309 - Gender-specific effects of long chain polyunsaturated fatty acid supplementation in very low birth weight infants

Poster Number: 309
Publication Number: 309.128

Brandy Frost, NorthShore University HealthSystem, Evanston, IL, United States; William MacKendrick, NorthShore University HealthSystem, Evanston, IL, United States

Background: Long chain polyunsaturated fatty acids (LCPUFA) contribute to eye and brain development in infants. LCPUFA levels decline in the first two weeks in very low birth weight (VLBW) infants from both baseline levels and expected in utero levels.  Supplementation of LCPUFA has been shown to improve levels in preterm infants.  We began to use routine LCPUFA supplementation in fall of 2020 in our neonatal intensive care unit (NICU).

Objective: To evaluate growth in VLBW infants supplemented with LCPUFA containing docosahexaenoic acid (DHA) and arachidonic acid (ARA) in calendar years 2021 and 2022, and compare them to a historical cohort from 2018 and 2019 that did not receive supplementation.

Design/Methods: We undertook a retrospective chart review of existing data in which all charts were reviewed for VLBW infants admitted to the NorthShore University HealthSystem NICU in calendar years 2018 and 2019 for the control group, with VLBW infants admitted in 2021 and 2022 as the treatment group. The main dependent variables were change in weight Z-score and head circumference Z-score between birth and 36 weeks postmenstrual age or discharge, whichever came first.  Independent variables included LCPUFA treatment,  gender, gestational age, birth weight Z-score, days to reach full enteral feeds, and morbidities including sepsis, necrotizing enterocolitis, gastrointestinal perforation, and chronic lung disease.  Linear regression models were used to explore the relationship between the dependent and independent variables.

Results: A total of 260 patients were included, 163 in the control group and 97 in the treatment group.  Initial models indicated a borderline effect of LCPUFA on weight z-score (p=0.09) but with gender showing a strong effect (p < 0.001).  When groups were stratified by gender, males showed a strong effect of LCPUFA on weight z-score (p=0.01), but no effect was seen in females.  Gestational age and birth weight z-score had marginally significant effects on weight z-score for males and females (p values 0.05-0.10).  In this study, there was no significant effect of LCPUFA on head circumference z-score in males or females.

Conclusion(s): In male VLBW infants, routine LCPUFA supplementation may improve growth as measured by weight z score.  Further research is needed to prospectively evaluate the effect of LCPUFA supplementation on growth in VLBW infants.