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Glutamine-enriched enteral nutrition in very-low-birth-weight infants and effects on feeding tolerance and infectious morbidity: a randomized controlled trial^1,2,3

¹ From the Department of Pediatrics (AvdB, RMvE, EAMW, WPFF) and the Institute of Research in Extramural Medicine (JWRT), VU University Medical Center, Amsterdam, Netherlands

Background: Glutamine depletion has negative effects on the functional integrity of the gut and leads to immunosuppression. Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion because nutrition is limited in the first weeks of life.

Objective: The objective was to determine the effect of glutamine-enriched enteral nutrition on feeding tolerance, infectious morbidity, and short-term outcome in VLBW infants.

Design: In a double-blind randomized controlled trial, VLBW infants (gestational age <32 wk or birth weight <1500 g) were allocated to receive enteral glutamine supplementation (0.3 g · kg^–1 · d^–1) or isonitrogenous control supplementation (alanine) between days 3 and 30 of life. The supplementations were added to breast milk or to preterm formula. The primary endpoint for the study was time to full enteral feeding. Secondary endpoints were other variables of feeding tolerance, infectious morbidity, and short-term outcome.

Results: Baseline patient and nutritional characteristics were not significantly different in the glutamine-supplemented (n = 52) and the control (n = 50) groups. The median time to full enteral feeding was 13 d (range: 7–31 d) in the glutamine-supplemented group and 13 d (range: 6–35 d) in the control group (hazard ratio: 1.19; 95% CI: 0.79, 1.79; P = 0.40). In the glutamine-supplemented group, 26 of 52 infants (50%) had 1 serious infection compared with 38 of 50 (76%) in the control group (odds ratio: 0.32; 95% CI: 0.14, 0.74; P = 0.008). Other variables of feeding tolerance and short-term outcome were not significantly different between groups.

Conclusions: Glutamine-enriched enteral nutrition did not improve feeding tolerance or short-term outcome in VLBW infants. However, infectious morbidity was significantly lowered in infants who received glutamine-enriched enteral nutrition.

Key Words: Infant • very-low-birth-weight • glutamine • enteral nutrition • randomized controlled trial

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				A. van den Berg, A. van Zwol, H. A. Moll, W. P. F. Fetter, and R. M. van Elburg Glutamine-Enriched Enteral Nutrition in Very Low-Birth-Weight Infants: Effect on the Incidence of Allergic and Infectious Diseases in the First Year of Life Arch Pediatr Adolesc Med, November 1, 2007; 161(11): 1095 - 1101. [Abstract] [Full Text] [PDF]

				A. van den Berg, W. P. F. Fetter, E. A. M. Westerbeek, I. M. van der Vegt, H. R. A. van der Molen, and R. M. van Elburg The Effect of Glutamine-Enriched Enteral Nutrition on Intestinal Permeability in Very-Low-Birth-Weight Infants: A Randomized Controlled Trial JPEN J Parenter Enteral Nutr, September 1, 2006; 30(5): 408 - 414. [Abstract] [Full Text] [PDF]