title: Effects of different arachidonic acid supplementation on psychomotor development in very preterm infants; a randomized controlled trial.
abstract: OBJECTIVE
  Nutritional supplementation with polyunsaturated fatty acids is important in preterm infants neurodevelopment, but it is not known if the omega-6/omega-3 ratio affects this process. This study was designed to determine the effects of a balanced contribution of arachidonic acid in very preterm newborns fed with formula milk.
  
  
  METHODS
  This was a randomized trial, in which newborns <1500 g and/or <32 weeks gestational age were assigned to one of two groups, based on the milk formula they would receive during the first year of life. Initially, 60 newborns entered the study, but ultimately, group A was composed of 24 newborns, who were given formula milk with an ω-6/ω-3 ratio of 2/1, and Group B was composed of 21 newborns, given formula milk with an ω-6/ω-3 ratio of 1/1. The infants were followed up for two years: growth, visual-evoked potentials, brainstem auditory-evoked potentials, and plasma fatty acids were periodically measured, and psychomotor development was assessed using the Brunet Lézine scale at 24 months corrected age. A control group, for comparison of Brunet Lézine score, was made up of 25 newborns from the SEN1500 project, who were fed exclusively with breast milk.
  
  
  RESULTS
  At 12 months, arachidonic acid values were significantly higher in group A than in group B (6.95 ± 1.55% vs. 4.55 ± 0.78%), as were polyunsaturated fatty acids (41.02 ± 2.09% vs. 38.08 ± 2.32%) achieved a higher average. Group A achieved a higher average Brunet Lézine score at 24 months than group B (99.9 ± 9 vs. 90.8 ± 11, p =0.028). The Brunet Lézine results from group A were compared with the control group results, with very similar scores registered between the two groups (99.9 ± 9 vs. 100.5 ± 7). There were no significant differences in growth or evoked potentials between the two formula groups.
  
  
  CONCLUSIONS
  Very preterm infants who received formula with an ω-6/ω-3 ratio of 2/1 had higher blood levels of essential fatty acids during the first year of life, and better psychomotor development, compared with very preterm newborns who consumed formula with an ω-6/ω-3 of 1/1. Therefore, formula milk with an arachidonic acid quantity double that of docosahexaenoic acid should be considered for feeding very preterm infants.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier NCT02503020.
authors.affiliation: Neonatology Unit, Department of Paediatrics, University Clinical Hospital of Santiago de Compostela. IDIS, CIBERER, Travesia Choupana, 15706, Santiago de Compostela, Spain. drayham@live.com.
authors.forename: Ayham
authors.initials: A
authors.lastname: Alshweki
authors.affiliation: Neonatology Unit, Department of Paediatrics, University Clinical Hospital of Santiago de Compostela. IDIS, CIBERER, Travesia Choupana, 15706, Santiago de Compostela, Spain. apmunuzuri@yahoo.es.
authors.forename: Alejandro Pérez
authors.initials: AP
authors.lastname: Muñuzuri
authors.affiliation: Neonatology Unit, Department of Paediatrics, University Clinical Hospital of Santiago de Compostela. IDIS, CIBERER, Travesia Choupana, 15706, Santiago de Compostela, Spain. anamariabana@gmail.com.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Baña
authors.affiliation: Neonatology Unit, Department of Paediatrics, University Clinical Hospital of Santiago de Compostela. IDIS, CIBERER, Travesia Choupana, 15706, Santiago de Compostela, Spain. mj.decastrol@gmail.com.
authors.forename: Ma José
authors.initials: MJ
authors.lastname: de Castro
authors.affiliation: Motabolism Group, BioCruces Health Research Institute, CIBER of Rare Diseases (CIBERER), Plaza de Cruces 12, 48903 Baracaldo, Vizcaya, Spain. fernando.andradelodeiro@osakidetza.net.
authors.forename: Fernando
authors.initials: F
authors.lastname: Andrade
authors.affiliation: Motabolism Group, BioCruces Health Research Institute, CIBER of Rare Diseases (CIBERER), Plaza de Cruces 12, 48903 Baracaldo, Vizcaya, Spain. luisjose.aldamiz-echevarazuara@osakidetza.net.
authors.forename: Luís
authors.initials: L
authors.lastname: Aldamiz-Echevarría
authors.affiliation: Neonatology Unit, Department of Paediatrics, La Paz University Clinical Hospital, P de la Castellana 261, 28064, Madrid, Spain. miguel.saenz@salud.madrid.org.
authors.forename: Miguel Sáenz
authors.initials: MS
authors.lastname: de Pipaón
authors.affiliation: Neonatology Unit, Department of Paediatrics, University Clinical Hospital of Santiago de Compostela. IDIS, CIBERER, Travesia Choupana, 15706, Santiago de Compostela, Spain. jose.maria.fraga.bermudez@sergas.es.
authors.forename: José M
authors.initials: JM
authors.lastname: Fraga
authors.affiliation: Neonatology Unit, Department of Paediatrics, University Clinical Hospital of Santiago de Compostela. IDIS, CIBERER, Travesia Choupana, 15706, Santiago de Compostela, Spain. maria.luz.couce.pico@sergas.es.
authors.forename: María L
authors.initials: ML
authors.lastname: Couce
mesh_terms: D016718:Arachidonic Acid / Q000008:administration & dosage* / Q000032:analysis; D002657:Child Development / Q000187:drug effects; D002675:Child, Preschool; D019587:Dietary Supplements; D004311:Double-Blind Method; D005227:Fatty Acids / Q000097:blood; D043371:Fatty Acids, Omega-6 / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000737:chemistry; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D008297:Male; D008895:Milk, Human; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D005227:Fatty Acids; D043371:Fatty Acids, Omega-6; D016718:Arachidonic Acid