Long chain polyunsaturated fatty acid supplementation in infants born at term

Background The long chain polyunsaturated fatty acids (LCPUFA) docosahexaenoic acid (DHA) and arachidonic acid (AA) are considered essential for maturation of the developing brain, retina and other organs in newborn infants. Standard infant milk formulae are not supplemented with LCPUFA; they contain only alpha‐linolenic acid and linoleic acid, from which formula‐fed infants must synthesise their own DHA and AA, respectively. Over the past few years, some manufacturers have added LCPUFA to formula milk and have marketed these products as providing an advantage for the overall development of full‐term infants. Objectives To assess whether supplementation of formula milk with LCPUFA is both safe and beneficial for full‐term infants, while focusing on effects on visual function, neurodevelopment and physical growth. Search methods Two review authors independently searched the Cochrane Central Register of Controlled Trials (CENTRAL; December 2016), MEDLINE (Ovid, 1966 to December 2016), Embase (Ovid, 1980 to December 2016), the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1980 to December 2016) and s of the Pediatric Academic Societies (2000 to 2016). We applied no language restrictions. Selection criteria We reviewed all randomised controlled trials (RCTs) evaluating effects of LCPUFA supplemented versus non‐supplemented formula milk on visual function, neurodevelopment and physical growth. We did not include trials reporting only biochemical outcomes. Data collection and analysis Two review authors extracted data independently. We assessed risk of bias of included studies using the guidelines of the Cochrane Neonatal Review Group. When appropriate, we conducted meta‐analysis to determine a pooled estimate of effect. Main results We identified 31 RCTs and included 15 of these in the review (N = 1889). Nine studies assessed visual acuity, six of which used visual evoked potentials (VEP), two Teller cards and one both. Four studies reported beneficial effects, and the remaining five did not. Meta‐analysis of three RCTs showed significant benefit for sweep VEP acuity at 12 months (log of the minimum angle of resolution (logMAR)) (mean difference (MD) ‐0.15, 95% confidence interval (CI) ‐0.17 to ‐0.13; I2 = 0; three trials; N = 244), but meta‐analysis of three other RCTs showed no benefit for visual acuity measured with Teller cards at 12 months (cycles/degree) (MD ‐0.01, 95% CI ‐0.12 to 0.11; I2 = 0; three trials; N = 256). GRADE analysis fo