Effect of Glutamine Enteral Supplementation in Post-Operative Intestinal Obstruction Neonates: A Randomized Control Trial

Martono Tri Utomo, Mahendra Tri Arif Sampurna, Muhammad Pradhika Mapindra, Muhammad Pradhiki Mahindra, Setya Mirtha, Kartika Dharma Handayani, Dina Angelika, Risa Etika


Surgical treatments targeted for infants suffering congenital intestinal obstruction are advantageous to increase clinical outcomes. However, the post-surgical period might encourage them to depletion of glutamine (Gln). This study aims to evaluate the efficacy of Gln to supply feeding requirements for infants during post-gastrointestinal tract surgical recovery. It was conducted in infants with congenital anomalies involving gastrointestinal (GI) and undergoing surgery using a double-blind, randomized trial design. The population was divided into control and trial groups. Afterward, the comparison of outcomes following the intervention is analyzed to determine the benefits of Gln supplementation. Eighteen of 20 infants were diagnosed with a congenital malformation that involved the GI tract after birth. As reported in 10 infants, anorectal malformation accounted for most of the types of malformations. There was no significant difference in clinical outcomes shown by infants supplied with Gln enteral diet and those who were not, in their birth weight and median time to full-enteral feeding (FEF). Enteral nutrition support using Gln enriched diet does not improve feeding tolerance for infants with congenital GI anomalies during post-surgical care. Concerning the novelty, this study found that the effect of Gln supplementation on babies undergoing GI surgical management is not significantly different from placebo.  

Keywords: birth weight, infants, full enteral feeding, glutamine, placebo.

Full Text:



VARGAS M. G., MIGUEL-SARDANETA M. L, ROSAS-TÉLLEZ M., PEREIRA-REYES D., and JUSTO-JANEIRO J. M. Neonatal intestinal obstruction syndrome. Pediatric Annals, 2018, 47: 220-225. https://doi.org/10.3928/19382359-20180425-02

BURGE D. M. The management of bilious vomiting in the neonate. Early Human Development, 2016, 102: 41-45. https://doi.org/10.1016/j.earlhumdev.2016.09.002

SIDLER D., DEBREW M., and LAKHOO K. Neonatal intestinal obstruction. In: AMEH E. A., BICKLER S. W., LAKHOO K., NWOMEH B. C., POENARU D., eds. Paediatric surgery: A comprehensive text book for Africa. Vol. II. 1st ed. Global HELP Organization, 2011: 376–380.

RICKHAM P. P. Neonatal intestinal obstruction. British Medical Journal, 2018, 1: 934.

CRUZAT V., ROGERO M. M., KEANE K. N., CURI R., and NEWSHOLME P. Glutamines: metabolism and immune function, supplement and clinical translation. Nutrients, 2018, 10(11):1564. DOI: 10.3390/nu10111564.

OLIVIA D. C., SILVA L. F., SANTORI T., SANTORS A. C. A., ROGERO M. M., and FOCK R. A. Glutamine metabolism and its effect on immune response: molecular mechanism and gene expression. Nutrire, 2016; 41: 14. DOI: 10.1186/s41110-016-0016-8

SPODENKIEWICZ M., DIEZ-FERNANDEZ C., RÜFENACHT V., GEMPERLE-BRISCHGI C., and HÄBERLE J. Lack of high amino acid synthesis, an ultra-rare raw material error. Biology (Basel), n.d., 5.

LIU G., REN W., FANG J., HU G., GUAN G, AL-DHABI N. A., YIN J., DURAIPANDIYAN V., CHEN S., PENG Y., and YIN Y. L-Glutamine and L-arginine protect against enterotoxigenic Escherichia coli infection via intestinal innate immunity in mice. Amino acids, 2017, 49: 1945-1954. https://doi.org/10.1007/s00726-017-2410-9.

SAMPURNA M, ANGELKA D, UTOMO MT, WIJAYA NA, ALKAFF F. F., BUDIONO B., IRAWAN R., and ETIKA R. Effect of enteral glutamine supplementation for low-birth-weight infants on weight gain patterns and levels of fecal secretory immunoglobulin A. Turkish Archives of Pediatrics, 2018, 53: 231-237. Doi: 10.5152/TurkPediatriArs.2018.6834.

KAI KANG K., SHU X.-L., ZHANG Y.-S., LIU X.-L., and ZHAO J. Effect of glutamine enriched nutrition support on surgical patients with gastrointestinal tumor: a meta-analysis of randomized controlled trials. Chinese Medical Journal, 2016, 128: 245-51. DOI: 10.4103/0366-6999.149219.

GUO M., LU C., and LI Y. Early intestinal rehabilitation therapy ameliorates intestinal adaptation in children with short bowel syndrome: the long-term outcome. The American Surgeon, 2016, 82: 1215-1220.

VIJEY AANANDHI M., and JOHN M. R. Enteral/oral glutamine supplementation in patients following surgery and accidental injury. Asian Journal of Pharmaceutical and Clinical Research, 2017, 10: 477-479. DOI: 10.22159/ajpcr.2017. v10i3.16569

ONG E. G. P., EATON S., WADE A. M., HORN V., LOSTY P. D., CURRY J. I., SUGARMAN I. D., KLEIN N. J., and PIERRO A, SIGN TRIAL GROUP. Randomized clinical trial of glutamine-supplemented versus standard parenteral nutrition in infants with surgical gastrointestinal disease. British Journal of Surgery, 2012, 99: 929-38. https://academic.oup.com/bjs/article/99/7/929/6141076

ANEMONE VAN DEN BERG, RUURD M VAN ELBURG, ELISABETH A.M. WESTERBEEK, JOS W.R. TWISK, and WILLEM P.F. FETTER. Glutamine-enriched enteral nutrition in very-low-birth-weight infants and effects on feeding tolerance and infectious morbidity: a randomized controlled trial. The American Journal of Clinical Nutrition, 81(6), 2005: 1397-1404, https://doi.org/10.1093/ajcn/81.6.1397

VAUGHN P., THOMAS P., CLARK R., and NEU J. Enteral glutamine supplementation and morbidity in low birth weight infants. Journal of Pediatrics, 2003, 142(6): 662-668. DOI: 10.1067/mpd.2003.208.

NEU J., ROIG J. C., VEERMAN M., CARTER C., MILLSAPS M., BOWLING D., DALLAS M. J., SLEASMAN J., KNIGHT T., and AUESTAD N. Enteral glutamine supplementation for very low birth weight infants decreases morbidity. Journal of Pediatrics, 1997: 131: 691-699. https://doi.org/10.1016/s0022-3476(97)70095-7


  • There are currently no refbacks.