Sara-Pier Paquet , Etienne Pronovost , David Simonyan , Georges Caouette , Célia Matte-Gagné , François Olivier , Julie Bartholomew , Alyssa Morin , Ibrahim Mohamed , Isabelle Marc , Mireille Guillot
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The participants received a high-dose DHA supplementation, or a placebo, through maternal breastmilk until 36 weeks’ postmenstrual age. Primary outcome was child behavioral functioning, assessed by the Total Difficulties Score from the Strengths and Difficulties Questionnaire (SDQ). Secondary outcomes included behavioral scores from the SDQ, executive functions assessment and global developmental performance. Neurodevelopmental outcomes were assessed through interviews with parents. Mean differences between DHA and placebo groups were estimated using mixed linear models. Subgroup analyses were conducted for sex and gestational age (GA) at birth.</div></div><div><h3>Results</h3><div>Among 177 eligible children, 132 (74.6 %) completed neurodevelopmental assessment at 5 years (DHA, N = 64, placebo, N = 68). Total Difficulties Score did not differ between the DHA and placebo groups (mean differences, −0.9 [95 % confidence interval, −2.7 to 0.8], P = 0.30), nor any of the secondary outcomes. There was no significant interaction between treatment groups and sex, nor GA, for the primary outcome. 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引用次数: 0
摘要
背景与目的:二十二碳六烯酸(DHA)是大脑中含量最丰富的欧米伽-3 脂肪酸,胎儿大脑在怀孕的最后三个月就会积累这种脂肪酸。我们的目的是确定在新生儿期补充高剂量 DHA 与补充安慰剂相比,是否能改善极早产儿 5 岁时的行为功能:这是对参加多中心随机对照试验的儿童进行的 5 岁随访。参加者在月经后 36 周之前一直通过母乳摄入高剂量 DHA 或安慰剂。主要结果是儿童的行为功能,通过优势与困难问卷(SDQ)中的困难总分进行评估。次要结果包括 SDQ 的行为得分、执行功能评估和总体发育表现。神经发育结果通过与家长的访谈进行评估。采用混合线性模型估算了DHA组和安慰剂组之间的平均差异。根据出生时的性别和胎龄(GA)进行了分组分析:在 177 名符合条件的儿童中,132 名(74.6%)在 5 岁时完成了神经发育评估(DHA,64 人;安慰剂,68 人)。DHA组和安慰剂组的总困难评分没有差异(平均差异为-0.9 [95%置信区间为-2.7至0.8],P=0.30),任何次要结果也没有差异。在主要结果方面,治疗组与性别和 GA 之间没有明显的交互作用。然而,在一些次要结果中,治疗组与性别或性别差异之间存在明显的交互作用:结论:对于早产儿,补充高剂量的 DHA 并不能改善其 5 岁时的行为功能:临床试验注册:ClinicalTrials.gov,NCT02371460,https://clinicaltrials.gov/study/NCT02371460。
Maternal high-dose docosahexaenoic acid supplementation and neurodevelopment at 5 Years of preterm children
Background & aims
Docosahexaenoic acid (DHA) is the most abundant omega-3 fatty acid in the brain and is accumulated by the fetal brain during the last trimester of pregnancy. Our objective was to determine whether high-dose DHA supplementation during the neonatal period, vs. placebo, improves behavioral functioning at 5 years in children born very preterm.
Methods
This is a follow-up at 5 years corrected age of a subset of children who participated in a multicenter randomized controlled trial. The participants received a high-dose DHA supplementation, or a placebo, through maternal breastmilk until 36 weeks’ postmenstrual age. Primary outcome was child behavioral functioning, assessed by the Total Difficulties Score from the Strengths and Difficulties Questionnaire (SDQ). Secondary outcomes included behavioral scores from the SDQ, executive functions assessment and global developmental performance. Neurodevelopmental outcomes were assessed through interviews with parents. Mean differences between DHA and placebo groups were estimated using mixed linear models. Subgroup analyses were conducted for sex and gestational age (GA) at birth.
Results
Among 177 eligible children, 132 (74.6 %) completed neurodevelopmental assessment at 5 years (DHA, N = 64, placebo, N = 68). Total Difficulties Score did not differ between the DHA and placebo groups (mean differences, −0.9 [95 % confidence interval, −2.7 to 0.8], P = 0.30), nor any of the secondary outcomes. There was no significant interaction between treatment groups and sex, nor GA, for the primary outcome. However, significant interactions between treatment groups and sex or GA were found for some secondary outcomes.
Conclusions
In very preterm infants, high-dose DHA supplementation did not improve behavioral functioning at 5 years.
期刊介绍:
Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.