Parenteral nutrition for preterm infants: correcting for arachidonic and docosahexaenoic acid may not suffice

In their review, Frazer and Martin1 address imbalanced supply with arachidonic (ARA) and docosahexaenoic acid (DHA) as central to preterm infant parenteral nutrition, advocating administration in adequate amounts and ratios, that fish oil containing suspensions corrupt physiological fatty acid profile and that supplying DHA without ARA is harmful to preterm infants <29 weeks. At 4 g/kg/d fat supply, SMOFlipid (2–7 mg/mL DHA) delivers 40–140 mg/kg/d DHA, but <10 mg/kg/d ARA (own unpublished data), contrasting with ~140–212 mg/kg/d ARA and ~43 mg/kg/d DHA physiological accretion during the third trimester. While we fully agree, additional aspects should be taken into account: 1. The authors suggest an ARA:DHA ratio of 2:1, which was associated with superior outcome when compared with lower …