Glutamine supplementation for prevention of morbidity in preterm infants.
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.


OBJECTIVE
To determine the effects of glutamine supplementation on morbidity and weight gain in preterm babies.


METHODS
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.


METHODS
Randomised controlled trials comparing glutamine supplementation to no glutamine supplementation in preterm babies at any time from birth to discharge from hospital.


METHODS
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.


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).


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.
Tubman
T R
TR
Neonatal Intensive Care Unit, Royal Maternity Hospital, Grosvenor Road, Belfast, Northern Ireland, UK. r.tubman@ntlworld.com
Thompson
S W
SW
D019587:Dietary Supplements; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature; D016032:Randomized Controlled Trials as Topic
D005973:Glutamine