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Possible benefit in omega-3 supplementation for extremely preterm infants

Joshi N, Carr LH

FAB RESEARCH COMMENT:

Infants born prematurely have 'missed out' on receiving some of the vital long-chain omega-3, and omega-6, fatty acids - DHA and AA respectively - that would have been transferred to them from the mother, had their pregnancy run to full term.

These two particular fatty acids are essential structural building blocks for the developing brain and nervous system (as well as other vital organs, and the rest of the body).

They also play innumerable 'functional' roles in the brain and body, as they are the 'substrates' (raw materials) for a huge array of substances needed to regulate blood flow, hormone balance and immune function; influence neurotransmitter and other cell signalling systems; and even help to control gene expression. 

During pregnancy, the placenta concentrates these essential long-chain polyunsaturated fatty acids (LC-PUFA), in a process known as 'biomagnification' - so that the foetus receives levels of AA and DHA that are much higher than those in the mother's own blood circulation. (Umbilical cord concentrations of omega-3 DHA are almost doubled relative to those of the mother, while AA is more than doubled). 

Furthermore, the placenta also actively 'blocks' the transfer of the short-chain omega-3 and omega-6 fats (ALA and LA respectively) - indicating that these shorter chain PUFA are not Nature's 'preferred' choice for optimal foetal development. 

The last trimester of pregnancy is the most rapid period of foetal brain growth, requiring ample supplies of both DHA and AA to support this, and the continuing body growth. 

So for babies who are born 'pre-term', ensuring that their nutrition is tailored to provide these particular long-chain omega-3 and omega-6 fats would appear to make sense, as some experts have long argued. See:


However, despite the compelling evidence and rationale for providing both AA and DHA pre-formed, standard nutritional fomulae for pre-term infants still does NOT include these essential nutrients, but provides only the shorter-chain omega-6 and omega-3 fats, LA and ALA. These can supposedly be converted within the body to AA and DHA respectively - but even in older children and adults this conversion process is known to be inefficient. 

The research study summarised very briefly in this news article is a systematic review of a few small trials that have investigated the effects of supplementing very pre-term infants with omega-3 DHA - to see if this might reduce the serious respiratory complications to which many of these babies are prone. See:


And for the recent update to the recommendations for feeding premature infants - which specifies the need for greater quantities of omega-3 LC-PUFA than formula designed for term infants - see also:

9 Jun 2014 - 2 Minute Medicine 

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1. This systematic review did not find an association between omega-3 fatty acid supplementation and decreased incidence of bronchopulmonary dysplasia (BPD) among neonates.

2. In a subset of extremely premature infants, effects of omega-3 fatty acid supplementation were still non-significant, but trended towards a lower risk of BPD and necrotizing enterocolitis.

Evidence Rating Level: 2 (Good)

Study Rundown: 

Bronchopulmonary dysplasia (BPD) is a common and significant complication of premature birth, resulting in long-term respiratory difficulties and the need for supplemental oxygen.

Long-chain polyunsaturated fatty acids (LCPUFAs), including omega-3 fatty acids, have been previously implicated in inflammatory modulation.

Dysregulation in the inflammatory cascade is postulated as a contributor to BPD, and research has indicated that premature infants are LCPUFA-deficient. As such, this systematic review gathered multiple studies analyzing the effects of omega-3 fatty acid supplementation on neonates.

Researchers found that omega-3 fatty acid supplementation was not associated with decreased BPD in neonates overall, but may show a benefit for BPD and nectrotizing enterocolitis in extremely premature infants.

This systematic review was greatly limited by homogeneity amongst included studies, including a lack of randomized control trials directly comparing supplementation to placebo in extremely premature infants.

The review however, indicated no adverse effects to supplementation, and sets up a platform for future trials of LCPUFA supplementation in neonates.