Miss Ffion Myfanwy Ridgway1 Dr Mark Johnson2,3
1. Faculty of Medicine, University of Southampton, Southampton
2. Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton
3. NIHR Biomedical Research Centre Southampton, Southampton
Introduction (include hypothesis)
Preterm infants born before 30 weeks’ gestation are at risk of poor growth and complications such as chronic lung disease (CLD), necrotising enterocolitis (NEC) and late onset sepsis (LOS). Nutrition may be a key factor. In particular, polyunsaturated fatty acids (PUFAs) have been associated with immune function, growth and disease risk. This study aimed to explore the association between PUFA intake and growth and outcomes in preterm infants.
Methods (include source of funding and ethical approval if required)
This study was a secondary data analysis of detailed nutrient intake and growth data from infants (born at <30weeks gestation with a birthweight <1500g) who took part in a previous nutritional intervention study carried out in a tertiary neonatal intensive care unit. Daily feed, growth and outcome data, were extracted from the study database. Feed PUFA content was determined from reference data for Arachidonic acid (AA), Docosahexaenoic acid (DHA), Linoleic Acid (LA) and Alpha Linolenic acid (ALA), and used to calculate the daily AA, DHA, LA and ALA intake for each infant. Growth was assessed as change in standard deviation score (cSDS) for weight, length and head circumference between birth and 36 weeks corrected gestational age (CGA). Linear and logistic regression were used to establish the relationship between PUFA intake and outcomes, with adjustments for sex, birthweight and gestational age (GA) where appropriate (SPSS v24).
331 preterm infants were included (mean GA and weight at birth 28.71 weeks and 1.039kg respectively). After adjusting for significant covariates, mean daily intake of AA, DHA, LA and ALA between birth and 36 weeks CGA were all positively associated with weight cSDS at 36 weeks CGA (p<0.01 for all). A 1mg/kg/day increase in each of AA, DHA, LA and ALA resulted in an improvement of weight SDS by 0.02, 0.04, 0.02 and 0.01 respectively. AA and DHA intake between birth and 36 weeks CGA were associated with reduced risk of CLD, NEC and LOS (p<0.01 for all). LA intake over the same time period was associated with a decreased risk of CLD (p<0.04). Increased intake of AA and DHA by 1mg/kg/day reduced the risk of NEC (Odds Ratio (OR) 0.858 and 0.768 respectively, p<0.01 for both). Increased mean daily intake of DHA of 1mg/kg/day in the first two weeks of life was associated with a decreased risk of CLD and LOS (OR 0.847 and 0.845 respectively, p<0.05 for both).
Higher PUFA intake during hospital stay is associated with improvements in weight gain at 36 weeks CGA and reduced risk of CLD, NEC and LOS. Ensuring adequate intake of PUFAs in preterm infants may therefore be important and warrants further investigation.