南澳大利亚健康与医学研究所Jacqueline F. Gould团队研究了新生儿补充二十二碳六烯酸对早产儿5岁智商的影响。2022年10月26日出版的《新英格兰医学杂志》发表了这项成果。

二十二碳六烯酸（DHA）是神经组织的一种成分。由于DHA在妊娠最后三个月时在胎儿大脑中累积量最大，因此在妊娠29周前出生的婴儿无法获得DHA的正常供应。这种缺陷对后续认知发展的影响尚不清楚。

研究组评估了参加新生儿DHA补充剂预防支气管肺发育不良试验的5岁儿童的一般智力。在此前试验中，妊娠29周前出生的婴儿被1:1随机分配，从最初3天的肠内喂养到36胎龄或出院回家（以先发生者为准），每天每公斤体重摄入60毫克DHA的肠内乳剂或对照乳剂。在最初的试验中，13个中心中有5个中心的儿童被邀请在5岁校正后接受韦氏学龄前和初级智力量表（WPPSI）的评估。主要结局是全面智商（FSIQ）评分。次要结局包括WPPSI的组成部分。

在最初的试验中，共有1273名婴儿接受了随机分组；在本次随访研究中纳入的656名在中心接受随机分组的存活儿童中，480名（73%）的FSIQ得分可用，DHA组为241分，对照组为239分。缺失数据插补后，DHA组的平均（±SD）FSIQ得分为95.4±17.3，对照组为91.9±19.1（校正后的差异为3.45，具有统计学意义）。次要结局的结果通常不支持主要结局的结果。两组的不良事件相似。

这项试验表明，在妊娠29周前出生的婴儿中，在胎龄36周前使用肠内DHA乳剂与5岁时FSIQ分数略高于对照喂养相关。

附：英文原文

Title: Neonatal Docosahexaenoic Acid in Preterm Infants and Intelligence at 5 Years

Author: Jacqueline F. Gould, Ph.D.,, Maria Makrides, Ph.D.,, Robert A. Gibson, Ph.D.,, Thomas R. Sullivan, Ph.D.,, Andrew J. McPhee, M.B., B.S.,, Peter J. Anderson, Ph.D.,, Karen P. Best, Ph.D.,, Mary Sharp, M.B., B.S.,, Jeanie L.Y. Cheong, M.D.,, Gillian F. Opie, M.B., B.S.,, Javeed Travadi, D.M.,, Jana M. Bednarz, G.Dip.,, Peter G. Davis, M.D.,, Karen Simmer, M.D.,, Lex W. Doyle, M.D.,, and Carmel T. Collins, Ph.D.

Issue&Volume: 2022-10-26

Abstract:

Background

Docosahexaenoic acid (DHA) is a component of neural tissue. Because its accretion into the brain is greatest during the final trimester of pregnancy, infants born before 29 weeks’ gestation do not receive the normal supply of DHA. The effect of this deficiency on subsequent cognitive development is not well understood.

Methods

We assessed general intelligence at 5 years in children who had been enrolled in a trial of neonatal DHA supplementation to prevent bronchopulmonary dysplasia. In the previous trial, infants born before 29 weeks’ gestation had been randomly assigned in a 1:1 ratio to receive an enteral emulsion that provided 60 mg of DHA per kilogram of body weight per day or a control emulsion from the first 3 days of enteral feeds until 36 weeks of postmenstrual age or discharge home, whichever occurred first. Children from 5 of the 13 centers in the original trial were invited to undergo assessment with the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) at 5 years of corrected age. The primary outcome was the full-scale intelligence quotient (FSIQ) score. Secondary outcomes included the components of WPPSI.

Results

A total of 1273 infants underwent randomization in the original trial; of the 656 surviving children who had undergone randomization at the centers included in this follow-up study, 480 (73%) had an FSIQ score available — 241 in the DHA group and 239 in the control group. After imputation of missing data, the mean (±SD) FSIQ scores were 95.4±17.3 in the DHA group and 91.9±19.1 in the control group (adjusted difference, 3.45; 95% confidence interval, 0.38 to 6.53; P=0.03). The results for secondary outcomes generally did not support that obtained for the primary outcome. Adverse events were similar in the two groups.

Conclusions

In infants born before 29 weeks’ gestation who had been enrolled in a trial to assess the effect of DHA supplementation on bronchopulmonary dysplasia, the use of an enteral DHA emulsion until 36 weeks of postmenstrual age was associated with modestly higher FSIQ scores at 5 years of age than control feeding.

DOI: 10.1056/NEJMoa2206868

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2206868