Longchain polyunsaturated fatty acid supplementation in preterm infants.
Longchain polyunsaturated fatty acid supplementation in preterm infants.
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DOI：
10.1002/14651858.cd000375.pub2
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发表时间：
2004
期刊：
影响因子：
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通讯作者：
K. Simmer;S. Patole
中科院分区：
文献类型：
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作者：
K. Simmer;S. Patole
背景n-3和n-6必需脂肪酸α亚麻酸（ALA）和亚油酸（LA）是n-3和n-6长链多不饱和脂肪酸（LCPUFA）的前体。关于LCPUFA是否是早产儿的必需营养素存在争议，因为早产儿可能无法合成足够量的LCPUFA来满足发育中的大脑和视网膜的需要。本综述的目的是评估添加LCPUFA的配方奶粉是否安全，是否对早产儿有益。研究策略通过MEDLINE（2003年10月）、牛津围产期试验数据库、科克伦对照试验中心注册库（CENTRAL，科克伦图书馆，2003年第2期）以及通过检查相关文章和会议记录的参考文献列表来识别试验。选择标准对所有添加LCPUFA配方奶粉的随机试验和临床终点进行了审查。数据收集和分析11项随机试验评估了补充LCPUFA的喂养配方奶粉的临床效果。主要结果在纳入本综述的11项随机试验中，由于评估方法的问题，尽管进行了盲法评估和完整的随访，但其中两项试验未被归类为高质量。视力：第一年的视力在6项研究中通过Teller视力卡测量，在4项研究中通过VEP测量，在2项研究中通过ERG测量。大多数研究发现，补充和对照组婴儿之间的任何视觉评估没有显着差异。大多数试验在产后12至24个月使用贝利婴儿发育量表（BSID），并显示补充后没有显着效果。三项研究（Fewtrell 2002，奥康纳2001，货车Wezel 2002）的BSID荟萃分析显示，补充剂对发育没有显著影响。Carlson（1993）和Carlson（1996）证明，与对照组相比，补充者对新奇事物的偏好较低（可能预示着智力较低）。然而，研究人员得出结论，补充的婴儿可能有更快的视觉信息处理，因为他们有更多的目光，每次目光的持续时间更短。生长大多数试验报告LCPUFA补充剂对早产儿的生长没有显著影响。两项试验（Carlson 1993，Carlson 1996）表明，补充LCPUFA的婴儿生长不如对照组，这可能是由于使用n-3补充剂而不使用n-6补充剂时AA水平降低。最近的试验中添加AA的补充报告没有显着影响的增长。Fewtrell 2002报告了18个月时的身长和体重z评分轻度降低。与这些结果相反，五项研究的荟萃分析（Uauy 1992，Carlson 1996，汉森1997，Vanderhoof 1999，Innis 2002）显示，补充营养的婴儿在足月后两个月体重和身长增加。副作用Uauy 1992报道补充LCPUFA对出血时间和红细胞膜脆性无显著影响。评审员结论：参加试验的婴儿是相对成熟和健康的早产儿。评估时间表和方法、补充剂的剂量和来源以及对照配方的脂肪酸组成在试验之间变化。对于接受添加LCPUFA的配方奶粉的婴儿来说，没有长期益处。没有证据表明添加n-3和n-6 LCPUFA的配方奶粉会损害早产儿的生长。
BACKGROUND The n-3 and n-6 essential fatty acids alpha linolenic acid (ALA) and linoleic acid (LA) are the precursors of the n-3 and n-6 longchain polyunsaturated fatty acids (LCPUFA). Controversy exists over whether LCPUFA are essential nutrients for preterm infants who may not be able to synthesise sufficient amounts of LCPUFA to satisfy the needs of the developing brain and retina. OBJECTIVES The aim of this review is to assess whether supplementation of formula with LCPUFA is safe and of benefit to preterm infants. SEARCH STRATEGY Trials were identified by MEDLINE (October 2003), Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2003) and by checking reference lists of relevant articles and conference proceedings. SELECTION CRITERIA All randomised trials of formula supplemented with LCPUFA and with clinical endpoints were reviewed. DATA COLLECTION AND ANALYSIS Eleven randomised trials assessing the clinical effects of feeding formula supplemented with LCPUFA were included in the review. MAIN RESULTS Of the eleven randomised trials included in the review, two of these were not classified as of high quality despite blinded assessment and complete follow-up, due to problems with assessment methodology. VISUAL ACUITY: Visual acuity over the first year was measured by Teller acuity cards in six studies, by VEP in four studies and by ERG in two studies. Most studies found no significant differences in any visual assessment between supplemented and control infants. DEVELOPMENT Most of the trials have used Bayley Scales of Infant Development (BSID) at 12 to 24 months postterm and shown no significant effect following supplementation. Meta-analysis of BSID of three studies (Fewtrell 2002, O'Connor 2001, van Wezel 2002) shows no significant effect of supplementation on development. Carlson 1993 and Carlson 1996 demonstrated lower novelty preferences (possibly predictive of lower intelligence) in the supplemented compared with the control group. The investigators however concluded that supplemented infants may have more rapid visual information processing given that they had more looks and each look was of shorter duration. GROWTH Most trials have reported no significant effect of LCPUFA supplementation on growth of preterm infants. Two trials (Carlson 1993, Carlson 1996) suggest that LCPUFA supplemented infants grow less well than controls, possibly due to a reduction in AA levels which occurs when n-3 supplements are used without n-6 supplements. Recent trials with addition of AA to the supplement have reported no significant effect on growth. Fewtrell 2002 reported mild reductions in length and weight z scores at 18 months. Contrary to these results, the meta-analysis of five studies (Uauy 1992, Carlson 1996, Hansen 1997, Vanderhoof 1999, Innis 2002) showed increased weight and length at two months post-term in supplemented infants. SIDE EFFECTS Uauy 1992 reported no significant effect of LCPUFA supplementation on bleeding time and red cell membrane fragility. REVIEWER'S CONCLUSIONS Infants enrolled in the trials were relatively mature and healthy preterm infants. Assessment schedule and methodology, dose and source of supplementation and fatty acid composition of the control formula varied between trials. No long-term benefits were demonstrated for infants receiving formula supplemented with LCPUFA. There was no evidence that supplementation of formula with n-3 and n-6 LCPUFA impaired the growth of preterm infants.