PMID- 14973956
OWN - NLM
STAT- MEDLINE
DCOM- 20040629
LR  - 20200511
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 1
DP  - 2004
TI  - Longchain polyunsaturated fatty acid supplementation in preterm infants.
PG  - CD000375
AB  - BACKGROUND: The n-3 and n-6 essential fatty acids alpha linolenic acid (ALA) and 
      linoleic acid (LA) are the precursors of the n-3 and n-6 longchain 
      polyunsaturated fatty acids (LCPUFA). Controversy exists over whether LCPUFA are 
      essential nutrients for preterm infants who may not be able to synthesise 
      sufficient amounts of LCPUFA to satisfy the needs of the developing brain and 
      retina. OBJECTIVES: The aim of this review is to assess whether supplementation 
      of formula with LCPUFA is safe and of benefit to preterm infants. SEARCH 
      STRATEGY: Trials were identified by MEDLINE (October 2003), Oxford Database of 
      Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The 
      Cochrane Library, Issue 2, 2003) and by checking reference lists of relevant 
      articles and conference proceedings. SELECTION CRITERIA: All randomised trials of 
      formula supplemented with LCPUFA and with clinical endpoints were reviewed. DATA 
      COLLECTION AND ANALYSIS: Eleven randomised trials assessing the clinical effects 
      of feeding formula supplemented with LCPUFA were included in the review. MAIN 
      RESULTS: Of the eleven randomised trials included in the review, two of these 
      were not classified as of high quality despite blinded assessment and complete 
      follow-up, due to problems with assessment methodology. VISUAL ACUITY: Visual 
      acuity over the first year was measured by Teller acuity cards in six studies, by 
      VEP in four studies and by ERG in two studies. Most studies found no significant 
      differences in any visual assessment between supplemented and control infants. 
      DEVELOPMENT: Most of the trials have used Bayley Scales of Infant Development 
      (BSID) at 12 to 24 months postterm and shown no significant effect following 
      supplementation. Meta-analysis of BSID of three studies (Fewtrell 2002, O'Connor 
      2001, van Wezel 2002) shows no significant effect of supplementation on 
      development. Carlson 1993 and Carlson 1996 demonstrated lower novelty preferences 
      (possibly predictive of lower intelligence) in the supplemented compared with the 
      control group. The investigators however concluded that supplemented infants may 
      have more rapid visual information processing given that they had more looks and 
      each look was of shorter duration. GROWTH: Most trials have reported no 
      significant effect of LCPUFA supplementation on growth of preterm infants. Two 
      trials (Carlson 1993, Carlson 1996) suggest that LCPUFA supplemented infants grow 
      less well than controls, possibly due to a reduction in AA levels which occurs 
      when n-3 supplements are used without n-6 supplements. Recent trials with 
      addition of AA to the supplement have reported no significant effect on growth. 
      Fewtrell 2002 reported mild reductions in length and weight z scores at 18 
      months. Contrary to these results, the meta-analysis of five studies (Uauy 1992, 
      Carlson 1996, Hansen 1997, Vanderhoof 1999, Innis 2002) showed increased weight 
      and length at two months post-term in supplemented infants. SIDE EFFECTS: Uauy 
      1992 reported no significant effect of LCPUFA supplementation on bleeding time 
      and red cell membrane fragility. REVIEWER'S CONCLUSIONS: Infants enrolled in the 
      trials were relatively mature and healthy preterm infants. Assessment schedule 
      and methodology, dose and source of supplementation and fatty acid composition of 
      the control formula varied between trials. No long-term benefits were 
      demonstrated for infants receiving formula supplemented with LCPUFA. There was no 
      evidence that supplementation of formula with n-3 and n-6 LCPUFA impaired the 
      growth of preterm infants.
FAU - Simmer, K
AU  - Simmer K
AD  - Neonatal Clinical Care Unit, King Edward Memorial Hospital for Women and Princess 
      Margaret Hospital for Children, Bagot Road, Subiaco, WA, Australia.
FAU - Patole, S
AU  - Patole S
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Fatty Acids, Unsaturated)
SB  - IM
UOF - Cochrane Database Syst Rev. 2000;(2):CD000375. PMID: 10796351
UIN - Cochrane Database Syst Rev. 2008;(1):CD000375. PMID: 18253973
MH  - *Dietary Supplements
MH  - Fatty Acids, Unsaturated/*administration & dosage
MH  - Humans
MH  - *Infant Nutritional Physiological Phenomena
MH  - Infant, Newborn
MH  - *Infant, Premature/growth & development
MH  - Randomized Controlled Trials as Topic
RF  - 27
EDAT- 2004/02/20 05:00
MHDA- 2004/06/30 05:00
CRDT- 2004/02/20 05:00
PHST- 2004/02/20 05:00 [pubmed]
PHST- 2004/06/30 05:00 [medline]
PHST- 2004/02/20 05:00 [entrez]
AID - 10.1002/14651858.CD000375.pub2 [doi]
PST - ppublish
SO  - Cochrane Database Syst Rev. 2004;(1):CD000375. doi: 
      10.1002/14651858.CD000375.pub2.