Clinical use of lactoferrin in preterm neonates: an update

Sepsis-related morbidity and mortality is an increasing concern in all neonatal intensive care units, with reported incidences that are dramatically high regardless of the improvements in the quality of neonatal assistance. Antimicrobial resistance is also becoming a global and regional threat to public health. Neonatal sepsis include bloodstream, urine, cerebrospinal, peritoneal infections, and are classified as early-onset (occurring <3 days of life, EOS) and late-onset sepsis (LOS), i.e., infections arising after the perinatal period. Whereas prevention of EOS relies mainly on maternal-perinatal policies, attempts to reduce LOS incidence are a task merely for neonatologists but are hampered by non-specific clinical features, inadequate sensitivity of diagnostic tests, and late recognition. The frequent occurrence of late neurodevelopmental impairment after LOS challenges neonatologists to seek effective preventative strategies rather than more efficacious antibiotics for treatment. In the area of prevention, consistent evidence is accumulating on fluconazole--for prevention of fungal LOS--and, more recently, on bovine lactoferrin for prevention of both bacterial and fungal LOS: this innate immune system glycoprotein plays an important role in "in vivo" host defenses, and has been shown effective in a multicenter RCT recently published on VLBW neonates. Future studies are warranted to better elucidate the extent of the prevention provided by Ictoferrin and to identify the most suitable dosages to be administered.