Parenteral Nutrition In Preterm Infants Research Articles

Quality of newborn care: adherence to guidelines for parenteral nutrition in preterm infants in four European countries

ObjectiveThe level of adherence to guidelines should be explored particularly in preterm infants for whom poor nutrition has major effects on outcomes in later life. The objective was to evaluate...

L’alimentation parentérale du prématuré : comment la prescrire pour optimiser la croissance et le développement

Nutrition and growth are still a major challenge in neonatal intensive care. Many studies have demonstrated that premature infants frequently develop severe cumulative nutritional deficit during the first weeks of life. This malnutrition is the primary etiology of postnatal growth restriction, which is still universally described in very premature infants. Furthermore, both postnatal nutritional deficit and postnatal growth restriction have been associated with adverse long-term outcome in adulthood. Due to their immaturity, premature infants are frequently not fed by the enteral route. Therefore, parenteral nutrition remains an essential therapy in neonatology. Most recent recommendations suggest starting parenteral nutrition as soon as possible after birth with a minimum of 40 kcal/kg/day with around 2-3g/kg/day of amino acids and 1g/kg/day of lipids. Afterwards, intake should increase rapidly during the first week of life, up to 90-120 kcal/kg/day with around 3.5 g/kg/day amino acids and 3g/kg/day of lipids. There is great heterogeneity in parenteral nutrition practices among neonatal units, with frequent discrepancies. This article discusses the principal theoretical aspects of parenteral nutrition in premature infants, the guidelines, and the opportunity to optimize nutritional support routinely, especially in very premature infants.

Lipids in total parenteral nutrition for premature infants.

BackgroundLipids of TPN can cause liver toxicity in premature infants, so it is important to evaluate the introduction of new emulsionsPurposeTo describe the safety of two lipid emulsions used in...

Benefits of a New Pediatric Triple‐Chamber Bag for Parenteral Nutrition in Preterm Infants

The aim of this study was to evaluate the efficacy, safety, flexibility, and ease of handling and use of the Ped3CB-A 300 mL, the first ready-to-use multichamber parenteral nutrition (PN) system, with optional lipid bag activation, specially designed for administration to preterm infants. In this prospective, open-label, multicenter, noncomparative, phase III clinical trial, preterm infants were treated with Ped3CB-A for 5 to 10 consecutive days. A total of 113 preterm infants were enrolled in the study and 97 (birth weight 1382 ± 520 g; gestational age 31.2 ± 2.5 weeks; postnatal age administration 5.6 ± 6.1 days) were included in the per protocol analysis accounting for 854 perfusion days. Double-chamber bag activation was used for 32 perfusion days. Macronutrient, electrolyte, and mineral supplements were primarily administered through a Y-line or directly in the activated bag. In all, 199 additions (mainly sodium, 95%) were made to the Ped3CB-A bags on 197 infusion days (23.1%) in 43 infants (44.3%). More than 1 of these nutrients was added to the bag on only 1 perfusion day. Mean and maximum parenteral nutrient intakes were 2.8 ± 0.7 and 3.6 ± 0.8 g amino acids per kilogram per day, and 80 ± 20 and 104 ± 22 kcal · kg(-1) · day(-1). Mean weight gain represented 10.0, 21.5, and 22. 6 g · kg(-1) · day(-1) according to age at inclusion (0-3, 4-7, or >7 days of life). A visual analog scale was completed and produced positive results. No adverse events were attributable to the design of the Ped3CB-A system. Ped3CB-A provides easy-to-use, well-balanced, and safe nutritional support. Nutritional intakes and weight gain were within the recent PN recommendations in preterm infants.

Practical Handling, Ease of Use, Safety and Efficacy of a New Pediatric Triple-Chamber Bag for Parenteral Nutrition in Preterm Infants

Background: In adults, multi-chamber parenteral nutrition is commonly used. However, this has not historically been used for preterm infants.Objective: To evaluate the efficacy, safety, flexibility, and ease of handling and use of the Ped3CB-A 300 mL, the first ready to use multi-chamber parenteral nutrition (PN) system, with optional lipid bag activation, specially designed for administration to preterm infants.Methods: In this prospective, open-label, multicenter, noncomparative, Phase III clinical trial, preterm infants were treated with Ped3CB-A for 5-10 consecutive days.Results: 113 preterm infants were enrolled in the study and 97 (BW:1382±520g, GA:31.2±2.5 weeks, PNA:5.6±6.1 d) were included in the per protocol analysis accounting for 854 perfusions days. Macronutrient, electrolyte, and mineral supplements were primarily administered through a Y-line or directly in the activated bag. In all, 199 additions (mainly sodium 95%) were made to the Ped3CB-A bags on 197 infusion days (23.1%) in 43 infants (44.3%). More than 1 of these nutrients was added to the bag on only 1 perfusion day. Mean±SD (standard deviation) of the averaged and maximum daily parenteral nutrient intakes were 2.8±0.7 and 3.6±0.8 g AA/kg*d and 80±20 and 104±22 kcal/Kg*d. Mean weight gain represented 10.0, 21.5 and 22.6 g/kg*d according to age at inclusion, 0-3,4-7 and >7 days of life. No adverse events were attributable to the design of the Ped3CB-A system.Conclusion: Ped3CB-A provides ease of use, well balanced and safe nutritional support. Nutritional intakes and weight gain were within the more recent recommendations for preterm infants

Parental nutrition with fish oil

Parental nutrition is now standard of care for infants who cannot feed and for very preterm infants. Adequate calories for growth can be delivered only by including lipid emulsions in the parental nutrition. However, the standard lipid emulsions in clinical use contain minimal amounts of the long chain polyunsaturated fatty acids that are needed for optimal neurodevelopment. D'Ascenzo et al report that a lipid emulsion that contains 20% fish oil improves the plasma and red cell membrane lipid profiles for preterm infants with birth weights <1250 g. This lipid emulsion was safe for short-term use in the 23 infants. It is important to question whether these changes in lipid profiles will translate to decreased inflammatory responses or, more importantly, to improved neurodevelopment. Safety for long-term use will also need to be tested. Parental nutrition is now standard of care for infants who cannot feed and for very preterm infants. Adequate calories for growth can be delivered only by including lipid emulsions in the parental nutrition. However, the standard lipid emulsions in clinical use contain minimal amounts of the long chain polyunsaturated fatty acids that are needed for optimal neurodevelopment. D'Ascenzo et al report that a lipid emulsion that contains 20% fish oil improves the plasma and red cell membrane lipid profiles for preterm infants with birth weights <1250 g. This lipid emulsion was safe for short-term use in the 23 infants. It is important to question whether these changes in lipid profiles will translate to decreased inflammatory responses or, more importantly, to improved neurodevelopment. Safety for long-term use will also need to be tested. Parenteral Nutrition of Preterm Infants with a Lipid Emulsion Containing 10% Fish Oil: Effect on Plasma Lipids and Long-Chain Polyunsaturated Fatty AcidsThe Journal of PediatricsVol. 159Issue 1PreviewTo compare plasma lipids in preterm infants given a new lipid emulsion containing 10% fish oil, 50% medium-chain triacylglycerols, and 40% soybean oil, compared with a standard preparation containing 50:50 medium-chain triacylglycerols: soybean oil. Full-Text PDF

Aluminium exposure from parenteral nutrition in preterm infants and later health outcomes during childhood and adolescence

Aluminium is the most common metallic element, but has no known biological role. It accumulates in the body when protective gastrointestinal mechanisms are bypassed, renal function is impaired, or exposure is high - all of which apply frequently to preterm infants. Recognised clinical manifestations of aluminium toxicity include dementia, anaemia and bone disease. Parenteral nutrition (PN) solutions are liable to contamination with aluminium, particularly from acidic solutions in glass vials, notably calcium gluconate. When fed parenterally, infants retain >75% of the aluminium, with high serum, urine and tissue levels. Later health effects of neonatal intravenous aluminium exposure were investigated in a randomised trial comparing standard PN solutions with solutions specially sourced for low aluminium content. Preterm infants exposed for >10 d to standard solutions had impaired neurologic development at 18 months. At 13-15 years, subjects randomised to standard PN had lower lumbar spine bone mass; and, in non-randomised analyses, those with neonatal aluminium intake above the median had lower hip bone mass. Given the sizeable number of infants undergoing intensive care and still exposed to aluminium via PN, these findings have contemporary relevance. Until recently, little progress had been made on reducing aluminium exposure, and meeting Food and Drug Administration recommendations (<5 μg/kg per d) has been impossible in patients <50 kg using available products. Recent advice from the UK Medicines and Healthcare regulatory Authority that calcium gluconate in small volume glass containers should not be used for repeated treatment in children <18 years, including preparation of PN, is an important step towards addressing this problem.

The lipid peroxidation of two methods of parenteral nutrition in premature infants

目的 本研究通过以不同静脉营养比例输注脂肪乳剂,比较脂质过氧化程度,以探讨临床上早产儿脂肪乳剂的合理输注方法.方法 选取我院2009年3月至2010年6月新生儿重症监护病房收治的早产极低出生体质量儿40例,随机分为A、B两组,各20例.A组:脂肪乳与氨基酸、葡萄糖混合后经由避光管输注,葡萄糖、氨基酸、脂肪乳三种供能比例调整为50%:15%:35%.B组:输注成分与A组相同,混合后亦由避光管输注,葡萄糖、氨基酸、脂肪乳供能按体质量每日递增至足量,除各类营养物质的浓度及总浓度不超过规定浓度外,比例不调整为50%:15%:35%.两组患儿均于静脉营养5 d后取静脉血5 ml,检测丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-PX)、胱抑素C(CysC)浓度.结果 MDA浓度A组较低[(15.49±1.38)μmol/L],B组较高[(26.47±2.26)μmol/L],两组比较差异有统计学意义(P＜0.01);GSH-PX A组较多,B组较少,两组比较差异有统计学意义(P＜0.01);CysC A组较多[(1.98±0.31)mg/L],B组较少[(1.69±0.17)mg/L],两组比较差异有统计学意义(P＜0.01).结论 早产儿输注静脉营养过程中,选用一次性黑色避光输注管输注、并使葡萄糖、氨基酸、脂肪乳供能的比例调整为尽量接近或达到50%:15%:35%时,脂质过氧化程度最轻,且CysC对判断脂质过氧化程度与GSH-PX一致,值得临床应用。

Parenteral Nutrition of Preterm Infants with a Lipid Emulsion Containing 10% Fish Oil: Effect on Plasma Lipids and Long-Chain Polyunsaturated Fatty Acids

To compare plasma lipids in preterm infants given a new lipid emulsion containing 10% fish oil, 50% medium-chain triacylglycerols, and 40% soybean oil, compared with a standard preparation containing 50:50 medium-chain triacylglycerols: soybean oil. Preterm infants weighing <1250 g at birth (n=47) were randomly assigned to receive parenteral nutrition with a fish oil lipid (n=23) or soybean oil (n=24). Plasma lipid classes and plasma and red blood cell fatty acids were determined by gas chromatography in cord blood and on postnatal days 7 and 14. On day 7, the infants receiving fish oil lipid had significantly lower plasma phospholipids, cholesterol esters, and free cholesterol but similar triglyceride concentrations. They also had significantly higher phospholipid docosahexaenoic acid (2.77 ± 0.08 versus 2.46 ± 0.01 mol%, P<.01) and eicosapentaenoic acid (1.58 ± 0.01 versus 0.25 ± 0.01 mol%, P<.01) as well as lower arachidonic acid (10.64 ± 0.29 versus 11.93 ± 0.29 mol%, P<.01) compared with those receiving soybean oil. Similar differences were found in red blood cells. The fish oil lipid emulsion was well tolerated, and infants receiving fish oil had lower plasma lipids and improved fatty acids status. The effect of these changes on inflammation, growth, and neurodevelopment should be explored.

Nutrition of preterm infants in relation to bronchopulmonary dysplasia

BackgroundThe pathogenesis of bronchopulmonary dysplasia (BPD) is multifactorial. In addition to prenatal inflammation, postnatal malnutrition also affects lung development.MethodsA retrospective study was performed to analyse during the first two weeks of life the total, enteral and parenteral nutrition of premature infants (<31 weeks, birth weight ≤1500 g) born between 08/04 and 12/06.ResultsNinety-five premature infants were analysed: 26 with BPD (27 ± 1 weeks) and 69 without BPD (28 ± 1 weeks). There was no statistical significant difference in the total intake of fluids, calories, glucose or protein and weight gain per day in both groups. The risk of developing BPD was slightly increased in infants with cumulative caloric intake below the minimal requirement of 1230 kcal/kg and a cumulative protein intake below 43.5 g/kg. Furthermore, the risk of developing BPD was significantly higher when infants had a cumulative fluid intake above the recommended 1840 ml/kg. In infants who developed BPD, the enteral nutrition was significantly lower than in non-BPD infants [456 ml/kg (IQR 744, 235) vs. 685 (IQR 987, 511)]. Infants who did not develop BPD reached 50% of total enteral feeding significantly faster [9.6 days vs. 11.5].ConclusionsPreterm infants developing BPD received less enteral feeding, even though it was well compensated by the parenteral nutrient supply. Data suggest that a critical minimal amount of enteral feeding is required to prevent development of BPD; however, a large prospective clinical study is needed to prove this assumption.

Nutritional support for extremely low-birth weight infants: abandoning catabolism in the neonatal intensive care unit

Obviously, the ultimate goal in neonatology is to achieve a functional outcome in premature infants that is comparable to healthy term-born infants. As nutrition is one of the key factors for normal cell growth, providing the right amount and quality of nutrients could prove pivotal for normal development. However, many premature infants are catabolic during the first week of life, which has directly been linked to growth failure, disease, and suboptimal long-term outcome. This review describes the progress in research on parenteral nutrition for premature infants with a focus on amino acids and the influence of nutrition on later outcome. Although randomized clinical trials on early nutrition for premature infants remain relatively sparse, evidence is accumulating on its beneficial effects both on the short-term and long-term. However, some research also warns for adverse effects. Despite the fact that substantially improved nutritional therapies for preterm neonates have been implemented, still, some reluctance exists when it comes to providing high amounts of nutrition to the most immature infants. Pros and cons are outlined, as well as deficits in knowledge, when it comes to providing the optimal nutrient strategy in the first postnatal phase.

Standardized Parenteral Nutrition in Preterm Infants: Early Impact on Fluid and Electrolyte Balance

Background: Parenteral nutrition is commonly given to premature infants. It has previously been suggested that standardized parenteral nutrition (SPN) may offer nutritional advantages compared to individualized parenteral nutrition (IPN). However, whether the same level of biochemical control is assured with SPN and with IPN remains uncertain. Objectives: To compare fluid and electrolyte balance in preterm infants receiving IPN versus SPN in the first week of life. Methods: 107 infants born at <33 weeks gestation were prospectively evaluated. Serum and urinary creatinine and electrolyte concentration, urine volume, body weight, fluid, electrolyte and energy intakes were recorded daily. Results: 40 infants received IPN and 67 SPN. Infants in IPN had significantly more water and less sodium intake than those receiving SPN. Energy and amino acid intakes were significantly lower in IPN than in SPN groups. Incidence of hypernatremia and hyponatremia was similar in both groups. Nonoliguric hyperkalemia (NOHK) was significantly more frequent in IPN than in SPN (20.0 vs. 2.9%) and mean serum K⁺ peak over the first 3 days was higher in IPN than in SPN (5.63 ± 1.05 vs. 4.91 ± 0.78 mmol/l). Weight loss (% of birth weight) at day 7 was significantly higher in IPN than in SPN (7.7 ± 5.8 vs. 4.2 ± 6.5) without differences in urine output/input fluid intake ratio and glomerular renal function between the two groups. Conclusions: There were no significant differences in water and sodium balance in preterm infants who received IPN versus SPN. The risk of NOHK was higher in IPN. Also, SPN significantly increased amino acid and caloric intakes, and it reduced early weight loss.

Early life events, sex, and arterial blood pressure in critically ill infants

To determine whether photo-protecting total parenteral nutrition in preterm infants influences arterial blood pressure differently according to gender. Blood pressure is influenced by complex mechanisms of vasomodulation. Oxidants are mediators and effectors in such reactions. Shielding total parenteral nutrition from light contributes to decrease the generation of peroxides. Girls may be better protected against an oxidant load than boys. We questioned whether shielding total parenteral nutrition may have cardiovascular effects that are influenced by gender. A post hoc subgroup analysis of the effect of shielding parenteral nutrition from light. Neonatal intensive care unit. Preterm infants <1000 g with indwelling arterial catheters who received light exposed (n = 20) or light protected (n = 20) parenteral nutrition. Invasive monitoring, total parenteral nutrition. Arterial blood pressure was recorded hourly and compared between light exposed and light protected over the first week of life; timed average maximum velocity (m/s) was measured in the superior mesenteric artery by Doppler; presence of ductus arteriosus was documented by cardiac ultrasound. Data were analyzed by analysis of variance. No differences were noted between light exposed and light protected in clinical determinants that may influence blood pressure. There was an interaction (p < .01) between gender and total parenteral nutrition on blood pressure. In girls (n = 17), systolic and diastolic blood pressures were higher (p < .01) and heart rate lower (p < .01) during light exposed. There was no effect on BP observed in boys (n = 23). The linear correlation between timed average maximum velocity and systolic blood pressure was positive (p < .05). There was no echocardographic difference in hemodynamic variables between boys (n = 21) and girls (n = 9) who had a patent ductus. Failure to shield total parenteral nutrition from light results in higher blood pressure in a selected population of critically ill female infants. This information adds to our understanding of the multiple determinants involved in optimizing arterial blood pressure in a critical care environment.

Aluminum Exposure From Parenteral Nutrition in Preterm Infants: Bone Health at 15-Year Follow-up

Aluminum has known neurotoxicity and may impair short-term bone health. In a randomized trial, we showed reduced neurodevelopmental scores in preterm infants who were previously exposed to aluminum from parenteral nutrition solutions. Here, in the same cohort, we test the hypothesis that neonatal aluminum exposure also adversely affects long-term bone health, as indicated by reduced bone mass. Bone area (BA) and bone mineral content (BMC) of lumbar spine, hip, and whole body were measured with dual radiograph absorptiometry in 13- to 15-year-olds who were born preterm and randomly assigned standard or aluminum-depleted parenteral nutrition solutions during the neonatal period. Fifty-nine children (32% of survivors) were followed. Those who were randomly assigned to standard parenteral nutrition solution had lower lumbar spine BMC, apparently explained by a concomitant decrease in bone size. In nonrandomized analyses, children who were exposed to neonatal aluminum intakes above the median (55 microg/kg) had lower hip BMC (by 7.6% [95% confidence interval: 0.12-13.8]; P = 0.02), [corrected] independent of bone (or body) size. Neonates who are exposed to parenteral aluminum may have reduced lumbar spine and hip bone mass during adolescence, potential risk factors for later osteoporosis and hip fracture. These findings need confirmation in larger, more detailed studies. Nevertheless, given our previous finding of adverse developmental outcome in these individuals and the sizeable number of contemporary infants who undergo intensive neonatal care and are still exposed to aluminum via parenteral feeding solutions, the potential adverse long-term consequences of early aluminum exposure now deserve renewed attention.

Outcomes of early parenteral nutrition for premature infants

The objective of this study was to evaluate the safety and efficacy of early amino acid (early AA) administration in very low birth weight (VLBW) infants. A pre- and post-intervention study was conducted after initiating an early AA administration protocol. Clinical outcomes were collected for all VLBW infants admitted on the first day of life for 9 months before protocol initiation (standard parenteral nutrition (PN)), and 10 months after initiation of early AA. In all, 88 infants met study criteria for standard PN, and 85 infants for early AA administration. The patient characteristics were similar between the groups. There were no differences in mortality, the day birth weight was regained, the day enteral feeds started, the duration of PN, the day full feeds achieved and weight at 32 weeks post-menstrual age. No differences were found for late sepsis, direct hyperbilirubinemia and chronic lung disease. Necrotizing enterocolitis (NEC) occurred more frequently in the early AA administration group (12 vs 1%, P=0.012). Early AA administration for VLBW infants was as efficacious as standard therapy, although increased NEC in the early AA period may have negatively affected growth and nutrition in that period.

Parenteral Nutrition Objectives for Very Low Birth Weight Infants: Results of a National Survey

The aim of the study was to evaluate parenteral nutrition objectives for very low birth weight (VLBW) infants in neonatal intensive care units (NICUs), and to compare nutritional protocol differences according to levels of care. A national survey was conducted in France through a questionnaire sent to 296 French neonatal departments to determine each team leader's nutritional objectives for parenteral nutrition of VLBW infants. A total of 172 of the 296 French neonatal departments responded to the questionnaire. Protein administration was not started during the first day of life in half of the responding units. Furthermore, half of the units initiated protein administration with less than 1 g x kg(-1) x day(-1). The day of introduction of lipid emulsions varied considerably from one unit to another, but more than half of the units started the lipid emulsions after the third day of life. Twenty percent of the units reported a target energy intake of 100 kcal x kg(-1) x day(-1), whereas 14% reported a target intake above or equal to 130 kcal x kg(-1) x day(-1). In comparison with recent guidelines for parenteral nutrition for VLBW infants, the results indicate that the majority of the departments are familiar with target macronutrient and energy intakes, but the time of introduction and the rate of progression of macronutrients, particularly proteins and lipids, are frequently lower than those defined by the guidelines. The large-scale publication of new nutritional guidelines for the parenteral nutrition of neonates and preterm infants as well as regular, specific training in the parenteral nutrition of preterm infants are needed.

Early individualised parenteral nutrition for preterm infants

Considerable effort should be made to optimise parenteral nutrition of preterm infants in order to limit the development of postnatal growth restriction. A monocentric before-and-after study design was used to...

Nutrição parenteral no recém-nascido pré-termo: proposta de protocolo prático

OBJETIVO: Revisar a literatura e os conceitos relacionados à terapia nutricional parenteral de recém-nascidos pré-termo e propor fluxograma prático de indicação, progressão dos parâmetros e monitoramento para utilização em unidades neonatais. FONTES DE DADOS: Artigos publicados em inglês e português nas bases de dados Medline, Embase, Lilacs e SciELO nos últimos dez anos, além de referências clássicas e consensos internacionais. As palavras-chave utilizadas como fonte de busca foram recém-nascido pré-termo, nutrição parenteral, terapia nutricional e emulsões lipídicas. SÍNTESE DOS DADOS: A nutrição parenteral é procedimento essencial no tratamento intra-hospitalar do recém-nascido pré-termo. Além dos avanços no conhecimento e progressos na legislação, vários fatores contribuíram para reduzir a morbimortalidade desses recém-nascidos e elevar a segurança na utilização da nutrição parenteral, tais como qualidade dos cateteres empregados, treinamento e capacitação adequada dos profissionais envolvidos, existência de equipes multiprofissionais e o desenvolvimento de novos insumos. CONCLUSÕES: Esse protocolo prático sobre nutrição parenteral para recém-nascidos prematuros foi desenvolvido com base em recomendações internacionais de sociedades científicas e na análise crítica de estudos científicos.

Use of Intravenous Lipids in Very Low-birthweight Infants

Lipids are essential components of parenteral nutrition for preterm infants to provide essential fatty acids and to meet high energy needs. However, there is concern about increased risks of sepsis, displacement of bilirubin from albumin, and pulmonary complications when parenteral lipids are provided to sick preterm infants early in postnatal life. Slow administration of intravenous lipid emulsions, with stepwise increases, appears to be well-tolerated in most preterm infants. High doses probably should be avoided in infants who have severe acute respiratory failure with or without pulmonary hypertension.

Effect of parenteral glutamine supplementation in premature infants

Glutamine, proposed to be conditionally essential for critically ill patients, is not added routinely to parenteral amino acid formulations for premature infants and is provided in only small quantities by the enteral route when enteral feeding is low. Parenteral feeding is the basic way of nutrition in the first days of life of premature infants. In this study, we evaluated the effects of glutamine supplemented parenteral nutrition for premature infants on growth and development, feeding toleration, and infective episodes. From December 2002 to July 2006, 53 premature infants were given either standard or glutamine supplemented parenteral nutrition for more than 2 weeks. Twenty-eight infants were in glutamine supplemented group, whose gestational age (31.4 +/- 2.0) weeks, birth weight range (1386 +/- 251) g; twenty-five infants were in control group, gestational age (31.1 +/- 1.7) weeks, with birth weight range (1346 +/- 199) g. There were no differences between the two groups. Various growth and biochemical indices were monitored throughout the duration of hospital stay. Data between groups were analyzed with Student's t test. Nonparametric data were analyzed using a Chi-square test. A two-tailed P value < 0.05 was considered statistically significant. The level of serum albumin was lower in the glutamine groups on the second week (3.0 vs 3.2 g/dl, P = 0.028), and blood urea nitrogen was higher in glutamine groups on the fourth week (8.1 vs 4.9 mg/dl, P = 0.014), but normal. Glutamine group infants took fewer days to regain birth weight (8.1 vs 10.4 days, P = 0.017), required fewer days on parenteral nutrition (24.8 vs 30.8 days, P = 0.035), with shorter stays in hospital (32.1 vs 38.6 days, P = 0.047). Episodes of hospital acquired infection in glutamine supplemented infants were lower than that in control group (0.96 vs 1.84 times, P = 0.000). Parenteral glutamine supplementation in premature infants can shorten days on parenteral nutrition and length of stay in hospital, and decrease hospital acquired infection episodes.