Glutamine supplementation to prevent morbidity and mortality in preterm infants

Royal Maternity Hospital, Neonatal Intensive Care Unit, Grosvenor Road, Belfast, Northern Ireland, UK.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2008; l(1):CD001457. DOI: 10.1002/14651858.CD001457.pub3
Source: PubMed


No evidence that supplementing preterm infants with the nutrient glutamine improves outcomes. Glutamine is an important nutrient for growth and development. Glutamine may be especially important in aiding recovery from criticalillness. This review found several well-conducted randomised controlled trails that assessed the impact of providing extra glutamine to very low birth weight infants. These trials did not find any evidence that glutamine supplementation affected the risk of death, serious infection,serious gut complications or long term development.

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    • "It plays an important role as a metabolic fuel43) and also maintains the functional integrity of the gut44). A meta-analysis of 5 randomized controlled trials on the effects of glutamine supplementation on NEC showed no statistically effect on its incidence of NEC45), but a recent randomized trial reported its statistically significant reduction of NEC incidence46). "
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    ABSTRACT: Necrotizing enterocolitis (NEC) is one of the most critical morbidities in preterm infants. The incidence of NEC is 7% in very-low-birth-weight infants, and its mortality is 15 to 30%. Infants who survive NEC have various complications, such as nosocomial infection, malnutrition, growth failure, bronchopulmonary dysplasia, retinopathy of prematurity, and neurodevelopmental delays. The most important etiology in the pathogenesis of NEC is structural and immunological intestinal immaturity. In preterm infants with immature gastrointestinal tracts, development of NEC may be associated with a variety of factors, such as colonization with pathogenic bacteria, secondary ischemia, genetic polymorphisms conferring NEC susceptibility, anemia with red blood cell transfusion, and sensitization to cow milk proteins. To date, a variety of preventive strategies has been accepted or attempted in clinical practice with regard to the pathogenesis of NEC. These strategies include the use of breast feeding, various feeding strategies, probiotics, prebiotics, glutamine and arginine, and lactoferrin. There is substantial evidence for the efficacy of breast feeding and the use of probiotics in infants with birth weights above 1,000 g, and these strategies are commonly used in clinical practice. Other preventive strategies, however, require further research to establish their effect on NEC.
    Korean Journal of Pediatrics 09/2011; 54(9):368-72. DOI:10.3345/kjp.2011.54.9.368
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    ABSTRACT: Objective: Review the literature regarding parenteral nutrition of preterm infants in order to propose a practical guideline for indication, increase of parameters and monitor- ing of this nutritional therapy in neonatal units. Data source: Studies in English and Portuguese from the last ten years were retrieved from Medline, Embase, Lilacs and SciELO using the following key-words: preterm infants, parenteral nutrition, nutrition therapy and lipid emulsions. Also classical studies and consensus on the theme were manually searched. Data synthesis: Parenteral nutrition is an essential treatment strategy for preterm infants. Besides progress in knowledge and legislation, several factors contribute to reduce neonatal morbidity and mortality of newborns using parenteral nutrition and to increase the security in its prescription such as catheters' quality, training of the multiprofessional team and development of new specifi c parenteral nutrition formulations. Conclusions: The practical parenteral nutrition guide- line proposed here follows international guidelines and was based on critical analysis of the studies published in the last 10 years.
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    ABSTRACT: The aim of the present study was to evaluate the effect of short-term (7 days) glycyl-glutamine-supplemented total parenteral nutrition (TPN) on nutrition and intestinal absorptive function in a rat model. Thirty Wistar rats, weighting 140-180 g, were divided into three groups (n=10) randomly. The animals received isonitrogenous and isocaloric TPN solutions for 7 days. The nitrogen was supplied by glycyl-glutamine dipeptide-supplemented amino acid solution (group G), and two standard amino acid solutions (group V, group N), respectively. Body weight, plasma glutamine level, nitrogen balance, total tissue water and intestinal absorptive function, assessed by (15-N)-glycine absorption, were investigated. Body weight decreased in three groups at the end of TPN; there was no significant difference in relative body-weight changes. There was a significant improvement of cumulative nitrogen balance and nitrogen retention in group G compared to other groups (P<0.05). There was no significant difference in intestinal glycine absorption (P>0.05) among the three groups. Total tissue water of left thigh muscle was significantly higher in group V and group N than that in group G (P<0.05). The results indicated that short-term (7 days) TPN supplemented with glycyl-glutamine improved plasma glutamine level and nitrogen balance, decreased water content of muscle, but had no beneficial effect on absorptive function in a rat model.
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