Glutamine solution in the parenteral nutrition for children with critical conditions

Nutritional support for children with critical conditions is currently considered as the most important factor in the complex of therapy, which can prevent catabolism and risk of postoperative complications. Underestimation of the nutritional factor can lead to poor outcomes, such as a decrease in immunological resistance and the occurrence of postoperative complications.

Acute trauma in critically ill patients is characterized by metabolic and systemic responses, including an immune-inflammatory response that leads to immunosuppression and nosocomial infections. Parenteral nutrition is prescribed for patients in the intensive care unit who cannot be fed naturally to provide protein and energy substrates because of impaired homeostasis. The active use of arginine, glutamine, and omega-3 fatty acids is mainly indicated for patients with injuries and burns. Moreover, the discussion about the use of immune nutrition (arginine, glutamine, and omega-3 fatty acids) continues given the need for active use in intensive care. The article provides a review of the literature on the use of glutamine solution in parenteral nutrition for children. The article discusses modern approaches to prescribing parenteral nutrition with the additional use of glutamine solution, which has beneficial effects on the child’s body — increases the absorption function of the intestine, increases the thickness of the intestinal mucosa, helps maintain the morphological integrity of the intestine, and reduces intestinal permeability. Recent meta-analyses have shown the effect of glutamine-rich diets especially in patients with critical conditions. The addition of glutamine improves cellular processes and functioning of organs and systems. This leads to an improvement in immune competence, barrier function, and cessation of the inflammatory process. It is also a substrate for the formation of nitrite oxide and improves the formation of adenosine triphosphate in cells. Glutamine is an energy substrate for proliferative cells, including lymphocytes. In general, glutamine has a positive effect on many organs and systems, including the gastrointestinal systems, kidneys, lungs, heart, and liver. Immune nutrition has an anti-inflammatory effect, which helps prevent the development of acute phase response. In addition, it restores the indicators of protein metabolism in the early stages of parenteral nutrition. Therefore, the use of glutamine solution in total or complementary parenteral nutrition programs can optimize the quality of treatment for children.