348 Effects of Glutamine Supplementation on Brain Development of Very Preterm Children: a Follow-Up Study at School-Age

Abstract

Background and Aims The amino acid glutamine has been shown to reduce the number of serious neonatal infections in very preterm children (< 32 weeks of gestation), which may benefit long term brain development. The aim of this study was to elucidate potential effects of glutamine supplementation on brain development in very preterm children at school-age. Methods First, we investigated growth trajectories of head circumference, weight, and length in the first year for 65 very preterm children that originally participated in a randomized controlled trial on enteral glutamine supplementation between day 3 and 30 of life. Second, we measured brain structure volumes and white matter integrity for 52 very preterm children at school-age, using magnetic resonance imaging (MRI) and Diffusion Tensor Imaging (DTI), respectively. Furthermore, differences in functional outcomes were explored. Group differences were tested using ANOVA statistics. Results Glutamine supplementation was associated with improved growth trajectories of head circumference in the first year of life (d=0.66, p=0.03). Furthermore, glutamine supplementation increased white matter (d=0.54, p=0.03), hippocampus (d=0.47, p=0.02), and brain stem (d=0.54, p=0.04) volumes at school-age. All differences were strongly related with the number of serious neonatal infections (all p<0.02). Glutamine supplementation did not influende measures of motor, cognitive, and behavioral functioning at school-age. Conclusions We found evidence that reduction of serious infections by neonatal glutamine supplementation improves head growth in the first year of life, as well as brain structure volumes at school-age. This suggests an early programming effect of nutritional intervention with enteral glutamine.