Glutamine supplementation in preterm infants receiving parenteral nutrition leads to an early improvement in liver function.

Objective: The aim of study was to confirm the protective effects of parenteral glutamine supplementation on liver injury in premature infants and determine how quickly effects became evident.

Methods: We performed a double-blind, randomized, controlled clinical study to assess the effect of parenteral nutrition (PN) supplemented with glutamine in premature infants. Thirty infants from two children's centers, were randomly assigned to either a control group (Standard PN; n=15) or a glutamine-supplemented group (GlnPN; n=15). The primary endpoint was hepatic function. The secondary endpoints were total duration of PN, weight and head circumference gain, length of hospitalization, and days on a ventilator.

Results: The serum level of alkaline phosphatase (AKP) after parenteral nutrition for 14 days was significantly higher (p<0.05) in the control group. But in the glutamine-supplemented group, the serum concentration of aspartate aminotransferase (AST) and gamma glutamyltransferase (GGT) significantly decreased after PN for 7 days and 14 days (p<0.05), and the level of alkaline phosphatase (AKP) showed no increase. The levels of AKP and GGT were significantly different with time by group interaction. Levels of AKP was higher in control group than glutamine-supplemented group, and GGT level was lower in glutamine-supplemented group compared with controls. There were no significant differences between the groups in terms of total duration of PN, weight gain (g/d), increase in head circumference (cm/w), length of hospitalization, and duration of mechanical ventilation.

Conclusion: The longer the duration of parenteral nutrition, the more severe hepatic dysfunction became. Parenteral glutamine supplementation suggested a hepatoprotective effect.