Parenteral glutamine supplementation does not reduce the risk of mortality or late-onset sepsis in extremely low birth weight infants.
BACKGROUND
Glutamine is one of the most abundant amino acids in both plasma and human milk, yet it is not included in standard intravenous amino acid solutions. Previous studies have suggested that parenteral nutrition (PN) supplemented with glutamine may reduce sepsis and mortality in critically ill adults. Whether glutamine supplementation would provide a similar benefit to extremely low birth weight (ELBW) infants is not known.


METHODS
We performed a multicenter, randomized, double-masked, clinical trial to assess the safety and efficacy of early PN supplemented with glutamine in decreasing the risk of death or late-onset sepsis in ELBW infants. Infants 401 to 1000 g were randomized within 72 hours of birth to receive either TrophAmine (control) or an isonitrogenous study amino acid solution with 20% glutamine whenever they received PN up to 120 days of age, death, or discharge from the hospital. The primary outcome was death or late-onset sepsis.


RESULTS
Of the 721 infants who were assigned to glutamine supplementation, 370 (51%) died or developed late-onset sepsis, as compared with 343 of the 712 infants (48%) assigned to control (relative risk: 1.07; 95% confidence interval: 0.97-1.17). Glutamine had no effect on tolerance of enteral feeds, necrotizing enterocolitis, or growth. No significant adverse events were observed with glutamine supplementation.


CONCLUSIONS
Parenteral glutamine supplementation as studied did not decrease mortality or the incidence of late-onset sepsis in ELBW infants. Consequently, although no harm was demonstrated, routine use of parenteral glutamine supplementation cannot be recommended in this population.
Poindexter
Brenda B
BB
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA. bpoindex@iupui.edu
Ehrenkranz
Richard A
RA
Stoll
Barbara J
BJ
Wright
Linda L
LL
Poole
W Kenneth
WK
Oh
William
W
Bauer
Charles R
CR
Papile
Lu-Ann
LA
Tyson
Jon E
JE
Carlo
Waldemar A
WA
Laptook
Abbot R
AR
Narendran
Vivek
V
Stevenson
David K
DK
Fanaroff
Avroy A
AA
Korones
Sheldon B
SB
Shankaran
Seetha
S
Finer
Neil N
NN
Lemons
James A
JA
D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D010288:Parenteral Nutrition; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control*; D016019:Survival Analysis
D005973:Glutamine