Early behavior and development are influenced by the n-6 and n-3 status in prematures

In a cohort of premature infants, consecutively included in the study at birth and followed to 18 months of age, the neonatal status of essential fatty acids and longchain polyunsaturated fatty acids (LCPUFA) were investigated and correlated to the development at 40 and 44 weeks gestational age and at 3, 6, 10 and 18 months corrected age. The diet reported by the mothers contained low EFA, 98% had an intake < 1 energy% of n-3 fatty acids. Fatty acid analyses were performed in early breast milk and in mothers’ and infants’ plasma phospholipids early after birth and at gestational age 40 and 44 weeks. The development of the infants were assessed with Brazelton Neonatal Behavioral Assessment Scale (BNBAS) at 40 and 44 weeks and with Bayley’s Scales of Infant Development (Second Edition (BSID-II) at 3, 6, 10 and 18 months corrected age. At 40 weeks and 3 months videotapes were made of the infants’ spontaneous motor behavior to assess the quality of their general movements. Adjustments for confounding background factors were made in multiple logistic regression analyses and mothers’ education had the highest impact of the background variables. At all ages tested the n-6 fatty acid concentrations, expressed as total concentrations, LA, AA or as ratios to n-3 fatty acids in breast milk and early plasma phospholipids were negatively associated with development. Positive associations with LCPUFA, especially DHA, were mainly found after 10 months of age. Both mental and motor developments had similar pattern of associations, fatty acid concentrations and background factors explaining 20-50% (R2) of the developmental scores. This was only an observational study, and it cannot be excluded that the highly negative influence of n- 6 fatty acids was an effect of the low intake of n-3 fatty acids, which in the context of the changes generally seen in Western diet imply urgent need for larger studies