Craig L Jensen

Effect of docosahexaenoic acid supplementation of lactating women on the fatty acid composition of breast milk lipids and maternal and infant plasma phospholipids

To determine whether docosahexaenoic acid (DHA) supplementation of breast-feeding mothers increases the DHA contents of breast milk and infant plasma phospholipids (PPs), breast-feeding women were randomly assigned to 3 DHA-supplementation groups (170-260 mg/d) or a control group. Group 1 (n = 6) consumed an algae-produced high-DHA triacylglycerol; group 2 (n = 6) consumed high-DHA eggs; group 3 (n = 6) consumed a high-DHA, low-eicosapentaenoic acid marine oil; and group 4 (n = 6) received no supplementation. From before to after supplementation (2 and 8 wk postpartum), mean (+/-SD) maternal PP DHA increased in groups 1, 2, and 3 by 1.20 +/- 0.53, 0.63 +/- 0.82, and 0.76 +/- 0.35 mol% of fatty acids, respectively (23-41%), but decreased in group 4 by 0.44 +/- 0.34 mol% (15%). Breast-milk DHA of groups 1, 2, and 3 increased by 0.21 +/- 0.16, 0.07 +/- 0.11, and 0. 12 +/- 0.07 mol%, respectively (32-91%) but decreased in group 4 by 0.03 +/- 0.04 mol% (17%). Mean infant PP DHA in groups 1, 2, and 3 increased by 1.63 +/- 0.79, 0.40 +/- 1.0, and 0.98 +/- 0.61 mol%, respectively (11-42%), but only by 0.18 +/- 0.74 mol% (5%) in group 4. Correlations between the DHA contents of maternal plasma and breast milk and of milk and infant PPs were significant. Breast-milk and maternal and infant PP 22:5n-6 concentrations were lowest in group 2. DHA supplementation increases the plasma and breast-milk DHA concentrations of lactating women, resulting in higher PP DHA concentrations in infants.

Intermediates in endogenous synthesis of C22:6 omega 3 and C20:4 omega 6 by term and preterm infants.

Objective: To describe the ScvO2 levels at the lower (86-90%) and higher (91 - 96%) end of the currently recommended range of pulseoximetry (SpO2) in newborn infants with respiratory insufficiency. Design: a prospective observational study. Patients: 10 newborn infants (birthweight: 720 - 3400 grams) suffering from RDS and treated with mechanical ventilation and oxygen administration. Methods: SpO2 and ScvO2 were measured continuously by pulseoximetry, and by a fiberoptic catheter inserted into the right atrium via the umbilical vein, respectively. Measurements and Results: SpO2, ScvO2 were registered and venous admixture (Ven Adm) (100- SpO2)/(100 - ScvO2) was calculated every 15 minutes. For each patient the mean values of SpO2, ScvO2 and Ven Adm were calculated for both levels of oxygenation (table). In all patients ScvO2 was significantly reduced and Ven Adm was significantly increased at the lower range of oxygenation (p < 0.05; unpaired Students T test).

Intermediates in Endogenous Synthesis of C22:6ω3 and C20:4ω6 by Term and Preterm Infants

An alternative pathway of ω3 and ω6 fatty acid metabolism has been described in isolated rat hepatocytes and human fibroblasts. This alternative pathway, which is independent of Δ4 desaturation, involves elongation of C22:5ω3 and C22:4ω6 to C24 fatty acids,Δ6 desaturation of the C24 fatty acids and subsequent β oxidation of the desaturated products to C22:6ω3 and C22:5ω6. To determine whether this alternative pathway is operative in the human infant and also to obtain additional information concerning endogenous conversion of C18:3ω3 and C18:2ω6 to longer chain more unsaturated fatty acids, presence of [M + 18] isotopomers of ω3 and ω6 fatty acids in the plasma phospholipid fraction of term and preterm infants after administration of [U-13C]18:3ω3 and [U-13C]18:2ω6 was determined by negative chemical ionization gas chromatography/mass spectrometry. [M + 18] isotopomers of the following ω3 fatty acids were detected: C18:3, C18:4, C20:3, C20:4, C20:5, C22:4, C22:5, C22:6, C24:4 (two infants only), C24:5, and C24:6. [M + 18] isotopomers of ω6 fatty acids detected included only C18:2, C18:3, C20:2, C20:3, and C20:4, but sensitivity was insufficient to detect [M + 18] isotopomers of C22 and C24 ω6 fatty acids. Presence of[M + 18] isotopomers of C24:5ω3 and C24:6ω3 indicates that these fatty acids were synthesized endogenously from C18:3ω3. This plus thein vitro data strongly suggests that infants use the recently described alternative pathway in endogenous synthesis of C22:6ω3. However, involvement also of Δ4 desaturation cannot be excluded. Detection of [M + 18] isotopomers of C20:3ω3, C20:2ω6, and C22:4ω3 suggests that C18:3ω3, C18:2ω6, and C20:4ω3 are elongated as well as desaturated. The specific fate of these elongation products and their importance in endogenous synthesis of ω3 and ω6 long chain polyunsaturated fatty acids remain to be determined.

Concurrent and Predictive Validity of the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) and the Mental Developmental Index of the Bayley Scales of Infant Development

The Cognitive Adaptive Test/ Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) was designed for use by primary pediatric health care providers to identify children with developmental delays. This study assesses the concurrent and predictive validity of CAT/CLAMS developmental quotient (DQ) scores and the Mental Developmental Index (MDI) of the Bayley Scales of Infant Development in healthy children without risk factors for developmental delay. Overall CAT/CLAMS DQ scores correlated significantly with Bayley MDI scores at both 12 (r=0.393; p=0.008) and 30 months (r=0.742; p=0.0001) of age. Overall CAT/CLAMS DQ scores at 12 months of age also correlated modestly with Bayley MDI scores at 30 months of age (r=0.181; p=0.036). Despite its modest predictive validity at 12 months, its satisfactory concurrent validity plus its ease and speed of administration make the CAT/CLAMS a reasonable choice for assessment of early development by primary pediatric health care providers.

Maternal Docosahexaenoic Acid (DHA) Supplementation Does Not Affect Neurodevelopmental Outcome of Breast-fed Term Infants at One Year of Age• 1584

Maternal Docosahexaenoic Acid (DHA) Supplementation Does Not Affect Neurodevelopmental Outcome of Breast-fed Term Infants at One Year of Age• 1584

EFFECT OF MATERNAL DOCOSAHEXAENOIC (DHA) SUPPLEMENTATION ON MILK AND INFANT PLASMA DHA. |[utrif]| 1857

The DHA content of plasma lipids of breast-fed infants, although higher than that of formula-fed infants, decreases over the first few weeks of life as does the DHA content of human milk. To determine if DHA supplementation of lactating mothers can prevent the decrease in DHA content of milk and infant plasma, breastfeeding women were assigned randomly to one of 3 DHA supplements, all providing daily DHA intakes of 200-260 mg, and the DHA content of their milk and infants plasma was determined before and after supplementation. Group 1 (n=6) received an algae-produced high-DHA triglyceride; Group 2 (n=6) received high-DHA eggs (2/d); Group 3 (n=6) received a high-DHA, low-EPA marine oil. Group 4 (n=6), received no supplementation. Milk DHA content of the 3 supplemented groups, respectively, increased by 100±123 (SD), 69±84 and 84±140 nmol/ml from 2 wks (when supplementation began) to 8 weeks postpartum (46-69%) while that of the control group decreased by 101±193 nmol/ml (51%). Concurrently, the mean percent of DHA in plasma phospholipid of infants of the 3 supplemented groups increased by 1.52±0.82%, 0.74±0.66% and 0.98±0.61%, respectively, (20-40% from baseline); the mean percent DHA in the control group increased by 0.33±0.72% (9% from baseline). These data illustrate that DHA supplementation of lactating women increases the DHA content of their milk and raises the DHA content of the recipient infants plasma phospholipid. The desirability of maternal DHA supplementation and, if so, the desirable amount of supplementation remain to be determined.

Concurrent and Predictive Validity of the Clinical Linguistic and Auditory Milestone Scale (CLAMS) and the Mental Developmental Index (MDI) of the Bayley Scales of Infant Development (BSID)

Concurrent and Predictive Validity of the Clinical Linguistic and Auditory Milestone Scale (CLAMS) and the Mental Developmental Index (MDI) of the Bayley Scales of Infant Development (BSID)

Evaluation of Methods for Assessing Visual Function of Infants † 1384

PURPOSE Commonly used behavioral and electrical testing methods for estimation of visual acuity and visual function in infants yield different estimates and may not accurately predict visual acuity and visual function in later life. Moreover, neither test-retest variability nor side-by-side comparisons of the various methods have been thoroughly evaluated in the same infant population. The purpose of this study was to provide such an evaluation. METHOD The test-retest variability of visual acuity and visual function was evaluated for the Teller Acuity Card (TAC) procedure, sweep visual evoked potential (VEP), as well as latency and amplitude measured by transient pattern VEP. Groups of approximately 20 infants contributed test-retest data. Visual function estimated by the various methods in a larger group of infants (n = 118) was compared. Correlations between methods and the validity of the various methods to detect maturational changes between 4 and 8 months of age were also assessed. Administration of these tests was according to standard and usual procedures. RESULTS The average percent difference between test and retest estimates of acuity as well as the SD was lowest for transient VEP latency (3%, 7% SD). The other methods were markedly more variable: sweep VEP (2%, 22% SD), TAC procedure (8%, 20% SD), and transient VEP amplitude (7.5%, 39% SD). Average coefficients of variation showed a similar trend: transient VEP latency, 8%; sweep VEP, 15%; TACs, 30%; and transient amplitude, 53%. Correlations among estimates by the methods were poor, but expected changes in visual maturation from 4 to 8 months of age were detected with all methods. CONCLUSIONS All methods evaluated provide valid and reliable test-retest data for a group, but are less valid for estimating visual acuity and visual function of an individual subject. The poor correlations between any 2 of the testing methods suggest that each test assesses a different aspect of vision. Nonetheless, expected maturational changes between 4 and 8 months of age were readily detectable by all methods evaluated.

CORRELATION BETWEEN ENDOGENOUS CONVERSION OF 18:3|[omega]|3 AND 18:2|[omega]|6 IN TERM AND PRETERM INFANTS. |[utrif]| 1902

Endogenous conversion of both 18:3ω3 and 18:2ω6 varies as a function of diet and age (Sauerwald et al. Pediatric Res, 1995) but there also is substantial variation within diet and age groups. We hypothesized that this latter variation is due to individual differences in conversion of the two fatty acids. To test this hypothesis, the fractional rates of conversion (FRC) of 18:3ω3 and 18:2ω6 and the fractional rates of incorporation(FRI) of 22:6ω3 and 20:4ω6 into plasma phospholipid (PL) were determined at 43 and 56 wk postmenstrual age in 11 preterm and 27 term infants fed formulas with 0.4%, 1% or 3.2% of fat as 18:3ω3 and correlations among FRC of 18:3ω3 and 18:2ω6 as well as FRI of 22:6ω3 and 20:4ω6 were determined by regression analysis. FRCs and FRIs were determined by a precursor/product compartmental model based on changes in enrichments of [M+18] fatty acids in plasma PL following administration of[U-13C]-18:3ω3 and -18:2ω6. The correlation coefficients(r) among FRCs and FRIs in 10 term infants on the same diet at 43 and 56 wk are shown: Table In all infants studied at both times, 55% of the variation in FRC of 18:2ω6 was explained by FRC of 18:3ω3 but only 12% of the variation in FRI of 20:4ω6 was explained by FRI of 22:6ω3. Although inherently obvious (ie, 18:3ω3 and 18:2ω6 are converted by the same desaturases and elongases), this is the first demonstration of such a correlation. It indicates that not only diet and age but individual differences in activity of desaturases and elongases may be important determinants of ω3 andω6 fatty acid status during infancy.

EFFECT OF α-LINOLENIC ACID (ALA) INTAKE DURING EARLY LIFE ON NEURODEVELOPMENTAL STATUS OF PRETERM INFANTS: ▴ 1915

EFFECT OF α-LINOLENIC ACID (ALA) INTAKE DURING EARLY LIFE ON NEURODEVELOPMENTAL STATUS OF PRETERM INFANTS: ▴ 1915