title: Effect of parenteral glutamine supplementation on plasma amino acid concentrations in extremely low-birth-weight infants.
abstract: BACKGROUND
  Glutamine is one of the most abundant amino acids in both plasma and human milk and may be conditionally essential in premature infants. However, glutamine is not provided by standard intravenous amino acid solutions.
  
  
  OBJECTIVE
  We assessed the effect of parenteral glutamine supplementation on plasma amino acid concentrations in extremely low-birth-weight infants receiving parenteral nutrition (PN).
  
  
  METHODS
  A total of 141 infants with birth weights of 401-1000 g were randomly assigned to receive a standard intravenous amino acid solution that did not contain glutamine or an isonitrogenous amino acid solution with 20% of the total amino acids as glutamine. Blood samples were obtained just before initiation of study PN and again after the infants had received study PN (mean intake: 2.3 +/- 1.0 g amino acids x kg(-1) x d(-1)) for approximately 10 d.
  
  
  RESULTS
  Infants randomly assigned to receive glutamine had mean plasma glutamine concentrations that increased significantly and were approximately 30% higher than those in the control group in response to PN (425 +/- 182 and 332 +/- 148 micromol/L for the glutamine and control groups, respectively). There was no significant difference between the 2 groups in the relative change in plasma glutamate concentration between the baseline and PN samples. In both groups, there were significant decreases in plasma phenylalanine and tyrosine between the baseline and PN samples; the decrease in tyrosine was greater in the group that received glutamine.
  
  
  CONCLUSIONS
  In extremely low-birth-weight infants, parenteral glutamine supplementation can increase plasma glutamine concentrations without apparent biochemical risk. Currently available amino acid solutions are likely to be suboptimal in their supply of phenylalanine, tyrosine, or both for these infants.
authors.affiliation: Indiana University, Indianapolis, USA.
authors.forename: Brenda B
authors.initials: BB
authors.lastname: Poindexter
authors.forename: Richard A
authors.initials: RA
authors.lastname: Ehrenkranz
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Koch
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
authors.forename: William
authors.initials: W
authors.lastname: Oh
authors.forename: Lu-Ann
authors.initials: LA
authors.lastname: Papile
authors.forename: Charles R
authors.initials: CR
authors.lastname: Bauer
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Edward F
authors.initials: EF
authors.lastname: Donovan
authors.forename: Avroy A
authors.initials: AA
authors.lastname: Fanaroff
authors.forename: Sheldon B
authors.initials: SB
authors.lastname: Korones
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: David K
authors.initials: DK
authors.lastname: Stevenson
authors.forename: Jon E
authors.initials: JE
authors.lastname: Tyson
authors.forename: James A
authors.initials: JA
authors.lastname: Lemons
mesh_terms: D000596:Amino Acids / Q000097:blood*; D000641:Ammonia / Q000097:blood; D005260:Female; D018698:Glutamic Acid / Q000097:blood; D005973:Glutamine / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000097:blood*; D008297:Male; D009751:Nutritional Requirements; D010288:Parenteral Nutrition; D010649:Phenylalanine / Q000097:blood; D012449:Safety; D014443:Tyrosine / Q000097:blood
chemical_list: D000596:Amino Acids; D005973:Glutamine; D018698:Glutamic Acid; D014443:Tyrosine; D010649:Phenylalanine; D000641:Ammonia