Glutamine Supplementation of Parenteral Nutrition Does Not Improve Intestinal Permeability, Nitrogen Balance, or Outcome in Newborns and Infants Undergoing Digestive-Tract Surgery: Results From a Double-Blind, Randomized, Controlled Trial
What this study found
L-glutamine supplementation did not improve intestinal permeability, nitrogen balance, or clinical outcomes. Urinary lactulose and rhamnose excretion ratios showed no between-group difference over weeks 1 to 4, and nitrogen excretion measures were not different. Clinical outcomes were also similar, including 31-day mortality, ICU and hospital length of stay, antibiotic use, and ICU resource use; septic episodes were 6 in the control group versus 9 with glutamine (P=0.53). No adverse effects were observed, and the authors concluded that parenteral glutamine is not warranted in this population…
- Study & population
- Double-blind, randomized, controlled trial in newborns and infants recovering from major digestive-tract surgery and receiving parenteral nutrition in a pediatric surgical intensive care setting.
- Intervention
- L-glutamine was added to parenteral nutrition at 0.4 g/kg/day, given daily by the parenteral route and started on postoperative day 2 after digestive-tract surgery.
- Key limitation
- The trial was conducted in a small, specialized neonatal and infant surgical population, which limits generalizability.
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Open PDFOriginal abstract
Objective:To assess the effect of isocaloric isonitrogenous parenteral glutamine supplementation on intestinal permeability and nitrogen loss in newborns and infants after major digestive-tract surgery. Summary Background Data:Glutamine supplementation in critically ill and surgical adults may normalize intestinal permeability, attenuate nitrogen loss, improve survival, and lower the incidence of nosocomial infections. Previous studies in critically ill children were limited to very-low-birthweight infants and had equivocal results. Methods:Eighty newborns and infants were included in a double-blind, randomized trial comparing standard parenteral nutrition (sPN; n = 39) to glutamine-supplemented parenteral nutrition (GlnPN; glutamine target intake, 0.4 g kg−1 day−1; n = 41), starting on day 2 after major digestive-tract surgery. Primary endpoints were intestinal permeability, as assessed by the urinary excretion ratio of lactulose and rhamnose (weeks 1 through 4); nitrogen balance (days 4 through 6), and urinary 3-methylhistidine excretion (day 5). Secondary endpoints were mortality, length of stay in the ICU and the hospital, number of septic episodes, and usage of antibiotics and ICU resources. Results:Glutamine intake plateaued at 90% of the target on day 4. No differences were found between patients assigned sPN and patients assigned GlnPN regarding any of the endpoints. Glutamine supplementation was not associated with adverse effects. Conclusions:In newborns and infants after major digestive-tract surgery, we did not identify beneficial effects of isonitrogenous, isocaloric glutamine supplementation of parenteral nutrition. Glutamine supplementation in these patients therefore is not warranted until further research proves otherwise.