Podcast: Enteral lactoferrin supplementation for prevention of sepsis and necrotizing enterocolitis in preterm infants

Sepsis is the most common cause of death for newborn babies worldwide. Mohan Pammi and Gautham Suresh from Baylor College of Medicine in Houston, USA updated the Cochrane review of the evidence on the use of lactoferrin, in March 2020, and we asked Mohan to describe the latest findings.

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Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. Sepsis is the most common cause of death for newborn babies worldwide. Mohan Pammi and Gautham Suresh from Baylor College of Medicine in Houston, USA updated the Cochrane review of the evidence on the use of lactoferrin, in March 2020, and we asked Mohan to describe the latest findings.

Mohan: Lactoferrin is present in significant amounts in human colostrum, milk, tears, saliva and in neutrophilic granules. It has significant anti-microbial activity against the microbes that cause neonatal sepsis, enhances host defense against infections and modulates inflammation. Neonatal sepsis and necrotizing enterocolitis, which I’ll shorten to NEC, are responsible for many deaths and illness in preterm babies, even if they receive adequate antibiotic therapy. Therefore, newer strategies that are anti-inflammatory as well as antimicrobial, may help. Our review investigates the effects of lactoferrin added to feeds, given that oral formulations of bovine lactoferrin are now widely available and generally regarded as safe.
We updated the review by running a new set of searches in January 2020 to look for the most recent evidence on the safety and effectiveness of adding lactoferrin to feeds for preventing sepsis and NEC in preterm babies. We also reviewed the effects of lactoferrin on other important problems for preterm babies, including duration of positive-pressure ventilation, development of chronic lung disease and length of hospital stay. We also updated the review adding data on long term effects on neuro-developmental outcomes at two years of age. 
We now have 12 randomized trials in the review, which were published in fourteen reports, with one Italian multicenter trial being published in three articles.
The data from the twelve trials gives us low to very low certainty evidence that addition of lactoferrin to feeds decreases sepsis that develops more than 72 hours after birth. However, it does not affect NEC stage II or III, deaths from all causes or neurodevelopmental outcome at two years of age.
In the studies that assessed addition of lactoferrin combined with probiotics, there is low to very low certainty evidence that this combination decreases late-onset sepsis and NEC of stage II or III, without adverse effects.
In summary, we found low-certainty evidence that addition of lactoferrin to feeds with or without probiotics, decreases late-onset sepsis but has little effect on other outcomes. Methodological limitations of the studies make it difficult to make recommendations for clinical practice.”

Monaz: If you would like to read more about the current evidence in Mohan’s review and to watch for future updates, just go online to Cochrane Library dot com and search 'lactoferrin and preterm infants'.

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