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Glutamine supplementation for preventing morbidity in preterm infants
1Neonatal Intensive Care Unit, Royal Maternity Hospital, Grosvenor Road, Belfast, Northern Ireland, UK. r.tubman@dnet.co.uk
Insights
Glutamine supplementation did not significantly improve outcomes or weight gain in preterm infants. Further research is needed to determine if glutamine enhances gut integrity and reduces sepsis rates in this population.
Area of Science:
- Neonatal Nutrition
- Pediatric Critical Care
- Amino Acid Metabolism
Background:
- Glutamine is a key fuel for rapidly dividing cells.
- Its role in critical illness is under investigation, primarily in adults and animal models.
- Limited data exists on glutamine's effects in infants, especially preterm babies.
Purpose of the Study:
- To evaluate the impact of glutamine supplementation on morbidity and weight gain in preterm infants.
- To synthesize evidence from randomized controlled trials on glutamine's efficacy in neonates.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials.
- Searches conducted in Medline and Embase databases.
- Included trials compared glutamine supplementation versus no supplementation in preterm infants.
Main Results:
- Three trials met inclusion criteria; meta-analysis of blood culture data showed no significant difference (RR = 0.73).
- No significant differences were found in time to full enteral nutrition, rate of weight gain, or duration of hospital stay.
- Pooled data from two studies indicated no statistically significant benefits from glutamine supplementation.
Conclusions:
- Current evidence does not support routine parenteral or enteral glutamine supplementation in preterm infants.
- A large randomized controlled trial is recommended to investigate glutamine's potential to improve gut integrity and reduce sepsis.
Background:
The amino acid glutamine is the preferred respiratory fuel for rapidly proliferating cells under normal conditions. Recent research has suggested a number of roles for glutamine during critical illness. This research has been largely performed in experimental animals and in adults in a variety of disease settings. There is little information on the role of glutamine in children and infants, or whether glutamine supplementation is beneficial in preterm babies.
Objectives:
To determine the effects of glutamine supplementation on morbidity and weight gain in preterm babies.
Search Strategy:
Searches were made using Medline and Embase electronic databases and specific handsearching in the English language. The search strategy followed the guidelines of the Neonatal Cochrane Review Group.
Selection Criteria:
Randomised controlled trials comparing glutamine supplementation to no glutamine supplementation in preterm babies at any time from birth to discharge from hospital.
Data Collection And Analysis:
Data regarding clinical outcomes including duration of parenteral nutrition, time to full enteral nutrition, rate of weight gain, rate of positive blood cultures and duration of hospital stay were extracted by both reviewers. Analysis was performed by the primary reviewer (TRJT) in accordance with the standards of the Cochrane Neonatal Review Group.
Main Results:
Three trials met the selection criteria. Data on proportion of babies having one or more of positive blood cultures were available from all three studies. Meta-analysis showed no significant difference between glutamine-supplemented and non-supplemented babies; RR = 0.73 (95% CI 0.44, 1.23), RD = -8.8% (95% CI -23.2, 5.5). Data for other outcome variables were pooled from two studies. There were no significant differences between glutamine-supplemented and non-supplemented babies for days to full enteral nutrition (WMD 0.42, 95% CI -3.0, 3.8), rate of weight gain (WMD 0.6 g/kg/d, 95% CI -1.6, 2.8) or days of hospital stay (WMD -2.4, 95% CI -14.9, 10.2).
Reviewer'S Conclusions:
There is no evidence to support the routine use of parenteral or enteral glutamine supplementation in preterm babies. A large randomised controlled trial should be performed to determine whether or not glutamine supplementation enhances gut integrity and reduces sepsis rate.
