The effect of glutamine-enriched enteral nutrition on intestinal microflora in very low birth weight infants: a randomized controlled trial.
OBJECTIVE
In a previous study, we have found that glutamine supplementation decreased the infection rate in very low birth weight (VLBW) infants. In this study, we investigated whether this beneficial effect originated from increased number of bifidobacteria and lactobacilli in the intestinal microflora of these infants.


METHODS
In a randomized controlled trial, VLBW infants (gestational age <32 weeks and/or birth weight <1500g) received enteral glutamine supplementation (0.3g/kg/day) or isonitrogenous placebo supplementation between d3 and d30 of life. Faecal microflora was determined by fluorescent in situ hybridization <48h, at d7, d14 and d30 of life.


RESULTS
In 43/52 (glutamine group) and 43/50 (control group) infants, > or = 2 samples were analyzed. Baseline characteristics were not different between groups. The prevalence of bifidobacteria, lactobacilli, Escheria coIi, streptococci and clostridia was not different between groups (p>0.05). In both groups, colonization with bifidobacteria was delayed, whereas potentially pathogenic bacteria such as E. coli, appeared rapidly after birth. Antibiotic treatment decreased the prevalence of all faecal bacteria (p<0.05).


CONCLUSIONS
Decreased infectious morbidity in VLBW infants that received glutamine supplementation was not associated with alterations in the prevalence of bifidobacteria, lactobacilli, E. coIi, streptococci and clostridia. In general, colonization with health-promoting bacteria was delayed, whereas potentially pathogenic bacteria appeared rapidly after birth. Antibiotic treatment delayed the bacterial colonization.
van den Berg
Anemone
A
Department of Paediatrics, Subdivision of Neonatology, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands. a.vandenberg@vumc.nl
van Elburg
Ruurd M
RM
Westerbeek
Elisabeth A M
EA
van der Linde
Esmeralda G M
EG
Knol
J
J
Twisk
Jos W R
JW
Fetter
Willem P F
WP
D001644:Bifidobacterium / Q000187:drug effects* / Q000254:growth & development; D015169:Colony Count, Microbial / Q000379:methods; D004311:Double-Blind Method; D004750:Enteral Nutrition / Q000379:methods*; D004926:Escherichia coli / Q000187:drug effects / Q000254:growth & development; D005243:Feces / Q000382:microbiology; D005260:Female; D005973:Glutamine / Q000008:administration & dosage* / Q000494:pharmacology; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000379:methods; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000254:growth & development; D007422:Intestines / Q000382:microbiology*; D007778:Lactobacillus / Q000187:drug effects* / Q000254:growth & development; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome
D005973:Glutamine