Glutamine supplementation for young infants with severe gastrointestinal disease

Grover Z, Tubman R, McGuire W

Published Online:

November 10, 2010

Currently, there is insufficient evidence to determine whether giving young infants with severe gastrointestinal problems supplemental glutamine is beneficial. Glutamine is an amino acid that helps tissues, particularly in the gastrointestinal tract, recover from damage. We looked for evidence that giving extra glutamine to young infants with severe bowel problems helps them to recover faster and more fully. At present, data are only available from two small trials and these are insufficient to determine whether glutamine supplements are beneficial or harmful. Further trials are needed. One such large trial is on-going and when data from that study are reported we will update this Cochrane review.

Abstract (click to read)

Background:

Endogenous glutamine biosynthesis may be insufficient to meet the needs of infants with severe gastrointestinal disease. Studies using animal models of gastrointestinal disease and controlled trials in adult patients have suggested that glutamine supplementation improves clinical outcomes.

Objectives:

To assess the evidence from randomised controlled trials that providing supplemental glutamine reduces mortality and morbidity in infants with severe gastrointestinal disease.

Search strategy:

The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2006), MEDLINE (1966 - August 2006), EMBASE (1980 - August 2006), conference proceedings, and previous reviews.

Selection criteria:

Randomised or quasi-randomised controlled trials that compared glutamine supplementation versus no glutamine supplementation in infants (up to three months old, corrected for preterm birth) with severe gastrointestinal disease (defined as a congenital or acquired gastrointestinal condition that is likely to necessitate providing parenteral nutrition for at least 24 hours).

Data collection and analysis:

Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by two reviewer authors, and synthesis of data using relative risk, risk difference and weighted mean difference.

Main results:

Two trials in which a total of 100 infants participated were identified. In one trial, a minority of participants were infants older than three months. These studies were generally of good methodological quality but were underpowered to detect clinically important effects of glutamine supplementation. Meta-analysis did not reveal a statistically significant difference in the risk of death before hospital discharge [typical relative risk 1.57 (95% confidence interval 0.25 to 9.66); typical risk difference 0.02 (95% confidence interval -0.06 to 0.10)], nor in the rate of invasive infection [typical relative risk 1.22 (95% confidence interval 0.55 to 2.70); typical risk difference: 0.04 (95% confidence interval -0.12 to 0.20)].

Authors' conclusions:

The available data from randomised controlled trials are not sufficient to determine whether glutamine supplementation confers clinically significant benefits for infants with severe gastrointestinal disease. Further trials are needed.

This record should be cited as:

Grover Z, Tubman R, McGuire W. Glutamine supplementation for young infants with severe gastrointestinal disease. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD005947. DOI: 10.1002/14651858.CD005947.pub2

Assessed as up to date:

October 12, 2006

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Primary Review Group:

Neonatal Group

Health topics:

Complementary & alternative medicine > Neonatal care > Feeding the term infant

Neonatal care > Feeding the term infant

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Glutamine supplementation for young infants with severe gastrointestinal disease

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