{
  "abstract": "Objective Investigate whether enteral supplementation with arachidonic acid (AA) and docosahexaenoic acid (DHA), from birth to term-equivalent age (TEA), promotes brain maturation as a prespecified secondary outcome of a multicentre randomised controlled trial.Participants 206 infants born at 22–28 weeks gestational age (GA) were randomised into intervention or control groups from three university hospitals in Sweden.Intervention The intervention group received an oil with AA (100 mg/kg/d) and DHA (50 mg/kg/d) starting at birth until 40 weeks postmenstrual age (PMA) in addition to standard nutrition. Standard-of-care infants received standard nutrition according to national guidelines.Main outcome and measures MRI volumetrics were defined a priori as a secondary outcome of the trial and included total brain, white and cortical grey matter, central structures and cerebellum. Univariable and multivariable linear regression models were used for comparisons.Results MRI data in 117 infants had sufficient quality for inclusion (n=58 intervention). Birth weight, GA at birth, sex distribution, and PMA at MRI were similar in the groups. Infants receiving intervention had significantly larger white-matter volume at TEA, as compared with standard of care, in models adjusted for GA at birth, sex, study centre and PMA at MRI (β=6.8 cm 3, 95% CI 0.7 to 12.9, p=0.028). The contribution of the intervention to white-matter volume corresponded to 10 days of prolonged gestation.Conclusion and relevance Our findings in this hypothesis-generating study suggest that AA+DHA promotes white matter growth, which may protect the developing brain in this vulnerable population.Trial registration number NCT03201588.",
  "authors": [
    {
      "affiliations": [
        "Institute of Clinical Sciences, Department of Pediatrics, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden",
        "Region Västra Götaland, Dept of Pediatrics, The Queen Silvia Children′s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden"
      ],
      "name": "William Hellström"
    },
    {
      "affiliations": [
        "Section for Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden",
        "Region Västra Götaland, Dept of Pediatric Ophtalmology, The Queen Silvia Children′s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden"
      ],
      "name": "Pia Lundgren"
    },
    {
      "affiliations": [
        "Section for Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Anders K Nilsson"
    },
    {
      "affiliations": [
        "Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Staffan Nilsson"
    },
    {
      "affiliations": [
        "Section for Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Anna-Lena Hård"
    },
    {
      "affiliations": [
        "Section for Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden",
        "Institute of Health and Care Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden"
      ],
      "name": "Ulrika Sjöbom"
    },
    {
      "affiliations": [
        "Section for Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden",
        "Institute of Health and Care Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden"
      ],
      "name": "Chatarina Löfqvist"
    },
    {
      "affiliations": [
        "Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden",
        "Department of Radiology, Section of Neuroradiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden"
      ],
      "name": "Isabella M Björkman-Burtscher"
    },
    {
      "affiliations": [
        "Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden",
        "Division of Neonatology, Department of Pediatrics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany"
      ],
      "name": "Dirk Wackernagel"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences, Lund, Pediatrics, Lund University, and Skåne University Hospital, Lund, Sweden"
      ],
      "name": "Ingrid Hansen-Pupp"
    },
    {
      "affiliations": [
        "The Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Lois EH Smith"
    },
    {
      "affiliations": [
        "Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Boubou Hallberg"
    },
    {
      "affiliations": [
        "Region Västra Götaland, Dept of Neonatology, The Queen Silvia Children′s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden"
      ],
      "name": "Karin Sävman"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences, Lund, Pediatrics, Lund University, and Skåne University Hospital, Lund, Sweden"
      ],
      "name": "David Ley"
    },
    {
      "affiliations": [
        "Section for Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden",
        "Region Västra Götaland, Dept of Pediatric Ophtalmology, The Queen Silvia Children′s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden"
      ],
      "name": "Ann Hellström"
    },
    {
      "affiliations": [
        "Department of Medical Radiation Sciences, Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Rolf A Heckemann"
    }
  ],
  "title": "Effect of enteral arachidonic acid and docosahexaenoic acid supplementation on brain volumes at term in preterm infants: a secondary outcome analysis of a randomised controlled trial",
  "uid": "64d8100f-b806-5eb9-b5f4-f78635d5c019"
}