Breast milk docosahexaenoic acid (DHA) correlates with DHA status of malnourished infants.

AIM: To investigate whether low docosahexaenoic acid (22:6omega3; DHA) status of malnourished, mostly breast fed infants is a result of low omega3 fatty acid intake via breast milk. METHODS: Fatty acid composition of breast milk of eight Pakistani mothers, and of the erythrocytes of their malnourished children was analysed. RESULTS: The milk of the Pakistani mothers contained low percentages of all omega3 and most omega6 fatty acids, compared with milk of Dutch mothers. Breast milk DHA was positively correlated with infant erythrocyte DHA and arachidonic acid (20:4omega6). CONCLUSION: DHA status of these malnourished children is strongly dependent on the omega3 fatty acid intake from breast milk. Augmentation of the infants' omega3 long chain polyunsaturated fatty acid status, or the omega3 and omega6 fatty acid status in general, by supplementation is indicated in deprived circumstances where access to fresh fish is difficult. However, in terms of prevention, maternal supplementation of these long chain polyunsaturated fatty acids, preferably from early pregnancy onwards, may be a better option.     

Fish oil supplementation improves docosahexaenoic acid status of malnourished infants

AIM—To investigate whether the low docosahexaenoic acid (DHA) status of malnourished, mostly breast fed, Pakistani children can be improved by fish oil (FO) supplementation.
METHODS—Ten malnourished children (aged 8-30 months) received 500 mg FO daily for nine weeks. The supplement contained 62.8 mol% (314mg) long chain polyunsaturated fatty acids of the ω3 series (LCPUFAω3) and 22.5 mol% (112 mg) DHA. Seven FO unsupplemented children served as controls. Red blood cell (RBC) fatty acids were analysed at baseline and at the study end.
RESULTS—FO supplementation augmented mean (SD) RBC DHA from 2.27 (0.81) to 3.35 (0.76) mol%, without significantly affecting the concentrations of LCPUFAω6. Unsupplemented children showed no RBC fatty acid changes. One FO supplemented child with very low initial RBC arachidonic acid showed a remarkable increase from 4.04 to 13.84 mol%, whereas another with high RBC arachidonic acid showed a decrease from 15.64 to 10.46 mol%.
CONCLUSION—FO supplementation improves the DHA status of malnourished children. The supplement is apparently well absorbed and not exclusively used as a source of energy.

     

Fish oil supplementation improves docosahexaenoic acid status of malnourished infants.

AIM: To investigate whether the low docosahexaenoic acid (DHA) status of malnourished, mostly breast fed, Pakistani children can be improved by fish oil (FO) supplementation. METHODS: Ten malnourished children (aged 8-30 months) received 500 mg FO daily for nine weeks. The supplement contained 62.8 mol% (314 mg) long chain polyunsaturated fatty acids of the omega3 series (LCPUFAomega3) and 22.5 mol% (112 mg) DHA. Seven FO unsupplemented children served as controls. Red blood cell (RBC) fatty acids were analysed at baseline and at the study end. RESULTS: FO supplementation augmented mean (SD) RBC DHA from 2.27 (0.81) to 3.35 (0.76) mol%, without significantly affecting the concentrations of LCPUFAomega6. Unsupplemented children showed no RBC fatty acid changes. One FO supplemented child with very low initial RBC arachidonic acid showed a remarkable increase from 4.04 to 13.84 mol%, whereas another with high RBC arachidonic acid showed a decrease from 15.64 to 10.46 mol%. CONCLUSION: FO supplementation improves the DHA status of malnourished children. The supplement is apparently well absorbed and not exclusively used as a source of energy.     

Smoking and alcohol use during pregnancy affects preterm infants' docosahexaenoic acid (DHA) status

This study investigated the effect of alcohol consumption and smoking during pregnancy on the fatty acid composition of the infants. A total of 40 very-low-birth-weight (VLBW) infants, weighing between 750 and 1500 g, were enrolled in the study after being hospitalized and ventilated for respiratory distress syndrome (RDS). Maternal and infant demographic information was recorded. Questions regarding maternal smoking (none, < 10 and > or = 10 cigarettes/d) and alcohol consumption (none, occasionally, moderate and severe) were recorded. Erythrocyte membrane (EMB; n = 40) total fatty acid analyses were performed at birth (baseline) and on days 14 and 28 postnatally. During pregnancy, 42% of mothers consumed alcohol and 50% smoked. At birth, infants of mothers who smoked and consumed alcohol during pregnancy, had significantly higher blood docosahexaenoic acid (DHA; p < 0.05) than infants of mothers who abstained from both alcohol and smoking. The consequences of this finding remain unknown.     

Erythrocyte membrane fatty acid content in infants consuming formulas supplemented with docosahexaenoic acid (DHA) and arachidonic acid (ARA): an observational study

In this observational study, we compared erythrocyte membrane fatty acids in infants consuming formula supplemented with docosahexaenoic acid (DHA) and arachidonic acid (ARA) with those consuming other types of milks. In 110 infants who were participants in a cohort study of otherwise healthy children at risk for developing type 1 diabetes, erythrocytes were collected at approximately 9 months of age, and fatty acid content was measured as a percentage of total lipids. Parents reported the type of milk the infants consumed in the month of and prior to erythrocyte collection: infant formula supplemented with ARA and DHA (supplemented formula), formula with no ARA and DHA supplements (non-supplemented formula), breast milk, or non-supplemented formula plus breast milk. Membrane DHA (4.42 versus 1.79, P < 0.001) and omega-3 fatty acid (5.81 versus 3.43, P < 0.001) levels were higher in infants consuming supplemented versus non-supplemented formula. Omega-6 fatty acids were lower in infants consuming supplemented versus non-supplemented formula (26.32 versus 29.68, P = 0.023); ARA did not differ between groups. Infants given supplemented formula had higher DHA (4.42 versus 2.81, P < 0.001) and omega-3 fatty acids (5.81 versus 4.45, P = 0.008) than infants drinking breast milk. In infants whose mothers did not receive any dietary advice, use of supplemented formula is associated with higher omega-3 and lower omega-6 fatty acid status.     

Breast milk jaundice in preterm infants

A retrospective study was performed comparing bilirubin levels in 40 preterm newborns with uncomplicated courses fed a combination of premature breast milk and formula to those of 60 comparable preterm newborns fed formula only. A significantly higher bilirubin level was noted in the group fed the combined diet on the 6th day of life and on the day of discharge. Seventy-six and seven tenths percent of the preterm infants fed breast milk and formula met the criteria for phototherapy, whereas only 45 percent were treated in the group fed formula alone. Our findings indicate that premature breast milk might cause early and late increase in bilirubin levels in healthy preterm newborns.     

Breast milk jaundice in premature infants.

In randomised study of 186 preterm infants those fed on maternal or banked breast milk had a significantly higher peak bilirubin concentration and a more prolonged jaundice than infants fed an artificial preterm formula and were over four times more likely to achieve plasma bilirubin values above 200 mumol/l (11.7 mg/100 ml). This dietary effect was seen even in a high risk subgroup of sick ventilated infants below 1500 g who were receiving restricted enteral intakes. We suggest that breast milk jaundice in preterm infants may increase clinical intervention. Our findings are discussed in the light of epidemiological data suggesting an association between moderate hyperbilirubinaemia (greater than 170 mumol/l) and neurodevelopmental outcome.     

Sows' milk attenuates dexamethasone-induced reductions in liver docosahexaenoic acid

The objective was to determine the effects of dexamethasone (Dex) on growth and arachidonic (AA) and docosahexaenoic (DHA) acid status. Piglets were randomized to suckling or formula feeding plus Dex or placebo treatment for 15 days. Weight and length at the beginning and end of study was used to assess growth. After 15 days, AA and DHA in phosphatidylethanolamine (PE) and phosphatidylcholine (PC) were measured in liver and plasma and total AA and DHA in forebrain and brainstem. Dex treatment significantly reduced weight and length. Dex reduced liver PC and PE DHA in the formula group, but the reduction in the suckled group was not significant. PC AA and DHA were positively related in liver and plasma. A main effect of Dex to reduce AA and DHA was observed in forebrain but not in brainstem. Sows' milk attenuated the Dex-induced reduction in liver DHA but not forebrain AA and DHA or somatic growth.     

Breast milk and cytomegalovirus infection in preterm infants

The incidence of postnatal human cytomegalovirus (HCMV) reactivation during lactation equals the maternal seroprevalence. Infectious virus, viral DNA and RNA can be isolated from cells and fat free milk whey. Early onset of viral DNAlactia and virolactia as well as high viral load in milk whey are maternal risk factors for virus transmission. Preterm infants below 1000 g birthweight and a gestational age below 30 weeks may be at high risk of acquiring a symptomatic HCMV infection. Several recent studies using frozen milk for feeding describe low transmission rates and mostly asymptomatically infected neonates. However despite different freeze-storing procedures HCMV transmission occurred and severe HCMV infections were observed. Only few data exist on the long-term outcome of postnatally acquired HCMV infection via breast milk. Additional long-term outcome studies are needed. The newly developed short-term pasteurisation may be a reliable alternative to freezing and Holder pasteurisation, since important milk constituents are conserved.     

Breast milk feeding in very low birthweight infants

ABSTRACT. The infant feeding practices of 77 very low birthweight (VLBW) survivors with birthweights under 1500 g were studied. 58 (75%) infants received fresh expressed breast milk (EBM) from their own mothers, of whom 42 were successfully breastfed at a medium postconceptual age of 36 weeks. Overall incidence of breastfeeding in the VLBW population was 44% at 3 months and 23% at 6 months. The postnatal ages at which breastfeeding stopped ranged from 2 months to 28 months (median 4 months). No significant differences in perinatal factors were found between the breast milk and milk formula groups. There were significantly more mothers in the breast milk group who were given advice and encouragement during their pregnancy on breastfeeding and who had planned in the antenatal period to breastfeed their infants. The most common reasons given for deciding against providing breast milk were related to extreme prematurity of the infant. Nursery weight gain of infants fed breast milk and milk formula were similar. Necrotizing enterocolitis occurred significantly less frequently in the breast milk group. The study suggested that the special attention and positve encouragement given to parents of VLBW infants had contributed to the successful establishment and continuation of a feeding regime utilizing fresh breast milk from the infant's own mother, which we believe has immunological, psychological and nutritional benefits in this high-risk infant population.     

Effects of different levels of intravenous alpha-linolenic acid and supplemental breast milk on red blood cell docosahexaenoic acid in very low birth-weight infants.

Preterm infants weighing less than 1,500 g were started on total parenteral nutrition (TPN) if unable to tolerate full enteral feedings. They were randomly assigned to receive intravenous lipids containing either 4.2 or 9.0% alpha-linolenic acid to assess the effect on red blood cell (RBC) phospholipid polyenoic fatty acid composition, particularly docosahexaenoic acid (22:6n3) (DHA). DHA ultimately comes from alpha-linolenic acid (18:3n3), although there is evidence in human preterm infants that they require preformed DHA. After 1 week of TPN, infants were started on gradually increasing amounts of enteral feeding, breast milk, if elected by mothers, or premature milk formula (Preemie Enfamil). RBC phospholipid fatty acids were measured weekly. Results were evaluated comparing samples from week 1 and week 6. Supplying 9% alpha-linolenic acid in intravenous lipids did not prevent a fall in DHA by 6 weeks; however, infants receiving breast-milk feeding did not have a significant decrease in DHA. Studies are needed to evaluate supplying DHA in intravenous lipids.     

Growth and development of preterm infants fed infant formulas containing docosahexaenoic acid and arachidonic acid

OBJECTIVES: To evaluate safety and benefits of feeding preterm infants formulas containing docosahexaenoic acid (DHA) and arachidonic acid (ARA) until 92 weeks postmenstrual age (PMA), with follow-up to 118 weeks PMA. STUDY DESIGN: This double-blinded study of 361 preterm infants randomized across three formula groups: (1) control, no supplementation; (2) algal-DHA (DHA from algal oil, ARA from fungal oil); and (3) fish-DHA (DHA from fish oil, ARA from fungal oil). Term infants breast-fed > or =4 months (n = 105) were a reference group. Outcomes included growth, tolerance, adverse events, and Bayley development scores. RESULTS: Weight of the algal-DHA group was significantly greater than the control group from 66 to 118 weeks PMA and the fish-DHA group at 118 weeks PMA but did not differ from term infants at 118 weeks PMA. The algal-DHA group was significantly longer than the control group at 48, 79, and 92 weeks PMA and the fish-DHA group at 57, 79, and 92 weeks PMA but did not differ from term infants from 79 to 118 weeks PMA. Supplemented groups had higher Bayley mental and psychomotor development scores at 118 weeks PMA than did the control group. Supplementation did not increase morbidity or adverse events. CONCLUSIONS: Feeding formulas with DHA and ARA from algal and fungal oils resulted in enhanced growth. Both supplemented formulas provided better developmental outcomes than unsupplemented formulas.     

Attention among very low birth weight infants following early supplementation with docosahexaenoic and arachidonic acid

Aim: To investigate the effect of supplementation with docosahexaenoic acid (DHA) and arachidonic acid (AA) in early neonatal life on cognitive functions among human milk fed very low birth weight infants (<1500 g) at 20 months chronological age. Methods: Randomized, double‐blinded, placebo‐controlled intervention supplementing human milk with 0.5 mL oil (containing 32 mg DHA and 31 mg AA or placebo) per 100 mL milk from 1 week after birth until discharge from hospital (9 weeks on average). The intervention and control group included 44 and 48 children, respectively. Attention capacity was evaluated by two ‘free‐play’ sessions. General cognitive functions were evaluated by the Bayley Mental Development Index (MDI) and an Ages and Stages Questionnaire. Results: The results from the free‐play sessions suggested positive effects from supplementation on functions related to attention. Neither the Bayley MDI nor the Ages and Stages Questionnaire showed significant difference between the intervention and control group. Plasma DHA concentration at discharge was positively correlated with both ‘Sustained Attention’ and the Bayley MDI according to chronological age. Conclusion: A positive effect of early supplementation with DHA and AA on 20 months attention capacity was indicated. These findings need further investigation.     

Oral rehydration therapy in malnourished infants with infectious diarrhoea

The clinical response and changes in water and salt homeostasis was studied for 36 hours during oral rehydration therapy with a rehydration solution containing 60 mmol sodium/l (ORS60) in 14 malnourished 3- to 15-month-old Turkish infants with acute infectious diarrhoea. All patients were successfully rehydrated with this treatment. Sodium was efficiently absorbed from the gut and water balance was rapidly restored. Because of excess fluid retention following the initial rehydration period about 50% of the patients became oedematous. Urine volume and urinary sodium excretion were found to be much lower than in well-nourished patients of the same age with acute diarrhoea who were treated in the same way. In all of the malnourished infants the serum sodium level remained within the normal range during treatment. The results show that malnourished infants retain much more fluid and sodium than infants who are in a normal nutritional state. Excessive retention of water and salt seem to be due to an inability of the kidneys to control sodium and fluid homeostasis while orally administered sodium and fluid are being absorbed from the gut. The results show that ORT is safe and efficient in the treatment of malnourished infants with acute diarrhoea. But since these infants run a high risk of developing a severe retention of fluid and salt, and consequently may develop circulatory failure due to hypervolaemia during oral rehydration therapy, it is important to carefully monitor the volume of fluid that is given.     

Breast milk and breast feeding in very low birthweight infants.

The feeding of 17 babies weighing less than 1500 g was examined retrospectively. 12 babies started breast feeding at a mean weight of 1324 g and 10 of them were fully breast fed by a mean weight of 1600 g. Their weight gains were comparable with bottle-fed babies receiving expressed breast milk. Practical aspects of breast feeding were considered to be: a knowledgeable maternal and nursing attitude, close mother and baby contact, early expression of breast milk, and early suckling. The increased incidence of breast feeding by mothers of both low birthweight and term babies ensures regular supplies of fresh breast milk. Therefore, sterilisation or storage of breast milk there is unnecessary.