Glutamine supplementation to prevent morbidity and mortality in preterm infants.
ABSTRACT Glutamine endogenous biosynthesis may be insufficient for tissue needs in states of metabolic stress. Trials in adults have suggested that glutamine supplementation improves clinical outcomes in critically ill adults. It has been suggested that glutamine supplementation may benefit preterm infants, particularly very low birth weight infants.
To determine the effects of glutamine supplementation on mortality and morbidity in preterm infants.
The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2007), MEDLINE (1966 - July 2007), EMBASE (1980 - July 2007), conference proceedings, and previous reviews.
Randomised or quasi-randomised controlled trials that compared glutamine supplementation versus no glutamine supplementation in preterm infants at any time from birth to discharge from hospital.
The standard methods of the Cochrane Neonatal Review Group were used, with separate evaluation of trial quality and data extraction by two authors. Data were synthesised using a fixed effects model and reported using typical relative risk, typical risk difference and weighted mean difference.
2365 preterm infants have participated in seven randomised controlled trials. All of the participating infants were of very low birth weight. Three trials assessed enteral glutamine supplementation and four trials assessed parenteral glutamine supplementation. The trials were generally of good methodological quality with adequate allocation concealment, blinding of caregivers and assessors to the intervention, and complete or near-complete follow-up of recruited infants. Glutamine supplementation does not have a statistically significant effect on mortality: typical relative risk 0.98 (95% confidence interval 0.80 to 1.20); typical risk difference 0.00 (95% confidence interval -0.03 to 0.02). The only trial that assessed long-term outcomes did not find any statistically significant differences in various assessments of neurodevelopment at 18 months corrected age. Glutamine supplementation does not have a statistically significant effect on other neonatal morbidities including invasive infection, necrotising enterocolitis, time to achieve full enteral nutrition, or duration of hospital stay.
The available data from good quality randomised controlled trials indicate that glutamine supplementation does not confer benefits for preterm infants. The narrow confidence intervals for the effect size estimates suggest that a further trial of this intervention is not a research priority.
- SourceAvailable from: Fabiola Suano[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE: Review the literature regarding parenteral nutrition of preterm infants in order to propose a practical guideline for indication, increase of parameters and monitoring 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 specific parenteral nutrition formulations. CONCLUSIONS: The practical parenteral nutrition guideline proposed here follows international guidelines and was based on critical analysis of the studies published in the last 10 years.Revista Paulista de Pediatria 09/2008; 26(3):278-289.
- Revista Paulista de Pediatria 01/2008; 26(3).
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ABSTRACT: This article reviews the current understanding of enteral and parenteral nutrition therapy in preterm infants, with an emphasis on very low birth weight babies. The protective effects of nutrition therapy against neonatal sepsis and necrotizing enterocolitis are discussed. Different methods of feeding preterm infants are evaluated. Special attention is given to the problems of very low birth weight babies and the protective effects of nutrition to counteract complications, especially infection. The preferential use of breast milk for enteral nutrition, the management of protein and energy offers, the use of early and minimal enteral nutrition, the early introduction of parenteral nutrition (within the first 24 hours of life) and the use of immunonutrients that are appropriately supported by a sufficient number of studies can provide good adjuvant therapy guidelines to prevent neonatal sepsis and necrotizing enterocolitis. However, we conclude that additional multicenter, randomized controlled studies are necessary to clarify the protective role of nutrition in preterm infants. Appropriate nutrition is not only effective in treating and preventing infective complications, but it also promotes neurodevelopment and prevents future harmful consequences.Revista brasileira de terapia intensiva. 12/2011; 23(4):492-498.