Published online June 2, 2008
PEDIATRICS Vol. 121 No. 6 June 2008, pp. 1137-1145 (doi:10.1542/peds.2007-1511)
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ARTICLE

Improved Cognitive Development Among Preterm Infants Attributable to Early Supplementation of Human Milk With Docosahexaenoic Acid and Arachidonic Acid

Christine Henriksen, PhDa, Kristin Haugholt, MScb, Magnus Lindgren, PhDb,c, Anne Karin Aurvåg, MScd, Arild Rønnestad, MDe, Morten Grønn, MD, PhDe, Rønnaug Solberg, MDf, Atle Moen, MDg, Britt Nakstad, MD, PhDd, Rolf Kristian Berge, MD, PhDh, Lars Smith, PhDb, Per Ole Iversen, MD, PhDa and Christian André Drevon, MD, PhDa

a Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine
b Institute of Psychology, University of Oslo, Oslo, Norway
c Department of Psychology, Lund University, Lund, Sweden
d Department of Pediatrics, Akershus University Hospital and University of Oslo, Akershus Faculty Division, Nordbyhagen, Norway
e Department of Pediatrics Rikshospitalet-Radiumhopitalet Medical Center, Oslo, Norway
f Department of Pediatrics, Vestfold Hospital, Vestfold, Norway
g Department of Pediatrics, Buskerud Hospital, Buskerud, Norway
h Section of Medical Biochemistry, Institute of Medicine, University of Bergen, Bergen, Norway

OBJECTIVE. The objective of our study was to evaluate the effect of supplementation with docosahexaenoic acid and arachidonic acid for human milk-fed preterm infants. The primary end point was cognitive development at 6 months of age.

METHODS. The study was a randomized, double-blind, placebo-controlled study among 141 infants with birth weights of <1500 g. The intervention with 32 mg of docosahexaenoic acid and 31 mg of arachidonic acid per 100 mL of human milk started 1 week after birth and lasted until discharge from the hospital (on average, 9 weeks). Cognitive development was evaluated at 6 months of age by using the Ages and Stages Questionnaire and event-related potentials, a measure of brain correlates related to recognition memory.

RESULTS. There was no difference in adverse events or growth between the 2 groups. At the 6-month follow-up evaluation, the intervention group performed better on the problem-solving subscore, compared with the control group (53.4 vs 49.5 points). There was also a nonsignificant higher total score (221 vs 215 points). The event-related potential data revealed that infants in the intervention group had significantly lower responses after the standard image, compared with the control group (8.6 vs 13.2). There was no difference in responses to novel images.

CONCLUSIONS. Supplementation with docosahexaenoic acid and arachidonic acid for very preterm infants fed human milk in the early neonatal period was associated with better recognition memory and higher problem-solving scores at 6 months.

Key Words: developmental outcomes • fatty acids • human milk • preterm infants • very low birth weight

Abbreviations: DHA—docosahexaenoic acid • AA—arachidonic acid • NC—negative central • ERP—event-related potential • VLBW—very low birth weight • EEG—electroencephalographic • EPA—eicosapentaenoic acid

Accepted Sep 28, 2007.