Summary: A novel study reveals that preterm babies given a supplement of omega-3 and omega-6 fatty acids show significantly better visual function by age two and a half.
Conducted between 2016 and 2019, the study involved 178 extremely preterm babies, born before the 28th week of pregnancy. The supplement not only reduced the risk of a sight-threatening eye disease but also seemed to enhance the brain’s interpretation of visual stimuli. The findings could influence new guidelines for neonatal care.
The study covered 178 extremely preterm babies in Sweden and found that those given a combination of omega-3 and omega-6 fatty acids had improved visual function by age two and a half.
The omega-3 and omega-6 supplements halved the risk of developing the eye disease ROP (retinopathy of prematurity).
The benefits of the supplement extend beyond retinal health, appearing to improve the brain’s ability to process visual impressions.
Source: University of Gothenburg
Preterm babies given a supplement with a combination of omega-3 and omega-6 fatty acids have better visual function by the age of two and a half. This has been shown by a study at the University of Gothenburg, Sweden.
The study, published in The Lancet Regional Health Europe, covers 178 extremely preterm babies at the neonatal units of the university hospitals in Gothenburg, Lund, and Stockholm between 2016 and 2019.
Extremely preterm babies are those born before the 28th week of pregnancy.
Around half of the children were given preventive oral nutritional supplements containing the omega-6 fatty acid AA (arachidonic acid) and the omega-3 fatty acid DHA (docosahexaenoic acid).
Neither AA nor DHA are included in the supplements that are currently routinely given to extremely preterm babies immediately after birth.
The researchers have previously found that the combination supplement led to the risk of contracting the sight-threatening eye disease ROP (retinopathy of prematurity) being halved.
The current study looks at children’s visual development at two and a half years of corrected age (i.e. age from the estimated date of birth).
Better visual interpretation in the brain
The study’s first author is Pia Lundgren, an associate professor in pediatric eye research at the University of Gothenburg’s Sahlgrenska Academy and a chief physician at Sahlgrenska University Hospital.
“The study shows that children who have received the combination supplement had improved visual function, regardless of whether or not they had previously had ROP,” she notes.
“The improved visual development was thus not only due to the beneficial effect on the retina. The supplement also seems to have improved the brain’s ability to interpret visual impressions.”
The issue of nutrition and supplementation for extremely preterm babies is a highly topical issue within neonatal care in many parts of the world. Sweden currently lacks precise guidelines for administering fatty acid supplements to extremely preterm children, but the guidelines are now being revised – partly on the basis of the current findings.
Studying cognition and neurology
“Importantly, we can now demonstrate the positive effects that the combination supplement appears to have on visual development when the child is older,” Pia adds.
“In the continued studies – on the same group of children – we will also look more closely at cognitive and neurological development, which will be particularly interesting.”
The research is supported by the Swedish Research Council’s call for clinical treatment research and is being led by Ann Hellström, Professor of Pediatric Ophthalmology at the University of Gothenburg who also works at Sahlgrenska University Hospital.
Other researchers are affiliated with Karolinska Institutet and Karolinska University Hospital, Lund University and Skåne University Hospital, and Harvard Medical School and Boston Children’s Hospital in the USA.
About this neurodevelopment and visual neuroscience research news
Visual outcome at 2.5 years of age in ω-3 and ω-6 long-chain polyunsaturated fatty acid supplemented preterm infants: a follow-up of a randomized controlled trial
We investigated ophthalmological outcomes at 2.5 years of corrected age in children born extremely preterm (EPT) to evaluate the effects of postnatal enteral supplementation with ω-3 and ω-6 long-chain polyunsaturated fatty acids.
In the Mega Donna Mega clinical trial, EPT infants born at less than 28 weeks of gestation were randomized to receive an enteral supplementation of docosahexaenoic acid (DHA) and arachidonic acid (AA) from birth to 40 weeks postmenstrual age. In this exploratory follow-up at 2.5 years of corrected age, we assessed visual acuity (VA), refraction, manifest strabismus, and nystagmus. Satisfactory VA was defined as ≥20/63. Multiple imputation (MI) was used to address the issue of missing data.
Of 178 children in the trial, 115 (with median gestational age (GA) of 25 + 4/7 weeks and median birth weights of 790 g) were ophthalmologically assessed at a median corrected age of 2.7 years (range 2.0–3.9 years). VA assessment was missing in 42.1% (75/178), in 41.7% (35/84) of the AA/DHA supplemented infants, and in 42.6% (40/94) of the control infants. After MI and adjustments for GA, study center, plurality, and corrected age at VA exam, no significant effect of AA/DHA supplementation was detected in VA outcome (≥20/63) (odds ratio 2.16, confidence interval 95% 0.99–4.69, p = 0.053).
In this randomized controlled trial follow-up, postnatal supplementation with enteral AA/DHA to EPT children did not significantly alter VA at 2.5 years of corrected age. Due to the high loss to follow-up rate and the limited statistical power, additional studies are needed.
The Swedish Medical Research Council #2020-01092, The Gothenburg Medical Society, Government grants under the ALF agreement ALFGBG-717971 and ALFGBG-971188, De Blindas Vänner, Knut and Alice Wallenberg Foundation – Wallenberg Clinical Scholars, NIH EY017017, EY030904 BCH IDDRC (1U54HD090255 Massachusetts Lions Eye Foundation) supported the study.