Protective effect of parenteral glutamine supplementation on hepatic function in very low birth weight infants.
OBJECTIVE
Hepatic dysfunction is one of the most frequent complications of parenteral nutrition. Very low birth weight (VLBW) infants are more sensitive to liver injury due to physiological immaturity. Our studies in animals showed that glutamine supplementation could attenuate TPN-associated liver injury. The aim of study was to investigate whether parenteral glutamine supplementation can improve hepatic tolerance in VLBW infants.


METHODS
We performed a double-blind, randomized, and controlled clinical study to investigate whether parenteral glutamine supplementation can improve hepatic tolerance in VLBW infants. Thirty VLBW infants at two children's centers were randomly assigned to either a control group or a glutamine-supplemented group. The primary endpoints were hepatic function and mortality. The secondary endpoints were the time to achieve full enteral nutrition, episodes of gastric residuals, duration of parenteral nutrition, weight and head circumference gain, length of hospitalization, and days on ventilator.


RESULTS
The serum levels of aspartate aminotransferase (AST) and total bilirubin (Tbi) were decreased after PN in the glutamine-supplemented group (P < 0.05). No deaths occurred in this study. Four infants assigned to the control group and two infants in the glutamine-supplemented group were withdrawn from the study, according to intention to treat: relative risk [RR]: 1.182; 95% confidence interval [CI]: 0.937-1.490.


CONCLUSIONS
Parenteral glutamine supplementation can improve hepatic tolerance in very low birth weight infant, suggesting a hepato-protective effect.
Wang
Ying
Y
Clinical Nutrition Center, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, PR China.
Tao
Ye-Xuan
YX
Cai
Wei
W
Tang
Qing-Ya
QY
Feng
Yi
Y
Wu
Jiang
J
D001786:Blood Glucose / Q000032:analysis; D001835:Body Weight; D003672:Defecation; D004311:Double-Blind Method; D005260:Female; D005746:Gastric Emptying; D005973:Glutamine / Q000627:therapeutic use*; D006257:Head / Q000254:growth & development; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight / Q000097:blood* / Q000254:growth & development; D007902:Length of Stay; D008099:Liver / Q000503:physiopathology*; D008107:Liver Diseases / Q000097:blood / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects* / Q000401:mortality; D020011:Protective Agents / Q000627:therapeutic use*; D012121:Respiration, Artificial; D013997:Time Factors
D001786:Blood Glucose; D020011:Protective Agents; D005973:Glutamine