title: Choline and polyunsaturated fatty acids in preterm infants' maternal milk.
abstract: BACKGROUND
  Choline, docosahexaenoic acid (DHA), and arachidonic acid (ARA) are essential to fetal development, particularly of the brain. These components are actively enriched in the fetus. Deprivation from placental supply may therefore result in impaired accretion in preterm infants.
  
  
  OBJECTIVE
  To determine choline, choline metabolites, DHA, and ARA in human breast milk (BM) of preterm infants compared to BM of term born infants.
  
  
  METHODS
  We collected expressed BM samples from 34 mothers (N = 353; postnatal day 6-85), who had delivered 35 preterm infants undergoing neonatal intensive care (postmenstrual age 30 weeks, range 25.4-32.0), and from mothers after term delivery (N = 9; postnatal day 6-118). Target metabolites were analyzed using tandem mass spectrometry and gas chromatography and reported as medians and 25th/75th percentiles.
  
  
  RESULTS
  In BM, choline was mainly present in the form of phosphocholine and glycerophosphocholine, followed by free choline, phosphatidylcholine, sphingomyelin, and lyso-phosphatidylcholine. In preterm infants' BM total choline ranged from 61 to 360 mg/L (median: 158 mg/L) and was decreased compared to term infants' BM (range 142-343 mg/L; median: 258 mg/L; p < 0.01). ARA and DHA comprised 0.81 (range: 0.46-1.60) and 0.43 (0.15-2.42) % of total preterm BM lipids, whereas term BM values were 0.68 (0.52-0.88) and 0.35 (0.18-0.75) %, respectively. Concentrations of all target parameters decreased after birth, and frequently 150 ml/kg/d BM did not meet the estimated fetal accretion rates.
  
  
  CONCLUSIONS
  Following preterm delivery, BM choline concentrations are lower, whereas ARA and DHA levels are comparable versus term delivery. Based on these findings we suggest a combined supplementation of preterm infants' BM with choline, ARA and DHA combined to improve the nutritional status of preterm infants.
  
  
  BACKGROUND
  This study was registered at www.clinicaltrials.gov. Identifier: NCT01773902.
authors.affiliation: Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tuebingen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Maas
authors.affiliation: Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tuebingen, Germany.|Center for Pediatric Clinical Studies, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tuebingen, Germany.
authors.forename: Axel R
authors.initials: AR
authors.lastname: Franz
authors.affiliation: Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tuebingen, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Shunova
authors.affiliation: Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tuebingen, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Mathes
authors.affiliation: Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tuebingen, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Bleeker
authors.affiliation: Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tuebingen, Germany.
authors.forename: Christian F
authors.initials: CF
authors.lastname: Poets
authors.affiliation: Department of Internal Medicine IV, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tuebingen, Germany.
authors.forename: Erwin
authors.initials: E
authors.lastname: Schleicher
authors.affiliation: Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tuebingen, Germany. wolfgang.bernhard@med.uni-tuebingen.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bernhard
mesh_terms: D000328:Adult; D016718:Arachidonic Acid / Q000008:administration & dosage / Q000097:blood; D002784:Cholesterol / Q000097:blood; D002794:Choline / Q000008:administration & dosage* / Q000097:blood; D019587:Dietary Supplements; D005231:Fatty Acids, Unsaturated / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood* / Q000254:growth & development; D008297:Male; D008895:Milk, Human / Q000737:chemistry*; D009752:Nutritional Status; D014280:Triglycerides
chemical_list: D005231:Fatty Acids, Unsaturated; D014280:Triglycerides; D016718:Arachidonic Acid; D002784:Cholesterol; D002794:Choline
keywords: Choline deficiency; Mothers’ milk; Neonate; Neurological development; Polyunsaturated fatty acids; Preterm infants