Randomized clinical trial of glutamine-supplemented<i>versus</i>standard parenteral nutrition in infants with surgical gastrointestinal disease

Ong, Evelyn; Eaton, Simon; Wade, Angie; Horn, V.; Losty, PD; Curry, Joe; Sugarman, Ian; Klein, Nigel; Pierro, Agostino

doi:10.1002/bjs.8750

Cited by 28 publications

(15 citation statements)

References 27 publications

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“…Strong consensus [81,[141][142][143][144][145][146][147][148] In critically ill children, does continuous feeding compared to intermittent bolus gastric feeding impact on outcomes?…”

Section: Discussionmentioning

confidence: 99%

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

et al. 2020

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Background: Nutritional support is considered essential for the outcome of paediatric critical illness. There is a lack of methodologically sound trials to provide evidence-based guidelines leading to diverse practices in PICUs worldwide. Acknowledging these limitations, we aimed to summarize the available literature and provide practical guidance for the paediatric critical care clinicians around important clinical questions many of which are not covered by previous guidelines. Objective:To provide an ESPNIC position statement and make clinical recommendations for the assessment and nutritional support in critically ill infants and children. Design: The metabolism, endocrine and nutrition (MEN) section of the European Society of Pediatric and NeonatalIntensive Care (ESPNIC) generated 15 clinical questions regarding different aspects of nutrition in critically ill children. After a systematic literature search, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was applied to assess the quality of the evidence, conducting meta-analyses where possible, to generate statements and clinical recommendations, which were then voted on electronically. Strong consensus (> 95% agreement) and consensus (> 75% agreement) on these statements and recommendations was measured through modified Delphi voting rounds. Results:The final 15 clinical questions generated a total of 7261 abstracts, of which 142 publications were identified relevant to develop 32 recommendations. A strong consensus was reached in 21 (66%) and consensus was reached in 11 (34%) of the recommendations. Only 11 meta-analyses could be performed on 5 questions. Conclusions:We present a position statement and clinical practice recommendations. The general level of evidence of the available literature was low. We have summarised this and provided a practical guidance for the paediatric critical care clinicians around important clinical questions.There is a lack of high-quality evidence to guide nutrition in paediatric critical illness. This position statement and clinical recommendations summarise the existing evidence around 15 of the most important clinical questions, and where no evidence is available, suggest good clinical practice.

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“…Strong consensus [81,[141][142][143][144][145][146][147][148] In critically ill children, does continuous feeding compared to intermittent bolus gastric feeding impact on outcomes?…”

Section: Discussionmentioning

confidence: 99%

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

et al. 2020

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“…Even if glutamine supplementation during PN did not reduce the incidence of sepsis in Group 2 of infants with surgical gastrointestinal disease, 74 , 75 it is still debated whether its role in the maintenance and repair of gastrointestinal mucosa may prevent PNAC/IFALD by protecting the hepatic function. A pilot RCT 75 with inadequate sample size (LoE 2b) on Group 2 of infants with surgical gastrointestinal disease showed that enteral glutamine supplementation had no apparent effect on the duration of PN, tolerance of enteral feeds, or intestinal absorptive or barrier function.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Prevention, and Treatment of Parenteral Nutrition–Associated Cholestasis and Intestinal Failure–Associated Liver Disease in Infants and Children

Lauriti

Zani²,

Aufieri³

et al. 2013

J Parenter Enteral Nutr

180

135

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“…In a double-blind, randomized trial, short-term glutamine-supplementation (0.4 g/kg/day) of PN did not show any benefit on intestinal permeability in newborns and infants after major digestive-tract surgery [79]. Similarly, in a recent randomized clinical trial of glutamine-supplemented versus standard PN, glutamine supplementation did not reduce the incidence of sepsis in surgical infants with gastrointestinal disease [85]. Thus, using the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2011, Issue 4), MEDLINE, EMBASE and CINAHL (to November 2011), conference proceedings and previous reviews, it has been recently concluded that the available trial data do not provide evidence that glutamine supplementation confers important benefits for preterm infants [102].…”

Section: Randomized Experimental and Clinical Studies Of Glutaminementioning

confidence: 99%

Glutamine Randomized Studies in Early Life: The Unsolved Riddle of Experimental and Clinical Studies

Briassouli

Briassoulis

2012

Clinical and Developmental Immunology

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Glutamine may have benefits during immaturity or critical illness in early life but its effects on outcome end hardpoints are controversial. Our aim was to review randomized studies on glutamine supplementation in pups, infants, and children examining whether glutamine affects outcome. Experimental work has proposed various mechanisms of glutamine action but none of the randomized studies in early life showed any effect on mortality and only a few showed some effect on inflammatory response, organ function, and a trend for infection control. Although apparently safe in animal models (pups), premature infants, and critically ill children, glutamine supplementation does not reduce mortality or late onset sepsis, and its routine use cannot be recommended in these sensitive populations. Large prospectively stratified trials are needed to better define the crucial interrelations of “glutamine-heat shock proteins-stress response” in critical illness and to identify the specific subgroups of premature neonates and critically ill infants or children who may have a greater need for glutamine and who may eventually benefit from its supplementation. The methodological problems noted in the reviewed randomized experimental and clinical trials should be seriously considered in any future well-designed large blinded randomized controlled trial involving glutamine supplementation in critical illness.

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Randomized clinical trial of glutamine-supplementedversusstandard parenteral nutrition in infants with surgical gastrointestinal disease

Abstract: ISRCTN83168963 (http://www.controlled-trials.com).

Cited by 28 publications

References 27 publications

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

Incidence, Prevention, and Treatment of Parenteral Nutrition–Associated Cholestasis and Intestinal Failure–Associated Liver Disease in Infants and Children

Glutamine Randomized Studies in Early Life: The Unsolved Riddle of Experimental and Clinical Studies

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