Potential for glutamine supplementation in critically Ill children

Abstract

Glutamine serves as a primary fuel for rapidly dividing cells, such as in the gut and immune system, and is used as a source of nitrogen to refill the citric acid cycle. During critical illness, the demand for glutamine may exceed that which can be mobilised from muscle stores. Clinical data over the past 20 years have provided evidence that glutamine supplementation may reduce mortality, the occurrence of infections and hospital length of stay in such patients. Experimental work has proposed various mechanisms of glutamine action but none of the randomised studies in early life could demonstrate any effect on mortality and only a few showed some effect in inflammatory response, organ function and a trend for infection control. However, the beneficial effect of glutamine, in adult and experimental models of sepsis, appears to be HSP70 dependent. The aim of this systematic literature review is to examine whether glutamine supplementation improves outcome in infants and children. Methodological problems in clinical trials and interrelations with stress-induced heat-shock protein and inflammatory response should be considered in future research involving glutamine supplementation in premature infants and critically ill children.