Glutamine supplementation to prevent morbidity and mortality in preterm infants
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.
Available from: mdpi.com
- " ÓNEC no reduction on sepsis and stays in NICU Sevastiadou S et al., 2011.  ÓNEC Ósepsis Tubman TR et al., 2008.  no effect on mortality no effect on NEC, infection, time to full enteral nutrition, or duration of hospitalization Mohamad Ikram I et al., 2011. "
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ABSTRACT: Necrotizing enterocolitis (NEC) is a critical intestinal emergency condition, which mainly occurs in preterm very low birth weight (PVLBW) infants. Despite remarkable advances in the care of PVLBW infants, with considerable improvement of the survival rate in recent decades, the incidence of NEC and NEC-related mortality have not declined accordingly. The fast progression from nonspecific signs to extensive necrosis also makes primary prevention the first priority. Recently, increasing evidence has indicated the important role of several nutrients in primary prevention of NEC. Therefore, the aim of this review is to summarize some potential immunomodulatory nutrients in the prevention of NEC, including bovine colostrum, probiotics, prebiotics (e.g., human milk oligosaccharides), long chain polyunsaturated fatty acids, and amino acids (glutamine, cysteine and N-acetylcysteine, l-arginine and l-citrulline). Based on current research evidence, probiotics are the most documented effective method to prevent NEC, while others still require further investigation in animal studies and clinical randomized controlled trials.
- "From the 22 MAs that met inclusion criteria, 165 RCTs were included (Figure 1). The included MAs addressed interventions for: infant respiratory function (n ¼ 6 MAs [5,89101112 and n ¼ 35 RCTs); preventing preterm labor (n ¼ 2 MAs [48,49] and n ¼ 22 RCTs); hypertension and/or pre-eclampsia (n ¼ 4 MAs72737475 and n ¼ 38 RCTs); maternal and/or neonatal infections (n ¼ 4 MAs114115116117 and n ¼ 37 RCTs); minimising permanent brain injury (n ¼ 3 MAs155156157 and n ¼ 17 RCTs158159160161162163164165166167168169170171172173174); and others, namely, methods of foetal monitoring during labor (n ¼ 1 MA  and n ¼ 5 RCTs176177178179180) and timing of umbilical cord clamping and glutamine supplementation (n ¼ 2 MAs [181,182] and n ¼ 11 RCTs183184185186187188189190191192193); see the Appendix. "
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ABSTRACT: Abstract Objective To systematically review meta-analyses (MAs) and randomised controlled trials (RCTs) of interventions for infants at risk of cerebral palsy (CP) to determine if consensus exists in study end-points. Methods MAs within the "Neonatal" and "Pregnancy and Childbirth" Review Groups in Cochrane Database of Systematic Reviews (to June 2011) were included if they contained risk factors for CP as a study end-point, and were either published in 2010 or 2011 or cited >20 times in Sciverse Scopus. Up to 20 RCTs from each MA were included. Outcome measures, definitions, and cut points for ordinal groupings were extracted from MAs and RCTs and frequencies calculated. Results Twenty-two MAs and 165 RCTs were appraised. High consistency existed in types of outcome domains listed as important in MAs. For 10/16 most frequently cited outcome domains, <50% of RCTs contributed data for meta-analyses. Low consistency in outcome definitions, measures, cut points in RCTs and long term follow-up prohibited data aggregation. Conclusions Variation in outcome measurement and long term follow up has hampered the ability of RCTs to contribute data on important outcomes for CP, resulting in lost opportunities to measure the impact of maternal and neonatal interventions. There is an urgent need for and long term follow up of these interventions and an agreed set of standardised and clinically relevant common data elements for study end-points.
Available from: ncbi.nlm.nih.gov
- "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.
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