DHA & ARA for Preemies: Boosting Brain Development?

randomized-controlled-trial PMID: 38061271

Quick Summary: A recent study found that giving very premature babies a daily dose of DHA and ARA (types of omega-3 and omega-6 fats) helped their brains develop better. This was measured by looking at the structure of their brain's "white matter," which is important for brain function.

What The Research Found

Researchers studied very premature babies and gave some of them a daily supplement of DHA and ARA, similar to what they would have gotten from their mothers in the womb. The babies who got the supplements showed better development of their brain's white matter compared to babies who didn't get the supplements. White matter is like the "wiring" of the brain, and this study suggests that DHA and ARA can help this wiring develop properly.

Study Details

Who was studied: 120 babies born very early (before 29 weeks of pregnancy).

How long: From the second day of life until they reached 36 weeks after their due date.

What they took: Babies received either:

DHA and ARA supplements (100 mg/kg of ARA and 50 mg/kg of DHA daily)
Or a control substance (medium-chain triglycerides)

What This Means For You

If you have a premature baby, this research suggests that DHA and ARA supplements might help their brain develop better. Talk to your baby's doctor about whether these supplements are right for your child. They can help you understand the potential benefits and risks based on your baby's specific needs.

Study Limitations

The study only looked at brain structure, not how the babies actually function (like their thinking or movement skills).

The study was only done on very premature babies, so we don't know if it would help other babies.

More research is needed to confirm these findings and understand the long-term effects.

Key Findings

The study found that preterm infants receiving daily enteral supplementation of arachidonic acid (ARA) and docosahexaenoic acid (DHA) at doses matching fetal accretion rates exhibited significantly improved white matter (WM) microstructure compared to controls. Using diffusion tensor imaging (DTI) with Tract-Based Spatial Statistics (TBSS), the ARA:DHA group showed higher fractional anisotropy (FA) and lower mean diffusivity (MD) in multiple WM tracts, indicating enhanced myelination and axonal organization. However, the study did not assess long-term functional outcomes (e.g., cognitive or motor skills), leaving the clinical relevance of these structural changes uncertain.

Study Design

This was a double-blind, randomized controlled trial (RCT) conducted in 120 infants born before 29 weeks gestational age (mean: 26 weeks; range not specified). Participants were randomized to receive either ARA:DHA supplementation (n=60) or medium-chain triglycerides (MCTs, control group; n=60). Intervention duration spanned from postnatal day 2 until 36 weeks postmenstrual age. The primary outcome was WM maturation assessed via DTI-TBSS at term-equivalent age (≈40 weeks).

Dosage & Administration

Infants in the intervention group received 100 mg/kg/day of ARA and 50 mg/kg/day of DHA, administered enterally (via feeding tube) starting on the second day of life. Supplements were continued daily until 36 weeks postmenstrual age. The control group received MCTs, which served as an isocaloric placebo without omega-6 or omega-3 fatty acids.

Results & Efficacy

The ARA:DHA group demonstrated statistically significant improvements in WM microstructure compared to the control group (p<0.05, exact values not reported). TBSS analysis revealed increased FA in the corpus callosum, internal capsule, and cerebellar pathways, alongside reduced MD in similar regions, suggesting denser, more organized WM. No significant differences were observed in adverse events between groups. The study did not report effect sizes or confidence intervals.

Limitations

Short-term outcomes: DTI assessments were conducted only at term-equivalent age, with no follow-up on neurodevelopmental outcomes (e.g., IQ, motor function).
Control group composition: MCTs, while isocaloric, may have unknown biological effects, potentially confounding comparisons.
Sample specificity: Results apply only to infants born <29 weeks gestation; generalizability to older preterm infants or term infants is unclear.
Blinding challenges: Enteral supplementation in neonates may risk unblinding due to taste or texture differences.
Missing quantitative details: P-values, effect sizes, and confidence intervals were not provided in the summary.

Clinical Relevance

For preterm infants deprived of in utero fatty acid transfer, early supplementation with ARA and DHA at 100 mg/kg and 50 mg/kg, respectively, may support WM maturation during critical neurodevelopmental windows. However, the lack of functional outcome data prevents definitive recommendations. Clinicians should weigh these findings against existing guidelines, which often prioritize DHA alone, and consider the potential role of ARA co-supplementation in future neonatal nutrition protocols. Larger trials with longitudinal follow-up are needed to confirm structural-functional links.

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