Glutamine supplementation in infants with gastrointestinal disease: a randomized, placebo-controlled pilot trial.
OBJECTIVE
Glutamine (Gln) is a non-essential amino acid that plays an important role in energy metabolism for gastrointestinal epithelia and other cells with rapid turnover. We evaluated the effects of enteral supplementation with Gln in infants undergoing surgery for congenital or acquired gastrointestinal disease.


METHODS
This was a randomized, double-masked, controlled clinical trial.


RESULTS
Twenty infants were randomly assigned to receive Gln (n = 9) or placebo amino acid (n = 11), with a goal of supplemental amino acid intake of 0.4 g.kg(-1).d(-1). Infants were weaned from parenteral nutrition, and enteral feeds were started according to a standardized feeding protocol. Median (interquartile range) durations of parenteral nutrition were 39 d (12 to 99) in the Gln group and 21 d (6 to 59) in the control group (P = 0.201). Median (interquartile range) durations needed to reach 80% of the US recommended dietary allowance for energy with enteral nutrition were 24 d (8 to 55) in the Gln group and 12.5 d (5 to 32) in the control group (P = 0.313). There were no differences in the occurrence of infections between groups. Among all infants enrolled, significant correlations were found between duration of parenteral nutrition and residual small bowel length, peak concentrations of direct bilirubin, and alanine aminotransferase. Peak direct bilirubin was associated with longer duration of parenteral nutrition, shorter gestation, older age before feeds were started, shorter bowel length, and larger amounts of parenteral energy and protein intake.


CONCLUSIONS
In this pilot trial, enteral Gln supplementation was well tolerated among infants with surgical gastrointestinal disease. There was no effect observed on the duration of parenteral nutrition, tolerance of enteral feeds, or intestinal absorptive or barrier function. Larger, multicenter trials in infants with surgical gastrointestinal disease are needed due to the variability in important outcome measurements.
Duggan
Christopher
C
Children's Hospital, Boston, MA 02115, USA. christopher.duggan@childrens.harvard.edu
Stark
Ann R
AR
Auestad
Nancy
N
Collier
Sharon
S
Fulhan
Jill
J
Gura
Kathleen
K
Utter
Sherri
S
Teixeira-Pinto
Armando
A
Donovan
Kate
K
Lund
Dennis
D
D019587:Dietary Supplements; D004311:Double-Blind Method; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery*; D005973:Glutamine / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007408:Intestinal Absorption / Q000187:drug effects; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods; D010865:Pilot Projects; D011184:Postoperative Period; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain / Q000187:drug effects
D005973:Glutamine