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The Effects of Glutamine-Supplemented Parenteral Nutrition in Premature Infants
Janet M. Lacey, DRPH, RD
Laboratory for Surgical Metabolism and Nutrition, Brigham and Women's Hospital, Boston
Jean B. Crouch, MPH, RD
Neonatal Intensive Care Unit, Brigham and Women's Hospital, Boston, Nutrition Support Service, Brigham and Women's Hospital, Boston
Kathleen Benfell, RPH
Research Pharmacy, Brigham and Women's Hospital, Boston
Steven A. Ringer, MD, PHD
Neonatal Intensive Care Unit, Brigham and Women's Hospital, Boston
C. Kristann Wilmore, RD
Laboratory for Surgical Metabolism and Nutrition, Brigham and Women's Hospital, Boston
Donnamarie Maguire, RN
Nutrition Support Service, Brigham and Women's Hospital, Boston
Douglas W. Wilmore, MD
Laboratory for Surgical Metabolism and Nutrition, Brigham and Women's Hospital, Boston, Nutrition Support Service, Brigham and Women's Hospital, Boston
Background: Glutamine (GLN) is the primary fuel for rapidly dividing cells, yet it is not a constituent of parenteral nutritional formulas administered to newborns. The aims of this prospective, randomized, double-blind trial were (1) to confirm the safety of glutamine supplementation for premature infants and (2) to examine the effects of glutamine-supplemented parenteral nutrition on length of stay, days on total parenteral nutrition (TPN), days on the ventilator, and other clinical outcomes. Methods: Premature infants received either standard or glutamine-supplemented TPN and were monitored throughout length of stay for various health and biochemical indices. The group was examined as a whole (n = 44; birth weight range: 530 to 1250 g) and in two weight subgroups, <800 and  800 g. Results: Serum ammonia, blood urea nitrogen, and glutamate tended to be higher in the GLN groups, but the levels were well within normal limits. In the <800-g cohort (n = 24), glutamine-supplemented infants required fewer days on TPN (13 vs 21 days, p = .02), had a shorter length of time to full feeds (8 vs 14 days, p = .03), and needed less time on the ventilator (38 vs 47 days, p = .04). There was a tendency toward a shorter length of stay in the NICU (73 vs 90 days, NS). These findings were not observed in the infants 800 g (n = 20). Conclusions: Glutamine appears to be safe for use in premature infants and seems to be conditionally essential in premature infants with extremely low birth weights. Larger multicenter trials are needed to confirm these observations and further evaluate the efficacy of GLN in these high-risk premature infants. (Journal of Parenteral and Enteral Nutrition 20:74-80, 1996)
Journal of Parenteral and Enteral Nutrition, Vol. 20, No. 1,
74-80 (1996)
DOI: 10.1177/014860719602000174
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