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Glutamine supplementation for prevention of morbidity in preterm infants
1Neonatal Intensive Care Unit, Royal Maternity Hospital, Grosvenor Road, Belfast, Northern Ireland, UK. r.tubman@ntlworld.com
Insights
Glutamine supplementation did not show significant benefits for preterm babies in the analyzed trials. Further research is needed to confirm its effects on gut health and sepsis rates in this population.
Area of Science:
- Neonatal Nutrition
- Critical Care Medicine
- Biochemistry
Background:
- Glutamine is a key fuel for rapidly dividing cells.
- Its role in critical illness is studied in adults and animals, with limited data in infants.
- The benefit of glutamine supplementation in preterm infants remains unclear.
Purpose of the Study:
- To assess the impact of glutamine supplementation on morbidity and weight gain in preterm infants.
- To evaluate clinical outcomes associated with glutamine use in neonates.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searches included major databases (Cochrane, Medline, Embase) and handsearching of pediatric journals (1980-2001).
- Included RCTs compared glutamine supplementation versus no supplementation in preterm babies.
Main Results:
- Three RCTs met inclusion criteria; meta-analysis of infection rates showed no significant difference (RR 0.73, 95% CI 0.44-1.23).
- No significant differences were found in time to full enteral nutrition (WMD 0.4 days), weight gain (WMD 0.6 g/kg/d), or hospital stay duration (WMD -2.4 days).
Conclusions:
- Current evidence from RCTs does not support routine glutamine supplementation in preterm infants.
- Larger RCTs are recommended to investigate glutamine's potential effects on gut integrity and sepsis reduction.
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 the Cochrane Controlled Trials Register, Medline and Embase electronic databases from 1980 - June 2001 (MeSH terms: glutamine, preterm, newborn, nutrition), handsearching of selected English language journals (Pediatrics, Journal of Pediatrics, Archives of Disease in Childhood and Journal of Pediatric Gastroenterology and Nutrition) from 1990 - June 2001, and cross-referencing from publications where necessary.
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 0.4 days, 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 days, 95% CI -14.9, 10.2).
Reviewer'S Conclusions:
There is no evidence from randomised trials 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.