SickKids基金會提供資金支持該研究，Mead Johnson Nutrition提供DHA膠囊，作者們皆宣告沒有相關財務關係。
小兒科學會2010年會：壁報1355.6。發表於2010年5月1日 。
Supplementation of Maternal Milk With Docosahexanoic Acid is Beneficial for Very Premature Infants
By Brian Hoyle
Medscape Medical News
May 3, 2010 (Vancouver, Canada) — A new study from Laval University in Quebec, Canada, and presented here at the Pediatric Academic Societies 2010 Annual Meeting indicates that supplementation of mothers with the omega-3 fatty acid docosahexanoic acid (DHA) boosts the DHA level in their breast milk compared with milk from mothers who do not receive supplementation.
During the first 42 days of life of the 12 very premature infants studied, supplementation delivered more DHA to the nursing infants compared with DHA levels in 22 infants fed unsupplemented milk, Isabelle Marc, MD, PhD, a professor of pediatrics, Centre Hospitalier Universitaire de Quebec, Universite Laval, told Medscape Pediatrics.
"Supplementing mothers is a feasible way to provide DHA to low-birth-weight premature infants, even before they reach full enteral feeding," said Dr. Marc. Although yet to be substantiated, the results may enable DHA delivery during the critical period of brain development and growth, she added.
"This conclusion is supported by the positive trends observed over time in the DHA concentrations in breast milk and babies' plasma lipids in the DHA-supplemented group," Dr. Marc pointed out.
Very premature infants, whose intake of nutrients is hampered by gastrointestinal immaturity and acute health problems, are vulnerable to a deficiency of omega-3 fatty acids, and in particular, DHA. As a result, brain development and growth can be compromised. Dr. Marc and colleagues from Laval and the universities of Sherbrooke and Montreal conducted the study to test whether the supplementation of the diet of breastfeeding mothers with DHA could boost the DHA levels in breastfed infants who had been delivered at less than 30 weeks' gestation.
Exclusion criteria included maternal consumption of more than 3 servings of fish weekly, fish allergy, and coagulation disorder or the use of anticoagulants. Of women aged 18 to 40 years who had delivered prematurely and who expressed an intention to breastfeed, 10 (27 ± 4.3 years of age with 12 infants: 6 boys and 6 girls, 27.6 ± 1.5 weeks gestational age) were approached within 7 days of delivery and agreed to receive DHA supplementation in the form of orally ingested capsules (1.2 g/day until 36 weeks postconception). Another 22 mothers (26.9 ± 4.1 years of age with 24 infants: 9 boys and 15 girls, 27.7 ± 1.1 weeks gestational age), who were blinded to the DHA supplementation aspect of the study, formed the reference group.
The daily DHA intake of the infants in the DHA and reference groups was determined from their birth until day 49 after birth. In addition, in the DHA group, the fatty acid profile in the breast milk was determined each week, and blood plasma phospholipid profiles were determined at baseline, day 14, and day 49. The breast milk fatty acid and blood plasma phospholipid profiles of the reference group of mothers were determined at baseline and day 49.
As much as possible, the milk the infants received came fresh from the source or was last-dated frozen breast milk of the mother. During the study period, breast milk made up 87% ± 30% of the diet of the DHA group of infants and 72% ± 41% of the diet of reference infants. The total milk intake (formula + maternal) was comparable between the infants receiving DHA (5555 ± 2930 mL) and the reference infants (5273 ± 2888 mL).
Although no difference was evident in the enteral feeding intake at day 49, the infants in the DHA group had received 55.2 ± 37.6 mg/kg/day of DHA compared with 7.2 ± 11.1 mg/kg/day in the reference group.
DHA plasma levels in the group of infants receiving DHA trended upward significantly (P = .0143) during the entire 49 days, although changes were marginal during the first 3 weeks. Notably, the day 49 plasma DHA level was significantly higher (P = .0014) in the group receiving DHA (60.3 ± 23.5 ng/mL) than in the reference group (31.7 ± 10.7 ng/mL).
Infant weight, length, and head circumference at day 49 were comparable in both groups. Moreover, comparison of the day 49 plasma fatty acid profile determined that DHA supplementation did not alter the content of arachidonic acid or eicopentaenoic acid.
According to Dr. Marc, the boost in DHA within the first 2 months of life among very premature infants may reap benefits in the brain development and growth that are hallmarks of that period.
"I think the data [Dr. Marc] showed is excellent and I have no objection," Josef Neu, MD, professor of pediatrics, Division of Neonatology, University of Florida, Gainesville, told Medscape Pediatrics.
However, he noted, "the amount of DHA these babies were receiving was very low until about 3 to 4 weeks after birth, despite higher concentrations in the breast milk.
"This is not because the level of DHA in the breast milk was low, but because these babies in reality receive very little milk. This is because neonatologists are reluctant to feed these babies, and they actually get very little milk. So, even if the moms are getting DHA and their milk DHA increases nicely, the babies still get very little milk, [and] hence very little DHA for the first 3 to 4 weeks," said Dr. Neu.
The study was supported by a grant from the SickKids Foundation. The DHA capsules were provided by Mead Johnson Nutrition. The authors have disclosed no relevant financial relationships.
