477 - Impact of Docosahexaenoic Acid and Arachidonic Acid Supplementation on Growth and Morbidity in Very Low Birth Weight Infants

Publication Number: 4468.477

Emily Hood, University of Tennessee Health Science Center - - Memphis, TN, Memphis, TN, United States; Adriann Skeen, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States; Ramesh Krishnan, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States; Bhuvaneshwari Jagadesan, Uthsc, Collierville, TN, United States

Background: Docosahexaenoic acid (DHA) and arachidonic acid (ARA) are essential long-chain polyunsaturated fatty acids that play a crucial role in neurodevelopment, growth, and cellular function. Preterm infants are at increased risk for growth impairment and complications related to reduced stores of DHA and ARA.

Objective: This study looks at the effect of DHA and ARA supplementation on growth and neonatal morbidities in preterm infants.

Design/Methods: A retrospective cohort study of infants < 29 weeks gestation and birth weight ≤1250 g admitted to a tertiary NICU between 2023 and 2024. Infants were stratified into two groups: controls and those receiving daily enteral DHA/ARA supplementation (0.5 mL/kg/day, 20-50mg/kg/day DHA and 40-100 mg/kg/day ARA). Supplementation was started at full feeds (120 ml/kg/day) until 36 weeks postmenstrual age or discharge. Maximum feeding volume, cumulative caloric, protein, and fat intake were recorded. Anthropometric data were assessed at birth and discharge. Major neonatal morbidities: necrotizing enterocolitis (NEC), chronic lung disease (CLD), cystic periventricular leukomalacia (CPVL), severe intraventricular hemorrhage (sIVH), severe retinopathy of prematurity (sROP), and late-onset sepsis (LOS) were analyzed.

Results: 129 infants were included (DHA/ARA n=42, control n=87). DHA/ARA group reached full feeds faster (15±6 vs. 19±10, p< 0.05) and achieved a higher maximum volume of feed (153±15 vs. 147±15, p< 0.05). They also demonstrated significantly higher cumulative DHA (51±5 vs. 25±7mg/kg/day, p< 0.05) and ARA (90±10 vs. 42±12 mg/kg/day, p< 0.05) levels, improved cumulative fat (8±1 vs. 6.8±1 g/kg/day, p< 0.05) and cumulative total caloric intake (133±12 vs. 128±12 kcals/kg/day, p< 0.05) compared to the controls. Protein content among groups was similar. Weight z-scores declined in both groups by discharge, with a larger decrease in DHA/ARA group (Δz −1.17±0.64 vs. −0.85±0.77, p=0.02). Length and head circumference did not differ. No statistically significant differences were observed between groups across major neonatal outcomes. Supplemented infants exhibited lower incidences of NEC and IVH, and higher incidences of CLD similar to literature already published.

Conclusion(s): DHA/ARA supplementation increased fatty acid energy intake without negatively affecting major neonatal outcomes. Supplemented infants showed a greater decline in weight Δz-scores. This could be due to increased fat consumption but needs further investigation. Notably, trends toward lower NEC and sIVH suggest a potential protective effect. These findings reinforce the safety of DHA/ARA supplementation.

Table 1
Impact of DHA and ARA Supplementation on Growth

Table 2
Impact of DHA and ARA Supplementation on Morbidity