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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.

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Preterm infants have an impaired gut barrier function. We aimed to determine the effects of enteral supplementation of a prebiotic mixture consisting of neutral oligosaccharides (short-chain galacto-oligosaccharides ( SC GOS)/long-chain fructo-oligosaccharides ( LC FOS)) and acidic oligosaccharides (AOS) on intestinal permeability of preterm infants as measured by the sugar absorption test in the first week of life. Furthermore, we determined host-and treatment-related factors associated with intestinal permeability. In a randomised controlled trial, preterm infants with a gestational age ,32 weeks and/or birth weight (BW) ,1500 g received enteral supplementation of SC GOS/ LC FOS/AOS or placebo (maltodextrin) between days 3 and 30 of life. Intestinal permeability, reflected by the urinary lactulose/mannitol (L/M) ratio after oral ingestion of lactulose and mannitol, was assessed at three time points: before the start of the study (t ¼ 0), at day 4 (t ¼ 1) and at day 7 (t ¼ 2) of life. Data were analysed by generalised estimating equations. In total, 113 infants were included. Baseline patient and nutritional characteristics were not different between the SC GOS/ LC FOS/AOS (n 55) and the placebo groups (n 58). SC GOS/ LC FOS/AOS had no effect on the L/M ratio between t ¼ 0 and t ¼ 2. In both the groups, the L/M ratio decreased from t ¼ 0 to t ¼ 2 (P,0·001). Low BW increased the L/M ratio (P¼ 0·002). Exclusive breast milk feeding and mixed breast milk/formula feeding during the first week of life decreased the L/M ratio (P, 0·001 and P,0·05, respectively). In conclusion, enteral supplementation of a prebiotic mixture does not enhance the postnatal decrease in intestinal permeability in preterm infants in the first week of life. Key words: Preterm infants: Intestinal permeability: PrebioticsDirectly after birth, preterm infants have an impaired gut barrier function, reflected by an increased intestinal permeability (1,2) . Due to this increased intestinal permeability, delayed intestinal colonisation and immaturity of the host immune defence system, potentially pathogenic bacteria may translocate from the intestinal lumen and cause systemic infections (3 -5) . Early enteral feeding is associated with decreased intestinal permeability (6) . In a recent study, intestinal permeability was decreased in preterm infants who received breast milk feeding v. preterm infants who received formula feeding (7) . These beneficial effects of breast milk may partially be attributed to the 'bifidogenic' effect of human milk. Increasing the number of 'bifidogenic' bacteria may improve gut barrier function and prevent systemic infections from translocation of gut bacteria (8,9) . Non-human milk oligosaccharides such as short-chain galacto-oligosaccharides ( SC GOS) and longchain fructo-oligosaccharides ( LC FOS) have been developed (10) . Non-human milk acidic oligosaccharides (AOS) can be derived from pectin. In studies with non-human milk oligosaccharides, enteral supplementation of neutral oligosaccharides stimulates ...