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Intervention Review

Glutamine supplementation for prevention of morbidity in preterm infants

  1. TRJ Tubman Consultant Neonatologist*,
  2. SW Thompson

Editorial Group: Cochrane Neonatal Group

Published Online: 23 OCT 2001

DOI: 10.1002/14651858.CD001457


How to Cite

Tubman TRJ, Thompson SW. Glutamine supplementation for prevention of morbidity in preterm infants. The Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD001457. DOI: 10.1002/14651858.CD001457.

Author Information

  1. Royal Maternity Hospital, Neonatal Intensive Care Unit, Belfast, Northern Ireland, UK

*TRJ Tubman, Consultant Neonatologist, Neonatal Intensive Care Unit, Royal Maternity Hospital, Grosvenor Road, Belfast, Northern Ireland, UK. richard.tubman@royalhospitals.n-i.nhs.uk.

Publication History

  1. Published Online: 23 OCT 2001

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Abstract

  1. Top of page
  2. Abstract
  3. Synopsis

Background

The amino acid glutamine is the preferred respiratory fuel for rapidly proliferating cells under normal conditions. Recent research has suggested a number of roles for glutamine during critical illness. This research has been largely performed in experimental animals and in adults in a variety of disease settings. There is little information on the role of glutamine in children and infants, or whether glutamine supplementation is beneficial in preterm babies.

Objectives

To determine the effects of glutamine supplementation on morbidity and weight gain in preterm babies.

Search strategy

Searches were made using the Cochrane Controlled Trials Register, Medline and Embase electronic databases from 1980 - June 2001 (MeSH terms: glutamine, preterm, newborn, nutrition), handsearching of selected English language journals (Pediatrics, Journal of Pediatrics, Archives of Disease in Childhood and Journal of Pediatric Gastroenterology and Nutrition) from 1990 - June 2001, and cross-referencing from publications where necessary.

Selection criteria

Randomised controlled trials comparing glutamine supplementation to no glutamine supplementation in preterm babies at any time from birth to discharge from hospital.

Data collection and analysis

Data regarding clinical outcomes including duration of parenteral nutrition, time to full enteral nutrition, rate of weight gain, rate of positive blood cultures and duration of hospital stay were extracted by both reviewers. Analysis was performed by the primary reviewer (TRJT) in accordance with the standards of the Cochrane Neonatal Review Group.

Main results

Three trials met the selection criteria.

Data on proportion of babies having one or more of positive blood cultures were available from all three studies. Meta-analysis showed no significant difference between glutamine-supplemented and non-supplemented babies; RR = 0.73 (95% CI 0.44, 1.23), RD = -8.8% (95% CI -23.2, 5.5).

Data for other outcome variables were pooled from two studies. There were no significant differences between glutamine-supplemented and non-supplemented babies for days to full enteral nutrition (WMD 0.4 days, 95% CI -3.0, 3.8), rate of weight gain (WMD 0.6 g/kg/d, 95% CI -1.6, 2.8) or days of hospital stay (WMD -2.4 days, 95% CI -14.9, 10.2).

Reviewers' conclusions

There is no evidence from randomised trials to support the routine use of parenteral or enteral glutamine supplementation in preterm babies. A large randomised controlled trial should be performed to determine whether or not glutamine supplementation enhances gut integrity and reduces sepsis rate.

 

Synopsis

  1. Top of page
  2. Abstract
  3. Synopsis

Synopsis

No evidence to show the effect of glutamine supplementation for improving intestinal function in preterm babies

Preterm babies are those babies born before 37 weeks. The immaturity of their gut leads to feeding problems including vomiting, reduced absorption of milk and abdominal distension. Glutamine is an amino acid found in plasma and muscle. It promotes cell growth and has been given to critically ill adults to help gut function. It may also improve gut function in sick babies but very few studies have been carried out. The review found no evidence from trials to show beneficial effects of glutamine supplements for preterm babies. More research is needed.