Makrides, M.Gibson, R.McPhee, A.Collins, C.Davis, P.Doyle, L.Simmer, K.Colditz, P.Morris, S.Smithers, L.Willson, K.Ryan, P.2009-11-302009-11-302009JAMA: Journal of the American Medical Association, 2009; 301(2):175-1820098-74841538-3598http://hdl.handle.net/2440/54123<h4>Context</h4>Uncertainty exists about the benefit of dietary docosahexaenoic acid (DHA) on the neurodevelopment of preterm infants.<h4>Objective</h4>To determine the effect of meeting the estimated DHA requirement of preterm infants on neurodevelopment at 18 months' corrected age.<h4>Design, setting, and participants</h4>Randomized, double-blind controlled trial enrolling infants born at less than 33 weeks' gestation from April 2001 to October 2005 at 5 Australian tertiary hospitals, with follow-up to 18 months.<h4>Intervention</h4>High-DHA (approximately 1% total fatty acids) enteral feeds compared with standard DHA (approximately 0.3% total fatty acids) from day 2 to 4 of life until term corrected age.<h4>Main outcome measures</h4>Bayley Mental Development Index (MDI) at 18 months' corrected age. A priori subgroup analyses were conducted based on randomization strata (sex and birth weight < 1250 g vs > or = 1250 g).<h4>Results</h4>Of the 657 infants enrolled, 93.5% completed the 18-month follow-up. Bayley MDI scores did not differ between the high- and standard-DHA groups (mean difference, 1.9; 95% confidence interval [CI], -1.0 to 4.7). The MDI among girls fed the high-DHA diet was higher than girls fed standard DHA in unadjusted and adjusted analyses (unadjusted mean difference, 4.7; 95% CI, 0.5-8.8; adjusted mean difference, 4.5; 95% CI, 0.5-8.5). The MDI among boys did not differ between groups. For infants born weighing less than 1250 g, the MDI in the high-DHA group was higher than with standard DHA in the unadjusted comparison (mean difference, 4.7; 95% CI, 0.2-9.2) but did not reach statistical significance following adjustment for gestational age, sex, maternal education, and birth order (mean difference, 3.8; 95% CI, -0.5 to 8.0). The MDI among infants born weighing at least 1250 g did not differ between groups.<h4>Conclusion</h4>A DHA dose of approximately 1% total fatty acids in early life did not increase MDI scores of preterm infants overall born earlier than 33 weeks but did improve the MDI scores of girls.<h4>Trial registration</h4>anzctr.org.au Identifier: ACTRN12606000327583.enHumansDocosahexaenoic AcidsDouble-Blind MethodChild DevelopmentNeuropsychological TestsDietary SupplementsInfantInfant, NewbornInfant, PrematureFemaleMaleJournal article002009003610.1001/jama.2008.9450002624055000192-s2.0-5824908883239421Makrides, M. [0000-0003-3832-541X]Gibson, R. [0000-0002-8750-525X]McPhee, A. [0000-0003-3820-5696]Collins, C. [0000-0003-3308-9948]Smithers, L. [0000-0002-6585-7836]