[Effects of glutamine supplemented parenteral nutrition on the incidence of necrotizing enterocolitis, nosocomial sepsis and length of hospital stay in very low birth weight infants].
BACKGROUND
Parenteral feeding is the basic way of nutrition in the first day of life in infants with very low birth weight. Due to its instability glutamine is not included in aminoacid solutions used for parenteral nutrition. Meanwhile glutamine is an important aminoacid, which plays a major role in the maturation of the gastrointestinal tract as well as the immunological system.


OBJECTIVE
The aim of our study was to estimate if glutamine supplementation of parenteral nutrition in neonates with the very low birth weight can decrease the incidence of necrotizing enterocolitis -- NEC (> 1 degree according to the Bell criteria), nosocomial sepsis, and shorten the total length of hospitalization.


METHODS
Prospective, randomized study included 55 neonates born between 26 and 32 weeks of gestation, with birth weight range of 580 g to 1250 g. On the third day of life patients were randomized into 2 groups. Each group was fed with a different aminoacid solution. Group 1 consisted of patients who received a standard aminoacid solution with an addition of glutamine dipeptide (20% of total amount of aminoacids). Group 2 (acknowledged as the control group) including 30 patients received a standard aminoacid solution. Glutamine and glutaminic acid levels were checked in the cord blood, and on the 3rd and 14th day of life. Venous samples were taken at 8 a.m. and were estimated using HPLC. The Ethics Committee of the Warsaw Medical University had approved the research.


RESULTS
In group 1 nosocomial sepsis had occurred in 7/25 neonates, and in the control group in 11/30; NEC was diagnosed in none of the 25 neonates in group 1 and in 5/30 of the control group; the total length of hospitalization in group 1 was 75 days (median 70) versus 73 in the control group (median 70). The lowest glutamine concentration was noted in cord blood samples, and increased on the third day of life in both groups. There were a statistically significant difference among the levels of glutamine concentration between the cord sample and the sample on the day three (p<0.01). On the 14th day of life glutamine concentration increased in both groups, but it was about 30% higher in group 1. This was statistically significant.


CONCLUSIONS
Glutamine supplemented parenteral nutrition from day 4 to day 14 among neonates with very low birth weight, decreased the incidence of necrotizing enterocolitis, but it did not influence the incidence of hospital acquired sepsis, as well as the length of stay in the intensive care unit, and the total time of hospitalization. Further research is needed to estimate the role of glutamine in preventing gastrointestinal complications observed during sepsis.
Klinika Neonatologii, Akademia Medyczna, ul. Karowa 2, 00-315 Warszawa, Poland.
Krystyna
K
Bober-Olesińska
Maria Katarzyna
MK
Kornacka
D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight / Q000378:metabolism*; D007902:Length of Stay; D008297:Male; D010289:Parenteral Nutrition, Total / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
D005973:Glutamine