The impact of oral glutamine supplementation on the intestinal permeability and incidence of necrotizing enterocolitis/septicemia in premature neonates

Objective. To examine the impact of oral glutamine (Gln) supplementation on gut integrity and on the incidence of necrotizing enterocolitis (NEC)/septicemia of premature neonates. Methods. Preterm neonates (n=101, gestational age <34 weeks, birth weight <2000 g) were randomly allocated to receive from day 3 to day 30 postpartum, either oral Gln (0.3 g/kg/day, n=51-Gln group) or placebo (caloreen-isocaloric, n=50-control group). Intestinal permeability was determined from the urinary lactulose/mannitol recovery (L/M ratio) following their oral administration and assessed at three time points: day 2 (before first administration), day 7 and day 30 of life. The incidence of NEC and septicemia over the study period was also recorded. Results. A decrease of lactulose recovery at days 7 (p=0.001) and 30 (p<0.001) and a decrease of L/M ratio at day 7 (p=0.002) were observed only in the Gln group. Lactulose recovery and L/M ratio at day 7 (p=0.022 and p=0.004, respectively), as well as lactulose recovery (p=0.001), mannitol recovery (p=0.042), and L/M ratio (p=0.001) at day 30, were decreased in the Gln group as compared to controls. NEC and septicemia were lower in the Gln group at the end of the first week (p=0.009 and p=0.041, respectively) and up to the end of the study (p<0.001 and p=0.048, respectively). Conclusion. Oral Gln administration may have beneficial effects on intestinal integrity and the overall incidence of NEC/septicemia in preterm infants.