Bishay, M;
Simchowitz, V;
HARRIS, K;
Macdonald, S;
De Coppi, P;
Klein, N;
Eaton, S;
(2020)
The Effect of Glutamine Supplementation on Microbial Invasion in Surgical Infants Requiring Parenteral Nutrition – Results of a Randomised Controlled Trial.
Journal of Parenteral and Enteral Nutrition
, 44
(1)
pp. 80-91.
10.1002/jpen.1700.
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Abstract
Background: To determine whether parenteral plus enteral glutamine supplementation influences microbial invasion in surgical infants requiring parenteral nutrition. // Methods: An ethically-approved prospective double-blind randomised controlled trial studying surgical infants receiving parenteral nutrition for at least five days for congenital or acquired intestinal anomalies (July 2009 – March 2012). Infants were randomised to receive either glutamine supplementation (parenteral plus enteral; total 400mg/kg/day) or isonitrogenous control. The primary endpoint was microbial invasion evaluated after five days of supplementation and defined as either: i) positive conventional blood culture; ii) evidence of microbial DNA in blood (PCR); iii) plasma endotoxin level ≥50 pg/mL; or iv) plasma level of lipopolysaccharide-binding protein (LBP) ≥50 ng/mL. Data are given as median (range) and compared by binary logistic regression. // Results: Sixty infants were randomised and reached the primary endpoint. 25 patients had congenital/neonatal intestinal obstruction, 19 had anterior abdominal wall defects, 13 had necrotising enterocolitis. Thirty six infants showed some evidence of microbial invasion during the study: 17 of these were not detected by conventional blood culture. There was no significant difference between the two groups in the primary outcome: evidence of microbial invasion after five days was found in 9/31 in the control group and 8/29 in the glutamine group: odds ratio 0.83 (0.24 – 2.86; p=0.77). // Conclusion: More than half of surgical infants requiring parenteral nutrition showed evidence of microbial invasion. Approximately half of this was not detectable by conventional blood cultures. Parenteral plus enteral glutamine supplementation had no effect on the incidence of microbial invasion.
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