Effect of parenteral glutamine supplementation on plasma amino acid concentrations in extremely low-birth-weight infants.
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.
Poindexter
Brenda B
BB
Indiana University, Indianapolis, USA.
Ehrenkranz
Richard A
RA
Stoll
Barbara J
BJ
Koch
Matthew A
MA
Wright
Linda L
LL
Oh
William
W
Papile
Lu-Ann
LA
Bauer
Charles R
CR
Carlo
Waldemar A
WA
Donovan
Edward F
EF
Fanaroff
Avroy A
AA
Korones
Sheldon B
SB
Laptook
Abbot R
AR
Shankaran
Seetha
S
Stevenson
David K
DK
Tyson
Jon E
JE
Lemons
James A
JA
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
D000596:Amino Acids; D005973:Glutamine; D018698:Glutamic Acid; D014443:Tyrosine; D010649:Phenylalanine; D000641:Ammonia