Tubman T R J, Thompson S W, McGuire W
Royal Maternity Hospital, Neonatal Intensive Care Unit, Grosvenor Road, Belfast, Northern Ireland, UK.
Cochrane Database Syst Rev. 2008 Jan 23(1):CD001457. doi: 10.1002/14651858.CD001457.pub3.
Glutamine endogenous biosynthesis may be insufficient for tissue needs in states of metabolic stress. Trials in adults have suggested that glutamine supplementation improves clinical outcomes in critically ill adults. It has been suggested that glutamine supplementation may benefit preterm infants, particularly very low birth weight infants.
To determine the effects of glutamine supplementation on mortality and morbidity in preterm infants.
The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2007), MEDLINE (1966 - July 2007), EMBASE (1980 - July 2007), conference proceedings, and previous reviews.
Randomised or quasi-randomised controlled trials that compared glutamine supplementation versus no glutamine supplementation in preterm infants at any time from birth to discharge from hospital.
The standard methods of the Cochrane Neonatal Review Group were used, with separate evaluation of trial quality and data extraction by two authors. Data were synthesised using a fixed effects model and reported using typical relative risk, typical risk difference and weighted mean difference.
2365 preterm infants have participated in seven randomised controlled trials. All of the participating infants were of very low birth weight. Three trials assessed enteral glutamine supplementation and four trials assessed parenteral glutamine supplementation. The trials were generally of good methodological quality with adequate allocation concealment, blinding of caregivers and assessors to the intervention, and complete or near-complete follow-up of recruited infants. Glutamine supplementation does not have a statistically significant effect on mortality: typical relative risk 0.98 (95% confidence interval 0.80 to 1.20); typical risk difference 0.00 (95% confidence interval -0.03 to 0.02). The only trial that assessed long-term outcomes did not find any statistically significant differences in various assessments of neurodevelopment at 18 months corrected age. Glutamine supplementation does not have a statistically significant effect on other neonatal morbidities including invasive infection, necrotising enterocolitis, time to achieve full enteral nutrition, or duration of hospital stay.
AUTHORS' CONCLUSIONS: The available data from good quality randomised controlled trials indicate that glutamine supplementation does not confer benefits for preterm infants. The narrow confidence intervals for the effect size estimates suggest that a further trial of this intervention is not a research priority.
在代谢应激状态下，谷氨酰胺的内源性生物合成可能不足以满足组织需求。针对成年人的试验表明，补充谷氨酰胺可改善危重症成年人的临床结局。有人提出，补充谷氨酰胺可能对早产儿有益，尤其是极低出生体重儿。
确定补充谷氨酰胺对早产儿死亡率和发病率的影响。
采用Cochrane新生儿综述小组的标准检索策略。这包括检索Cochrane对照试验中心注册库（CENTRAL，Cochrane图书馆，2007年第3期）、MEDLINE（1966年至2007年7月）、EMBASE（1980年至2007年7月）、会议论文集以及以往的综述。
比较从出生到出院的任何时间补充谷氨酰胺与不补充谷氨酰胺的早产儿的随机或半随机对照试验。
采用Cochrane新生儿综述小组的标准方法，由两位作者分别评估试验质量并提取数据。数据采用固定效应模型进行综合分析，并以典型相对风险、典型风险差和加权均数差进行报告。
2365名早产儿参与了7项随机对照试验。所有参与试验的婴儿均为极低出生体重儿。3项试验评估了肠内补充谷氨酰胺，4项试验评估了肠外补充谷氨酰胺。这些试验的方法学质量总体良好，分配隐藏充分，护理人员和评估人员对干预措施不知情，且对招募的婴儿进行了完整或近乎完整的随访。补充谷氨酰胺对死亡率无统计学显著影响：典型相对风险为0.98（95%置信区间为0.80至1.20）；典型风险差为0.00（95%置信区间为 -0.03至0.02）。唯一一项评估长期结局的试验在矫正年龄18个月时的各项神经发育评估中未发现任何统计学显著差异。补充谷氨酰胺对包括侵袭性感染、坏死性小肠结肠炎、实现完全肠内营养的时间或住院时间在内的其他新生儿疾病无统计学显著影响。
高质量随机对照试验的现有数据表明，补充谷氨酰胺对早产儿无益处。效应大小估计的置信区间较窄表明，进一步开展该干预措施的试验并非研究重点。
