Long-chain polyunsaturated fatty acid supplementation in preterm infants.

BACKGROUND: Controversy exists over whether longchain polyunsaturated fatty acids (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 (1966 to December 2009), Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2009) and by checking reference lists of articles and conference proceedings.

SELECTION CRITERIA: All randomised trials of formula supplemented with LCPUFA and with clinical endpoints were reviewed.

DATA COLLECTION AND ANALYSIS: All authors assessed eligibility and trial quality, two authors extracted data separately. Study authors were contacted for additional information.

MAIN RESULTS: Of the 17 trials included in the review, 13 were classified as of high quality. Visual acuity Visual acuity over the first year was measured by Teller or Lea acuity cards in eight studies, by VEP in six studies and by ERG in two studies. Most studies found no significant differences in visual assessment between supplemented and control infants.Development Three out of seven studies reported some benefit of LCPUFA on neurodevelopment in different populations at different postnatal ages. Meta-analysis of Bayley Scales of Infant Development of four studies at 12 months (N = 364) and three studies at 18 months (N = 494) post-term showed no significant effect of supplementation on neurodevelopment.Growth Four out of 15 studies reported benefits of LCPUFA on growth of supplemented infants at different postnatal ages. Two trials suggested that LCPUFA supplemented infants grow less well than controls. One trial reported mild reductions in length and weight z scores at 18 months. Meta-analysis of five studies showed increased weight and length at two months post-term in supplemented infants. Meta-analysis of four studies at 12 months (N = 271) and two studies at 18 months (N = 396) post-term showed no significant effect of supplementation on weight, length or head circumference.

AUTHORS' 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. On pooling of results, no clear long-term benefits or harms were demonstrated for preterm infants receiving LCPUFA-supplemented formula.