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Chapter 5
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The RCT by Larsen et al., as well as the post-hoc analysis of this RCT, investigated 32 infants
undergoing elective open-heart surgery with cardiopulmonary bypass and compared the
effect of the pre- and post-operative administration of two types of parenteral lipid formulas,
namely Intralipid® (LCT soybean oil) in the control group and Lipoplus® (50% MCT, 40% LCT,
10% Fish oil) in the intervention group
11,17
. In the primary trial
17
, the authors report significantly
lower plasma concentrations of TNF-alpha and IL-6 (primary outcome measures) on the first
postoperative day in the treatment group receiving Lipoplus®. On day 7, the plasma TNF-
alpha and IL-6 concentrations were no longer different. Also duration of stay in PICU/hospital,
incidence of sepsis, inotrope scores or ventilator days (secondary outcome measures) were
similar in both groups. The post-hoc analysis
11
also reported lower levels of other inflammation
biomarkers (procalcitonin, leukotriene B4, lymphocytes) in the Lipoplus® group.
Two RCTs by Chaloupecky et al. were studies of 29 and 37 infants, respectively, undergoing
cardiac surgery, in which the impact on proteolysis and plasma amino acid profiles of early
parenteral administration of a higher dose of amino acids and of glucose as compared with
a low dose maintenance glucose infusion on the first postoperative day was investigated
10,12
.
Thereafter, all patients received enteral nutrition in equal amounts. The authors reported
less negative nitrogen balances, less proteolysis as suggested by urinary 3-methylhistidine
excretion, and higher levels of plasma amino acids during the first postoperative day in the
intervention group who received more parenteral amino acids and glucose. Although clinical
outcome measures were not explicitly described, the authors report no severe complications
such as low cardiac output syndrome, renal failure, sepsis or mortality in any of the groups.
Duration of intubation and inotropic support did not differ between treatment groups.
The RCT by Jordan et al. investigated 98 children suffering from severe sepsis or admitted
after major surgery who were identified as requiring parenteral nutrition. The study compared
the impact of glutamine-supplemented parenteral nutrition in the intervention group
with standard parenteral nutrition in the control arm
13
. The authors report that glutamine-
supplemented parenteral nutrition evoked a higher plasma concentration of heat shock
protein 70 on day 5, whereas plasma concentrations of IL-6 and IL-10 were not affected. Clinical
outcome measures were not significantly different in the 2 study groups.
The RCT by Lekmanov et al. studied 40 children with severe thermic burns and concomitant
injuries and compared the effect of glutamine-supplemented total parenteral nutrition during
at least one week in the intervention group to standard total parenteral nutrition in the control
group
14
. The authors reported no significant differences between the two groups for the serum
levels of protein, albumin and glutamine on day 5 and 7 of PICU stay, but found a significantly
shorter duration of mechanical ventilation in the intervention group (7 days versus 12 days in
the control group). This result should be interpreted with caution, since the methods section
was incomplete without information on the statistical analyses. Also plasma concentrations of
glutamine were not significantly different between the two groups.