Summary: Supplementing very preterm infants with the omega‑3 fatty acid docosahexaenoic acid (DHA) after birth was associated with an average increase of about 3.5 IQ points at age five compared with preterm infants who did not receive DHA.
Source: SAHMRI
New findings from SAHMRI indicate a measurable link between neonatal DHA supplementation and higher intelligence test scores in children born extremely preterm.
Babies born before full term face a higher risk of cognitive delays and lower IQ scores compared with children born at term. This difference is thought to be related in part to the interruption of key nutrient transfer that normally occurs during the final trimester of pregnancy.
Dr. Jacqueline Gould, the study lead and senior author of the trial now published in the New England Journal of Medicine, explains that infants delivered very early miss much of the natural accumulation of DHA that takes place in the brain late in gestation. Lower brain DHA concentrations may be one factor contributing to later cognitive difficulties.
“These babies have lower DHA levels in brain tissue, which could help explain some of the poorer cognitive outcomes we see after very preterm birth,” Dr. Gould said. “Our trial tested whether supplying DHA after birth, while infants remain in hospital, could partially make up for that loss and support brain development.”
In the clinical trial follow-up reported here, infants born before 29 weeks’ gestation were randomized to receive an enteral emulsion that provided 60 mg of DHA per kilogram of body weight per day or a control emulsion without DHA. The initial enrollment included 323 infants in the DHA group and 333 in the control group. Children were assessed at five years of corrected age using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI).
At follow-up, outcome data were available for 480 children from the centers participating in this assessment: 241 children who had received DHA and 239 who had been in the control group. After accounting for missing data through standard statistical imputation, the mean full‑scale IQ (FSIQ) was 95.4 (±17.3) in the DHA group and 91.9 (±19.1) in the control group. The adjusted mean difference was 3.45 points (95% confidence interval, 0.38 to 6.53; P = 0.03).
“On average, children who received the DHA emulsion scored about 3.5 points higher on the WPPSI than those who did not,” Dr. Gould noted. “While this is a modest increase, it is encouraging because any improvement in cognitive function for infants born extremely preterm can have meaningful implications for learning and development across childhood.”
The trial also examined WPPSI subscales and other secondary outcomes; these generally did not show consistent differences that matched the primary FSIQ result. Rates of adverse events were similar between the DHA and control groups, indicating the enteral DHA emulsion was well tolerated in this sample.
Advances in neonatal care over the past three decades have substantially improved survival for infants born before 29 weeks’ gestation, yet progress in long‑term cognitive outcomes has been limited. This study suggests that a straightforward nutritional intervention—supplying an enteral DHA emulsion during the neonatal period until about 36 weeks’ postmenstrual age—may offer a practical strategy to support brain development in this vulnerable population.
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Author: Press Office
Source: SAHMRI
Contact: Press Office – SAHMRI
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Original Research: Closed access. “Neonatal Docosahexaenoic Acid in Preterm Infants and Intelligence at 5 Years” by Jacqueline F. Gould et al., New England Journal of Medicine.
Abstract
Neonatal Docosahexaenoic Acid in Preterm Infants and Intelligence at 5 Years
BACKGROUND
Docosahexaenoic acid (DHA) is a structural component of neural tissue that accumulates rapidly in the brain during the final trimester of pregnancy. Infants born before 29 weeks’ gestation miss much of this in utero accretion and therefore have lower DHA reserves at birth. The long‑term consequences of this deficiency for cognitive development have been uncertain.
METHODS
This follow‑up assessed general intelligence at five years of age in children originally enrolled in a randomized trial of neonatal DHA supplementation. In that trial, infants born before 29 weeks’ gestation were assigned to receive an enteral emulsion providing 60 mg of DHA per kilogram per day or a control emulsion from the start of enteral feeds until 36 weeks’ postmenstrual age or discharge home. Children at five centers were invited to undergo assessment with the WPPSI; the primary outcome was the full‑scale IQ score, with WPPSI component scores as secondary outcomes.
RESULTS
Of the infants randomized in the original trial, 480 children from participating centers had FSIQ data available at follow‑up (241 DHA, 239 control). After imputing missing values, the mean FSIQ was 95.4 in the DHA group versus 91.9 in the control group (adjusted difference, 3.45; 95% CI, 0.38 to 6.53; P = 0.03). Secondary outcomes did not consistently mirror the primary result. Adverse event rates were similar across groups.
CONCLUSIONS
In this follow‑up of infants born before 29 weeks’ gestation, neonatal administration of an enteral DHA emulsion until 36 weeks’ postmenstrual age was associated with a modest but statistically significant increase in full‑scale IQ at five years compared with control feeding. These findings support further consideration of DHA supplementation as a neonatal strategy to support cognitive outcomes in very preterm infants. (Funded by the Australian National Health and Medical Research Council and Nu‑Mega Ingredients.)