial, enteral DHA supplementation administered at the estimated in utero dosage for infants born at less than 29 weeks’ gestation did not precipitate improvements in behavioural functioning at the age of 5 years. Significantly, the study offered assurance by revealing an absence of adverse effects linked to DHA supplementation.Â
In summation, this meticulous follow-up analysis of a randomized clinical trial not only extends our understanding of the protracted effects of DHA supplementation in premature infants but also raises crucial considerations for neonatal nutrition and its repercussions on long-term health outcomes in preterm infants.
While the indispensability of DHA for neurodevelopment is underscored, the study conclusively underscores that administering it at the studied dosage fails to yield observable enhancements in behavioural outcomes during early childhood. The notable absence of adverse effects lends credence to the safety of such interventions, steering the discourse on neonatal nutrition into a realm enriched with empirical insights.Â
Journal Reference Â
Jacqueline F. Gould et al, High-Dose Docosahexaenoic Acid in Newborns Born at Less Than 29 Weeks’ Gestation and Behavior at Age 5 Years, JAMA Pediatrics (2023). DOI: 10.1001/jamapediatrics.2023.4924Â
