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PEDIATRICS Vol. 108 No. 2 August 2001, pp. 359-371
Received Jun 2, 2000; accepted Feb 9, 2001.
,
,,,,
From the * Ross Products Division, Abbott Labs, Columbus, Ohio;
Objectives. A randomized, masked,
controlled trial was conducted to assess effects of supplementing
premature infant formulas with oils containing the long-chain
polyunsaturated fatty acids, arachidonic acid (AA; 20:4n6), and
docosahexaenoic acid (DHA; 22:6n3) on growth, visual acuity, and
multiple indices of development.
Methods. Infants (N = 470) with birth
weights 750 to 1800 g were assigned within 72 hours of the first
enteral feeding to 1 of 3 formula groups with or without long-chain
polyunsaturated fatty acids: 1) control (N = 144),
2) AA+DHA from fish/fungal oil (N = 140), and 3)
AA+DHA from egg-derived triglyceride (egg-TG)/fish oil (N = 143). Infants were fed human milk and/or
Similac Special Care with or without 0.42% AA and 0.26% DHA to term
corrected age (CA), then fed human milk or NeoSure with or without
0.42% AA and 0.16% DHA to 12 months' CA. Infants fed exclusively
human milk to term CA (EHM-T; N = 43) served as a
reference.
Results. Visual acuity measured by acuity cards at 2, 4, and 6 months' CA was not different among groups. Visual acuity
measured by swept-parameter visual-evoked potentials in a subgroup from
3 sites (45 control, 50 AA+DHA [fish/fungal]; 39 AA+DHA
[egg-TG/fish]; and 23 EHM-T) was better in both the AA+DHA
(fish/fungal; least square [LS] means [cycle/degree] ± standard
error [SE; octaves] 11.4 ± 0.1) and AA+DHA (egg-TG/fish;
12.5 ± 0.1) than control (8.4 ± 0.1) and closer to that of
the EHM-T group (16.0 ± 0.2) at 6 months' CA. Visual acuity
improved from 4 to 6 months' CA in all but the control group. Scores
on the Fagan test of novelty preference were greater in AA+DHA
(egg-TG/fish; LS means ± SE, 59.4 ± 7.7) than AA+DHA
(fish/fungal; 57.0 ± 7.5) and control (57.5 ± 7.4) at 6 months' CA, but not at 9 months' CA. There were no differences in the
Bayley Mental Development Index at 12 months' CA. However, the Bayley
motor development index was higher for AA+DHA (fish/fungal; LS
means ± SE, 90.6 ± 4.4) than control (81.8 ± 4.3) for
infants Conclusion. These results showed a benefit of
supplementing formulas for premature infants with AA and DHA from
either a fish/fungal or an egg-TG/fish source from the time of first
enteral feeding to 12 months' CA.
Children's Mercy Hospital, Kansas City, Missouri; § University of
Louisville and Kosair Children's Hospital, Louisville, Kentucky;
INTA Univ de Chile, Santiago, Chile; ¶ Oregon Health Sciences Univ,
Portland, Oregon; # MetroHealth Medical Center, Cleveland, Ohio;
** Hunter College, New York, New York; Institute of Child Health,
London, United Kingdom; §§ Weill Medical College, Cornell University,
New York, New York; || Rainbow Babies & Children's Hospital,
Cleveland, Ohio; ¶¶ University of Nottingham, Nottingham, United
Kingdom; ## Arkansas Children's Hosp, Little Rock, Arkansas; and
*** Yeshiva Univ, Bronx, New York.
1250 g. When Spanish-speaking infants and twins were excluded
from the analyses, the MacArthur Communicative Development Inventory
revealed that control infants (LS means ± SE, 94.1 ± 2.9)
had lower vocabulary comprehension at 14 months' CA than AA+DHA
(fish/fungal) infants (100.6 ± 2.9) or AA+DHA (egg-TG/fish) infants (102.2 ± 2.8). There were no consistent differences in weight, length, head circumference, or anthropometric gains.
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