Pilot study with a glutamine-supplemented enteral formula in critically ill infants

Abstract

Seriously ill infants often display protein-calorie malnutrition due to the metabolic demands of sepsis and respiratory failure. Glutamine has been classified as a conditionally essential amino acid, with special usefulness in critical patients. Immunomodulation, gut protection, and prevention of protein depletion are mentioned among its positive effects in such circumstances. With the intent of evaluating the tolerance and clinical impact of a glutamine supplement in seriously ill infants, a prospective randomized study was done with nine patients. Anthropometric and biochemical determinations were made, and length of stay in the intensive care unit (ICU), in the hospital, and under artificial ventilation, and septic morbidity and mortality were tabulated. Infants in the treatment group (n = 5) were enterally administered 0.3 g/kg of glutamine, whereas controls received 0.3 g/kg of casein during a standard period of five days. Septic complications occurred in 75% of the controls (3/4) versus 20% of the glutamine-treated group (1/5, p < or = 0.10), and two patients in the control group died of bacterial infections (50% vs. 0%, p < or = 0.10). Days in the ICU, in the hospital, and with ventilation numerically favored glutamine therapy, although without statistical significance. The supplements were usually well tolerated, and no patient required discontinuation of the program. The conclusion was that glutamine supplementation was safe and tended to be associated with less infectious morbidity and mortality in this high-risk population.

The effects of long-term total parenteral nutrition on gut mucosal immunity in children with short bowel syndrome: a systematic review

“…Overall, this study results showed that glutamine supplementation was safe, but had no effect on duration of TPN, tolerance of enteral feeds, or intestinal absorption or barrier function. However, in a PRCT pilot study Barbosa and colleagues [150] examined the tolerance and efficiency of glutamine in a pediatric intensive care unit setting with nine mechanically ventilated infants (treatment group = 5, and control group = 4). Their results showed that tolerance to glutamine-supplemented diet was good.…”

A suplementação de glutamina é benéfica em crianças com doenças graves?

“…Em relação aos lactentes e às crianças maiores, não há trabalhos, até o momento, que demonstrem benefícios da glutamina em promover melhor tolerância à dieta enteral 9,10 . O assunto também continua controverso em relação aos adultos, visto que os estudos, até o momento com pacientes pós-transplante de medula óssea e aqueles criticamente enfermos, demonstram RN= recém-nascidos; NP= nutrição parenteral; TGI= trato gastrintestinal; EV= endovenoso; AA= aminoácidos; SOG= sonda orogástrica; IG= idade gestacional; CRIB= escore clínico de risco para recém-nascidos.…”

“…Na presente revisão, verificou-se que a redução de infecção foi significante somente nos estudos de Dallas et al 11 e Neu et al 13 , enquanto que no grupo estudado por Barbosa et al 10 , foi evidenciada apenas uma tendência à redução -fato decorrente, provavelmente, da pequena amostra de pacientes. Nenhuma diferença foi observada nos estudos de Anderson et al 9 , Lacey et al 12 14 , a suplementação deste aminoácido não promoveu redução da mortalidade.…”

“…Apesar da presente revisão não evidenciar vantagens do uso da glutamina em reduzir o tempo de internação 10,11,13 , sendo detectada apenas uma tendência a essa redução no estudo de Lacey et al 12 , a literatura evidencia reduções significantes no tempo de hospitalização, nos estudos com adultos pós-cirúrgicos, com doenças hematológicas e com adultos criticamente enfermos 8,22,27,28,31,32 .…”

Nutritional Support In The Critically Ill Child

“…They are believed to play an active role in enhancing immunity and help wound healing. Trials on immunonutrition have shown beneficial results [25].…”