Glutamine supplementation for young infants with severe gastrointestinal disease

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 threemonths. 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.