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BMJ Open. 2018 May 26;8(5):e020043. doi: 10.1136/bmjopen-2017-020043.

Assessing whether early attention of very preterm infants can be improved by an omega-3 long-chain polyunsaturated fatty acid intervention: a follow-up of a randomised controlled trial.

Author information

Department of Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Schiefelbusch Institute for Life Span Studies and Department of Psychology, University of Kansas, Kansas, USA.
Dole Human Development Center, Lawrence, Kansas, USA.
Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
School of Agriculture, Food and Wine, Faculty of Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.



Docosahexaenoic acid (DHA) accumulates in the frontal lobes (responsible for higher-order cognitive skills) of the fetal brain during the last trimester of pregnancy. Infants born preterm miss some of this in utero provision of DHA, and have an increased risk of suboptimal neurodevelopment. It is thought that supplementing infants born preterm with DHA may improve developmental outcomes. The aim of this follow-up is to determine whether DHA supplementation in infants born preterm can improve areas of the brain associated with frontal lobe function, namely attention and distractibility.


We will assess a subset of children from the N-3 (omega-3) Fatty Acids for Improvement in Respiratory Outcomes (N3RO) multicentre double-blind randomised controlled trial of DHA supplementation. Infants born <29 weeks' completed gestation were randomised to receive an enteral emulsion containing 60 mg/kg/day of DHA or a control emulsion from within the first 3 days of enteral feeding until 36 weeks' postmenstrual age.Children will undergo multiple measures of attention at 18 months' corrected age. The primary outcome is the average time to be distracted when attention is focused on a toy. Secondary outcomes are other aspects of attention, and (where possible) an assessment of cognition, language and motor development with the Bayley Scales of Infant and Toddler Development, Third Edition.A minimum of 72 children will be assessed to ensure 85% power to detect an effect on the primary outcome. Families, and research personnel are blinded to group assignment. All analyses will be conducted according to the intention-to-treat principal.


All procedures were approved by the relevant institutional ethics committees prior to commencement of the study. Results will be disseminated in peer-reviewed journal publications and academic presentations.


ACTRN12612000503820; Pre-results.


attention; docosahexaenoic acid; neurodevelopment; preterm infant; randomised control trial

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: Study product was donated by Clover Corporation Limited, Australia. JFG is supported by a Women’s and Children’s Hospital Foundation MS McLeod Research Fellowship. MM is supported by an Australian National Health and Medical Research Council (NHMRC) Senior Research Fellowship ID: 1061704 and CTC is supported by a NHMRC Translating Research into Practice (TRIP) Fellowship ID 1132596. Honoraria have been paid to JFG’s institution to support conference travel by the Nestle Nutrition Institute. MM reports serving on scientific advisory boards for Nestle and Fonterra. Associated honoraria for MM are paid to her institution to support conference travel and continuing education for postgraduate students and early career researchers. JC also serves on scientific advisory boards for Nestle and Fonterra and is a consultant for Mead Johnson Nutrition. No other authors reported any financial disclosures. The contents of the published material are solely the responsibility of the authors and do not reflect the views of the NHMRC.

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