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

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. The active intervention arm included postoperative infants with median weight 2.8 kg, median age 8 days, and median PRISM and SSS scores of 9 and 11, respectively.

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. The glutamine was supplied as a 2.5% solution in sterile water within an isocaloric, isonitrogenous PN regimen.

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 based on these data.

The trial was conducted in a small, specialized neonatal and infant surgical population, which limits generalizability. Follow-up was short, and several outcomes were available only in subsets of participants, reducing precision for secondary analyses. The study was performed in a single clinical context with no reported geographic detail, and some findings were limited to nonsignificant trends rather than robust effect estimates.