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Meta-Analysis
. 2016 Apr 18;4(4):CD001457.
doi: 10.1002/14651858.CD001457.pub6.

Glutamine supplementation to prevent morbidity and mortality in preterm infants

Thirimon Moe-Byrne  1 , Jennifer V E Brown, William McGuire
Affiliations
Meta-Analysis

Glutamine supplementation to prevent morbidity and mortality in preterm infants

Thirimon Moe-Byrne et al. Cochrane Database Syst Rev. .

Abstract

Background: Glutamine is a conditionally essential amino acid. Endogenous biosynthesis may be insufficient for tissue needs in states of metabolic stress. Evidence exists that glutamine supplementation improves clinical outcomes in critically ill adults. It has been suggested that glutamine supplementation may also benefit preterm infants.

Objectives: To determine the effects of glutamine supplementation on mortality and morbidity in preterm infants.

Search methods: We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 12), MEDLINE, EMBASE and Maternity and Infant Care (to December 2015), conference proceedings and previous reviews.

Selection criteria: Randomised or quasi-randomised controlled trials that compared glutamine supplementation versus no glutamine supplementation in preterm infants at any time from birth to discharge from hospital.

Data collection and analysis: We extracted data using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by two review authors. We synthesised data using a fixed-effect model and reported typical relative risk, typical risk difference and weighted mean difference.

Main results: We identified 12 randomised controlled trials in which a total of 2877 preterm infants participated. Six trials assessed enteral glutamine supplementation and six trials assessed parenteral glutamine supplementation. The trials were generally of good methodological quality. Meta-analysis did not find an effect of glutamine supplementation on mortality (typical relative risk 0.97, 95% confidence interval 0.80 to 1.17; risk difference 0.00, 95% confidence interval -0.03 to 0.02) or major neonatal morbidities including the incidence of invasive infection or necrotising enterocolitis. Three trials that assessed neurodevelopmental outcomes in children aged 18 to 24 months and beyond did not find any effects.

Authors' conclusions: The available trial data do not provide evidence that glutamine supplementation confers important benefits for preterm infants.

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Conflict of interest statement

None.

Figures

1
1
Funnel plot of comparison: 1 Glutamine supplementation versus no supplementation, outcome: 1.1 Death prior to hospital discharge.
2
2
Funnel plot of comparison: 1 Glutamine supplementation versus no supplementation, outcome: 1.3 Invasive infection.
3
3
Funnel plot of comparison: 1 Glutamine supplementation versus no supplementation, outcome: 1.4 Necrotising enterocolitis.
4
4
Funnel plot of comparison: 1 Glutamine supplementation versus no supplementation, outcome: 1.6 Time to full enteral nutrition (days).
5
5
Funnel plot of comparison: 1 Glutamine supplementation versus no supplementation, outcome: 1.7 Duration of hospital stay (days).
6
6
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Glutamine supplementation versus no supplementation, Outcome 1 Death prior to hospital discharge.
1.2
1.2. Analysis
Comparison 1 Glutamine supplementation versus no supplementation, Outcome 2 Neurodevelopmental impairment.
1.3
1.3. Analysis
Comparison 1 Glutamine supplementation versus no supplementation, Outcome 3 Invasive infection.
1.4
1.4. Analysis
Comparison 1 Glutamine supplementation versus no supplementation, Outcome 4 Necrotising enterocolitis.
1.5
1.5. Analysis
Comparison 1 Glutamine supplementation versus no supplementation, Outcome 5 Rate of weight gain (g/day).
1.6
1.6. Analysis
Comparison 1 Glutamine supplementation versus no supplementation, Outcome 6 Time to full enteral nutrition (days).
1.7
1.7. Analysis
Comparison 1 Glutamine supplementation versus no supplementation, Outcome 7 Duration of hospital stay (days).
2.1
2.1. Analysis
Comparison 2 Trials in low‐ and middle‐income countries, Outcome 1 Death prior to hospital discharge.
2.2
2.2. Analysis
Comparison 2 Trials in low‐ and middle‐income countries, Outcome 2 Invasive infection.
2.3
2.3. Analysis
Comparison 2 Trials in low‐ and middle‐income countries, Outcome 3 Necrotising enterocolitis.
2.4
2.4. Analysis
Comparison 2 Trials in low‐ and middle‐income countries, Outcome 4 Rate of weight gain (g/day).
2.5
2.5. Analysis
Comparison 2 Trials in low‐ and middle‐income countries, Outcome 5 Time to full enteral nutrition (days).
2.6
2.6. Analysis
Comparison 2 Trials in low‐ and middle‐income countries, Outcome 6 Duration of hospital stay (days).
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Barbosa 1999 {published data only}
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