Location: Children's Nutrition Research CenterTitle: Reevaluation of the DHA requirement for the premature infant Author
Submitted to: Prostaglandins Leukotrienes and Essential Fatty Acids
Publication Type: Review Article
Publication Acceptance Date: 2/1/2009
Publication Date: 8/1/2009
Citation: Lapillonne, A., Jensen, C.L. 2009. Reevaluation of the DHA requirement for the premature infant. Prostaglandins Leukotrienes and Essential Fatty Acids. 81(2-3):143-150. Interpretive Summary: An adequate supply of docosahexaenoic acid (DHA) to infants born prematurely is crucial for optimal brain development. This analysis demonstrates that many premature infants do not receive an adequate DHA supply because current formulas and most human milk fed to preterm infants contain insufficient DHA to meet the requirements of these infants. To prevent deficiency of DHA, a recommendation was made to increase the DHA content of preterm infant formulas and human milk fed to preterm infants. This has implications for infant formula manufacturers, mothers of preterm infants and the preterm infants themselves.
Technical Abstract: The long-chain polyunsaturated fatty acid (LC-PUFA) intake in preterm infants is crucial for normal central nervous system development and has the potential for long-lasting effects that extend beyond the period of dietary insufficiency. While much attention has focused on improving their nutritional intake, many premature infants do not receive an adequate DHA supply. We demonstrate that enterally fed premature infants exhibit daily DHA deficit of 20 mg/kg.d, representing 44% of the DHA that should have been accumulated. Furthermore, the DHA content of human milk and current preterm formulas cannot compensate for an early DHA deficit, which may occur during the first month of life. We recommend breast-feeding, which supplies preformed LC-PUFA, as the preferred method of feeding for preterm infants. However, to fulfill the specific DHA requirement of these infants, we recommend increasing the DHA content of human milk either by providing the mothers with a DHA supplement or by adding DHA directly to the milk. Increasing the DHA content above 1% total fatty acids appears to be safe and may enhance neurological development particularly that of infants with a birth weight below 1250 g. We estimate that human milk and preterm formula should contain 1.5% of fatty acid as DHA to prevent the appearance of a DHA deficit and to compensate for the early DHA deficit.