Exploring the Impact of AA/DHA Supplementation on Visual Outcomes in Extremely Preterm Infants

In the realm of neonatal care, the delicate balance of providing essential nutrients for optimal growth and development in extremely preterm infants (EPT) continues to captivate researchers and medical professionals alike.

A groundbreaking study, Mega Donna Mega, initially investigated the intricate factors influencing the health trajectories of EPT children, focusing on their visual outcomes.

This follow-up exploration delves into the implications of postnatal enteral supplementation with arachidonic acid (AA) and docosahexaenoic acid (DHA) at 2.5 years corrected age, shedding light on a multifaceted landscape of findings.

The relationship between AA and DHA and their profound roles in the development of the central nervous system is firmly established. The intricacies of their impact extend to the retina and the broader neural structures of the visual system.

This study expands on this foundation, suggesting that AA and DHA supplementation holds the potential to bolster membrane integrity, mitigate oxidative stress, and pave the way for enhanced visual maturation. The visual system, an intricate interplay of photoreceptors, optic pathways, and cerebral processing centers, is uniquely influenced by these fatty acids.

Notably, the study’s scope extends beyond retinal maturation to encompass the broader neural components contributing to the visual process.

A key facet of the study lies in unraveling the complex interplay between supplementation, retinopathy of prematurity (ROP), and ultimate visual outcomes. Notably, the severity of ROP does not emerge as a significant factor influencing visual acuity outcomes in this context.

This finding challenges conventional assumptions and emphasizes the need for comprehensive investigations into the intricate relationship between retinal maturation, ROP, and subsequent visual development. A call for future preclinical studies to untangle the precise mechanisms governing this interplay emerges as an imperative.

The existing landscape of research on supplementation’s impact on visual outcomes in preterm infants is rife with contradictions. Moon et al.’s Cochrane review casts doubt on the efficacy of supplementation, while Shulkin et al.’s work highlights potential positive effects. The discordance, attributed to varying supplementation regimes and assessment methodologies, underscores the complexity of this domain.

The present study contributes to this discourse, offering insights into the role of AA and DHA supplementation. A pivotal aspect of the study is the quantification of actual LC-PUFA levels in supplemented children, providing a nuanced understanding of the intervention’s effects.

With serum fractions of AA and DHA consistently higher in supplemented infants, especially among the most premature, a novel angle emerges in the pursuit of enhanced visual outcomes.

The significance of LC-PUFAs in infant formula is a point of contention, further underscored by conflicting recommendations. The European Food Safety Authority advocates for DHA fortification, while the European Academy of Paediatrics asserts the importance of AA supplementation.

This study’s focus on AA/DHA combined supplementation leaves the individual contributions of each fatty acid to visual outcomes to be untangled in future research.

A cornerstone of this exploration is the meticulous assessment of visual outcomes, hinging on validated thresholds for “normal VA outcome” in children aged 30–35 months. The challenge lies in children unable to undergo traditional visual testing, often due to suspected neurological deficits.

This limitation underscores the symbiotic relationship between visual impairment and neurological challenges, urging further neurological testing within this demographic. The intricate correlation between visual deficits and later cognitive impairment advocates for an integrated approach to assessment and intervention.

The multifaceted evaluation of visual outcomes, ranging from preferential-looking tests to visual evoked potentials (VEP), adds depth to this study. VEP, circumventing the need for a child’s cooperation, paints a distinct picture of visual pathway function. While some studies report improved acuity and latency in supplemented children, the complexity of visual development and its interplay with supplementation remain enigmatic.

The shadows of uncertainty loom larger as the follow-up extends into long-term outcomes, as evidenced by Collins et al. and Molloy et al.’s findings at 7 years of age. The quest to unearth the mechanisms underpinning these observed improvements is a tantalizing avenue for future research.

The subtleties of visual perceptual problems and their connection with cortically rooted visual impairment (CVI) emerge as intriguing focal points. The underdiagnosis of CVI in EPT children, coupled with the crucial role of DHA in the visual process, beckons further exploration into the impact of LC-PUFAs on cortical visual pathways.

In conclusion, the Mega Donna Mega study’s exploratory follow-up traverses the intricate landscape of visual outcomes in EPT children with postnatal enteral AA/DHA supplementation.

While initial findings hint at positive impacts, the significance dissipates upon adjusting for various confounding factors.

The multifaceted nature of visual development in tandem with supplementation raises myriad questions yet to be answered. This study, with its meticulous assessments and innovative insights, adds a new layer to the discourse on LC-PUFAs and preterm visual outcomes, sparking the call for continued research to illuminate the intricate interplay of nutritional supplementation and neurological maturation.

reference link : https://www.sciencedirect.com/science/article/pii/S2666776223001151#sec4