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Original Research Communication |
1 From Indiana University, Indianapolis (BBP and JAL); Yale University, New Haven, CT (RAE); Emory University, Atlanta (BJS); the Research Triangle Institute, Research Triangle Park, NC (MAK); the National Institute of Child Health and Human Development, Bethesda, MD (LLW); the Women and Infant’s Hospital, Providence, RI (WO); the University of New Mexico, Albuquerque (L-AP); the University of Miami (CRB); the University of Alabama, Birmingham (WAC); the University of Cincinnati (EFD); Case Western Reserve University, Cleveland (AAF); the University of Tennessee, Memphis (SBK); the University of Texas Southwestern Medical Center, Dallas (ARL); Wayne State University, Detroit (SS); Stanford University, Stanford, CA (DKS); and the University of Texas at Houston (JET).
Background: Glutamine is one of the most abundant amino acids in both plasma and human milk and may be conditionally essential in premature infants. However, glutamine is not provided by standard intravenous amino acid solutions.
Objective: We assessed the effect of parenteral glutamine supplementation on plasma amino acid concentrations in extremely low-birth-weight infants receiving parenteral nutrition (PN).
Design: A total of 141 infants with birth weights of 401–1000 g were randomly assigned to receive a standard intravenous amino acid solution that did not contain glutamine or an isonitrogenous amino acid solution with 20% of the total amino acids as glutamine. Blood samples were obtained just before initiation of study PN and again after the infants had received study PN (mean intake: 2.3 ± 1.0 g amino acids · kg-1 · d-1) for 
10 d.
Results: Infants randomly assigned to receive glutamine had mean plasma glutamine concentrations that increased significantly and were 30% higher than those in the control group in response to PN (425 ± 182 and 332 ± 148 µmol/L for the glutamine and control groups, respectively). There was no significant difference between the 2 groups in the relative change in plasma glutamate concentration between the baseline and PN samples. In both groups, there were significant decreases in plasma phenylalanine and tyrosine between the baseline and PN samples; the decrease in tyrosine was greater in the group that received glutamine.
Conclusions: In extremely low-birth-weight infants, parenteral glutamine supplementation can increase plasma glutamine concentrations without apparent biochemical risk. Currently available amino acid solutions are likely to be suboptimal in their supply of phenylalanine, tyrosine, or both for these infants.
Key Words: Glutamine • phenylalanine • tyrosine • extremely low-birth-weight • premature infants • low-birth-weight infants • parenteral nutrition • neonatology • neonatal care
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  R. H. Clark, D. H. Chace, A. R. Spitzer, and for the Pediatrix Amino Acid Study Group Effects of Two Different Doses of Amino Acid Supplementation on Growth and Blood Amino Acid Levels in Premature Neonates Admitted to the Neonatal Intensive Care Unit: A Randomized, Controlled Trial Pediatrics, December 1, 2007; 120(6): 1286 - 1296. [Abstract] [Full Text] [PDF]
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B. B. Poindexter, R. A. Ehrenkranz, B. J. Stoll, L. L. Wright, W. K. Poole, W. Oh, C. R. Bauer, L.-A. Papile, J. E. Tyson, W. A. Carlo, et al. Parenteral Glutamine Supplementation Does Not Reduce the Risk of Mortality or Late-Onset Sepsis in Extremely Low Birth Weight Infants Pediatrics, May 1, 2004; 113(5): 1209 - 1215. [Abstract] [Full Text] [PDF]
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