Glutamine supplementation: Is it beneficial to critically ill children?

Abstract

Although there have been several randomized trials, conducted with critically ill adults, reporting the benefits
of glutamine supplementation, there is scarce information on the role of glutamine in the treatment outcome
of critically ill children. Our objective was to evaluate existing studies on the effect of glutamine supplementation,
aiming at verifying the clinical benefits of such supplementation for critically ill children. A computerized
search was conducted to select prospective, randomized, clinical trials of critically ill children, published
between 1992 and 2003. Studies were included if, besides presenting the characteristics already mentioned,
they evaluated the effects of parenteral and the enteral glutamine supplementing vs. those of standard care.
The variables on clinical outcomes were: time to achieve full enteral nutrition, hospital length of stay,
complication rates, and mortality. Three bibliographic databases were searched: Medline, LILACS and Cochrane
Library. Search terms included: glutamine, critically ill, trauma, sepsis, burned, injured, bone marrow
transplantation, intensive care, and mechanic ventilation. Initial screening resulted in 33 original articles; of
these potentially eligible articles, only 7 fulfilled the inclusion criteria. Length of hospital stay, mortality rate,
and hospital costs were not different for patients receiving glutamine-supplemented nutrition, when compared
to those receiving non-supplemented diet. Glutamine was associated with reduction in the time necessary to
achieve full enteral feeding and parenteral nutrition. There is no evidence to support the routine use of either
parenteral or enteral glutamine supplement when treating critically ill children. The small number of patients,
heterogeneity with respect to the studied groups, routes of administration, and confounding effects of
concomitant diseases, all limit the inferences we can make from the results.