Funded Projects

Nutrition as Intervention: Trial of PUFA to Boost Development of Preterm Toddlers

Grantee: The Research Institute at Nationwide Children's Hospital
Principal Investigator: Sarah Keim
Project Number: R40MC28316
Project Date: 04/01/2015

Age group(s)

• Perinatal/Infancy (0-12 months)

Abstract

One in 9 U.S children is born preterm, and significant racial disparities persist in the risk of preterm birth. Children born preterm face significant cognitive deficits compared to term peers, and prematurity increases the risk of Attention Deficit Hyperactivity Disorder more than twofold. Decades of research have confirmed the effectiveness of comprehensive early intervention for improving long-term developmental outcomes; however, recent research has highlighted the potential of enhanced nutritional interventions to provide additional benefit, especially to children from low income or minority households. Additionally, national data have documented disparities in diet quality among US children, demonstrating that the children most likely to have significant health care needs are often those with poor diets. The benefits to cognitive development of dietary docosahexaenoic acid (DHA, an omega-3 polyunsaturated fatty acid (PUFA)) supplementation during early infancy for preterm infants are fairly wellestablished, but the question of whether supplementation during the active neurodevelopmental period in the second year of life provides additional benefit remains unanswered. Our long-term goal is to find safe, effective, and low-cost interventions to improve cognitive and behavioral outcomes in children born preterm. Our objective here is to determine the efficacy of nutrition as intervention, specifically, DHA plus arachidonic acid (AA) supplementation, in improving cognitive ability and early behavior problems (poor effortful control, high activity level) in toddlers born at less than 35 weeks' gestation. In this randomized controlled trial, data will be collected through parent report and direct assessment. Aim 1 is to evaluate the potential of DHA+AA supplementation to be a component of early intervention for children born preterm by comparing cognitive ability between the DHA+AA and placebo arms after 180 days of intervention. Aim 2 is to compare effortful control and activity level in a similar manner. Our central hypothesis is that children 10-16 months' corrected age randomized to DHA+AA supplementation will exhibit better cognitive ability, greater effortful control and less hyperactivity, compared to placebo. The rationale for the proposed research is that, if proven efficacious, this intervention will become a low-risk, low-cost complement to early intervention with this population, potentially as an expansion of Affordable Care Act-funded home visiting programming. Thus, the proposed study has the potential to promote healthy development and decrease health disparities in a special population of children born preterm; outcomes that are aligned with 'MCHB Strategic Research Issue #II: MCH services and systems of care efforts to eliminate health disparities' and 'MCHB Strategic Research Issue #IV: Promoting the healthy development of MCH populations.' The proposed study can be expected to rapidly advance the field: testing a low-cost nutritional intervention that has been beneficial to cognitive development in previous trials of younger children and to behavior in school-age children and pilot tested by our team allows us to achieve our goals within 3 years. The expected outcomes of the proposed study will contribute to achieving our long-term goal of finding safe, effective, and low-cost interventions to be integrated with early intervention approaches to improve outcomes for children born preterm.

Publications

Listed is descending order by year published.

Saleska JL, Sheppard K, Turner AN, Boone KM, Keim SA. Parental perceptions and behaviors regarding child weight status among toddlers born preterm. Am J Perinatol. 2020.

Boone KM, Nelin MA, Chisolm DJ, Keim SA. Gaps and factors related to receipt of care within a medical home for toddlers born preterm. The Journal of Pediatrics. 2019 Apr 1;207:161-8.e1.

Boone KM, Rausch J, Pelak G, Li R, Turner AN, Klebanoff MA, Keim SA. Docosahexaenoic acid and arachidonic acid supplementation and slep in toddlers born preterm: Secondary analysis of a randomized clinical trial. Journal of Clinical Sleep Medicine, 15(9),1197-1208.

Ingol TT, Li R, Boone KM, et al. Docosahexaenoic and arachidonic acid supplementation of toddlers born preterm does not affect short-term growth or adiposity. J Nutr. Dec 2019.

Ingol TT, Li R, Boone KM, Rausch J, Klebanoff MA, Turner AN, Yeates KO, Nelin MA, Sheppard KW, Keim SA. Docosahexaenoic and arachidonic acid supplementation of toddlers born preterm does not affect short-term growth or adiposity. The Journal of Nutrition. 2019 Jun 12.

Keim SA, Rogers LK, Klebanoff MA. Supplementing essential polyunsaturated fatty acids—a matter of respecting fetal development—reply. JAMA Pediatr. 2019;173(5):500. doi:10.1001/jamapediatrics.2019.0347

Saleska JL, Sheppard K, Turner AN, Boone KM, Keim SA. Parental perceptions and behaviors regarding child weight status among toddlers born preterm. American Journal of Perinatology. 2019 Mar 27.

Keim SA, Boone KM, Klebanoff MA, Turner AN, Rausch J, Nelin MA, Rogers LK, Yeates KO, Nelin L, Sheppard KW. Effect of docosahexaenoic acid supplementaion vs placebo on developmental outcomes of toddlers born preterm: a randomized clinical trial. JAMA Pediatrics. 2018 Dec 1;172(12):1126-34.