Glutamine supplementation in infants with gastrointestinal disease: a randomized, placebo-controlled pilot trial.

OBJECTIVE: Glutamine (Gln) is a non-essential amino acid that plays an important role in energy metabolism for gastrointestinal epithelia and other cells with rapid turnover. We evaluated the effects of enteral supplementation with Gln in infants undergoing surgery for congenital or acquired gastrointestinal disease. METHODS: This was a randomized, double-masked, controlled clinical trial. RESULTS: Twenty infants were randomly assigned to receive Gln (n = 9) or placebo amino acid (n = 11), with a goal of supplemental amino acid intake of 0.4 g.kg(-1).d(-1). Infants were weaned from parenteral nutrition, and enteral feeds were started according to a standardized feeding protocol. Median (interquartile range) durations of parenteral nutrition were 39 d (12 to 99) in the Gln group and 21 d (6 to 59) in the control group (P = 0.201). Median (interquartile range) durations needed to reach 80% of the US recommended dietary allowance for energy with enteral nutrition were 24 d (8 to 55) in the Gln group and 12.5 d (5 to 32) in the control group (P = 0.313). There were no differences in the occurrence of infections between groups. Among all infants enrolled, significant correlations were found between duration of parenteral nutrition and residual small bowel length, peak concentrations of direct bilirubin, and alanine aminotransferase. Peak direct bilirubin was associated with longer duration of parenteral nutrition, shorter gestation, older age before feeds were started, shorter bowel length, and larger amounts of parenteral energy and protein intake. CONCLUSIONS: In this pilot trial, enteral Gln supplementation was well tolerated among infants with surgical gastrointestinal disease. There was no effect observed on the duration of parenteral nutrition, tolerance of enteral feeds, or intestinal absorptive or barrier function. Larger, multicenter trials in infants with surgical gastrointestinal disease are needed due to the variability in important outcome measurements.

Nutrition for the pediatric office: update on vitamins, infant feeding and food allergies.

PURPOSE OF REVIEW: Advances in the field of pediatric nutrition continue to help the pediatric office practitioner provide excellent clinical care to their patients. In 2003, several important papers were published in the field of clinical nutrition that are reviewed. RECENT FINDINGS: New recommendations by the American Academy of Pediatrics for vitamin D supplementation for breast-fed infants have been published that underscore the importance of routine supplementation with 200 IU vitamin D per day. Vitamin K should be provided (0.5 to 1 mg intramuscularly) to all newborns. The authors also review original reports evaluating the role of long-chain polyunsaturated fatty acids in infant formulas, the duration of exclusive breast-feeding, and the natural history of food allergies. Some observational studies support exclusive breast-feeding for 6 months. Data concerning the efficacy of long-chain polyunsaturated fatty acids are conflicting but do support the safety of these additives. SUMMARY: Regular supplementation with vitamin D, and newborn provision of vitamin K, are important nutritional interventions for infants and children.

Update on pediatric nutrition: breastfeeding, infant nutrition, and growth.

Recent studies continue to point out the critical nature of a patient's nutritional status in helping to determine important health outcomes in pediatrics. We review recent data concerning the composition of breast milk and its adequacy to support infant growth in the first six months of life, as well as trials that support breastfeeding as an important method to delay or reduce the incidence of atopic diseases such as eczema, allergies, and asthma. Studies have also been published that show how physician education and training about breastfeeding can be optimized. Studies showing how nutritional status is measured (using standard anthropometric techniques as well as more modern measures of basal metabolic rate) are highlighted, as well as the role of micronutrient supplementation of patients with the human immunodeficiency virus infection and diarrheal diseases.