title: Long-chain polyunsaturated fatty acid supplementation in infants born at term.
abstract: BACKGROUND
  The n-3 and n-6 fatty acids linolenic acid and linoleic acid are precursors of the n-3 and n-6 long chain fatty acids (LCPUFA). Infant formula has historically only contained the precursor fatty acids. Over the last few years, some manufacturers have added LCPUFA to formulae and marketed them as providing an advantage for the development of term infants.
  
  
  OBJECTIVE
  To assess whether supplementation of formula with LCPUFA is safe and of benefit to term infants.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, April, 2011), MEDLINE (1966 to April 2011), EMBASE (1980 to April 2011), CINAHL (December 1982 to April 2011) and abstracts of the Society for Pediatric Research (1980 to 2010). No language restrictions were applied.
  
  
  METHODS
  Randomised and quasi randomised trials comparing LCPUFA supplemented vs. non-supplemented formula milk and with clinical endpoints were reviewed.
  
  
  METHODS
  Methodological quality of studies was assessed using the guidelines of Cochrane neonatal review group. Data were sought regarding effects on visual acuity, neurodevelopmental outcomes and physical growth. When appropriate, meta-analysis was conducted to provide a pooled estimate of effect.
  
  
  RESULTS
  Twenty-five randomised studies were identified; fifteen were included (n = 1889) and ten excluded.Visual acuity was assessed by nine studies. Visual evoked potential was used in six studies, two used Teller cards and one used both. Four studies reported beneficial effects while the remaining five did not.Neurodevelopmental outcome was measured by eleven studies. Bayley scales of infant development (BSID) was used in nine studies; only two showed beneficial effects. Meta-analysis did not show significant benefits of supplementation. One study followed the infants up to nine years of age and did not find benefit of supplementation. One study reported better novelty preference measured by Fagan Infant test at nine months. Another study reported better problem solving at 10 months. One study used Brunet and Lezine test to assess the developmental quotient and did not find beneficial effects.Physical growth was measured by thirteen studies; none found beneficial or harmful effects of supplementation. Meta-analysis found that supplemented group may have marginally lower weight at one year of age.
  
  
  CONCLUSIONS
  Majority of the RCTS have not shown beneficial effects of LCPUFA supplementation on the neurodevelopmental outcomes of term infants. The beneficial effects on visual acuity have not been consistently demonstrated. Routine supplementation of term infant milk formula with LCPUFA can not be recommended.
authors.affiliation: Neonatal Care Unit, King Edward Memorial Hospital for Women and Princess Margaret Hospital for Children, Bagot Road, Subiaco, WA, Australia, 6008.
authors.forename: Karen
authors.initials: K
authors.lastname: Simmer
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Patole
authors.forename: Shripada C
authors.initials: SC
authors.lastname: Rao
mesh_terms: D019587:Dietary Supplements; D005231:Fatty Acids, Unsaturated / Q000008:administration & dosage*; D006128:Growth; D006801:Humans; D041943:Infant Formula / Q000737:chemistry*; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D016032:Randomized Controlled Trials as Topic; D047929:Term Birth; D014792:Visual Acuity / Q000502:physiology
chemical_list: D005231:Fatty Acids, Unsaturated