Mohamad Ikram, Ilias
(2008)
A randomized controlled trial of
parenteral glutamine in newborns
receiving total parenteral nutrition
(TPN) in Hospital Universiti Sains Malaysia
(HUSM).
Masters thesis, Universiti Sains Malaysia.
Abstract
Glutamine is a conditionally essential amino acid. Addition of glutamine in TPN of
critically ill adults causes a reduction of complications such as infection. In neonates
however, no clear benefits of addition of glutamine to TPN were shown in a limited
number of studies, mainly performed in high income countries To determine whether the addition of glutamine to standard TPN in neonates in HUSM,
Malaysia improves selected neonatal outcomes This was a double blinded randomized controlled trial. Babies admitted to the NICU
during the 1-year study period, requiring TPN were eligible for inclusion. Subjects were
randomized either to receive glutamine added TPN (intervention) or standard TPN
(control). Primary outcome measures included time taken to reach full enteral nutrition,
incidence of sepsis and NEC, time taken to achieve extubation, and time to discharge
from NICU Out of 270 subjects included in the study 132 were randomized to the intervention group
and 138 to the control group. There were no significant differences between the two
groups in terms of baseline data. The median time taken to reach full enteral nutrition
was similar for both intervention and control group (6 days in each group, p= 0.52). The
time taken to achieve extubation was also similar in both groups (2 days in each group,
p=O. 76). The incidence of necrotising enterocolitis in the intervention group was slightly
lower than for the control group but the difference was not significant (5.8% vs. 7.1% ,
p=O. 68). The incidence of clinical sepsis and culture proven sepsis was also not
significantly different in the intervention and the control group (15.7% vs10.2%,p=0.2J
and 16.5% vs 15.7%, p=0.38 respectively). Sub-group analysis for preterm and term
babies for the same outcomes also showed no statistically significant differences Addition of glutamine to TPN for neonates was not shown to improve outcome.
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