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Role of lactoferrin in neonatal care: a systematic review
Deepak Sharma1, Sweta Shastri2, Pradeep Sharma3
1a Consultant Neonatologist, NEOCLINIC, Plot number 3 & 4, Everest Vihar, TN Mishra Marg, Nirman Nagar , Jaipur , Rajasthan , India.
Insights
Lactoferrin (LF) shows promise in reducing late-onset sepsis and necrotizing enterocolitis in preterm infants. Further research is needed to determine its impact on neonatal mortality, bronchopulmonary dysplasia, and retinopathy of prematurity.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Infectious Disease Prevention
Background:
- Lactoferrin (LF), a protein found in breast milk, possesses antimicrobial, antiviral, antifungal, and anticancer properties.
- Emerging research highlights the potential benefits of LF in neonatal care.
- This review focuses on evaluating the specific roles of LF in preterm infants.
Purpose of the Study:
- To systematically review and evaluate the efficacy of lactoferrin (LF) in neonatal care for preterm infants.
- To assess the impact of LF on common neonatal morbidities and mortality.
Main Methods:
- A comprehensive literature search was conducted across multiple electronic databases and clinical trial registries.
- Included studies were systematically reviewed to identify eligible research on LF in preterm neonates.
- Nine studies met the inclusion criteria for this systematic review.
Main Results:
- Four studies indicated a reduction in late-onset sepsis (LOS) with LF supplementation.
- Three studies showed a significant decrease in the incidence of necrotizing enterocolitis (NEC).
- Evidence suggests LF may reduce invasive fungal infections (IFI), ventilator-associated pneumonia (VAP), and mortality.
Conclusions:
- Lactoferrin (LF) demonstrates potential as an effective agent for reducing LOS and NEC in preterm infants.
- The role of LF in preventing neonatal mortality, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP) requires further investigation.
- Ongoing clinical trials are expected to provide more definitive answers regarding LF's benefits.
Background:
Lactoferrin (LF) is present in breast milk and have numerous properties including antimicrobial, antiviral, antifungal, and anticancer. Recent studies have emphasized the role of LF in neonatal care Aims and objective: To evaluate the various roles of LF in neonatal care in preterm infants.
Search Methods:
The literature search was done for this systematic review by searching the electronic database namely Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Web of Science, Scopus, Index Copernicus, African Index Medicus (AIM), Thomson Reuters (ESCI), Chemical Abstracts Service (CAS), SCIWIN (Scientific World Index), Google Scholar, Latin American and Caribbean Health Sciences Information System (LILACS), Index Medicus for the Eastern Mediterranean Region (IMEMR), Index Medicus for the South-East Asian Region (IMSEAR), Western Pacific Region Index Medicus (WPRIM), various sites for ongoing trials namely clinical trial registry ( www.clinicaltrials.gov , www.controlled-trials.com , Australian and New Zealand Clinical Trials Registry ( http://www.anzctr.org.au ), Indian Clinical Trials Registry ( http://ctri.nic.in/Clinicaltrials ), and the World Health Organization (WHO) International Clinical Trials Registry, and Platform ( http://www.who.int/ictrp/search/en/ ) and abstracts of conferences namely proceedings of Pediatric Academic Societies (American Pediatric Society, Society for Pediatric Research, and European Society for Pediatric Research).
Results:
Nine eligible studies were analyzed that fulfilled the inclusion criteria of the systematic review. Six duplicate publications were excluded from review. Four studies were excluded due to nonfulfillment of inclusion criteria. All of the studies had more than one outcome of interest. Four studies showed reduction in late onset sepsis (LOS), one showed reduction in invasive fungal infection (IFI), three showed significant decrease in incidence of necrotizing enterocolitis (NEC), one showed reduction in NEC scares, and two showed decrease in mortality, and one showed decrease in combined death and/or NEC. Only one study evaluated role of LF for ventilator-associated pneumonia (VAP) reduction and showed lower rate of VAP. Still the role of LF in Bronchopulmonary dysplasia (BPD) and Retinopathy of prematurity (ROP) is unclear.
Conclusion:
LF has shown to be promising agent for reduction of LOS and NEC. The role of LF in prevention of neonatal mortality, BPD, and ROP needs further studies. The trials that are going on around the world may be able to give reply of this question in future.
