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Published on: July 28, 2022
Evidence from systematic reviews of randomized trials on enteral lactoferrin supplementation in preterm neonates
Mohan Pammi1, Geoffrey A Preidis2, William O Tarnow-Mordi3
1Department of Pediatrics, Section of Neonatology, Baylor College of Medicine & Texas Children's Hospital, Houston, TX 77030, USA.
Insights
Enteral lactoferrin supplementation in preterm infants shows clinical benefits, reducing infections and hospital stay without adverse effects. However, it did not significantly decrease necrotizing enterocolitis or mortality.
Area of Science:
- Neonatal Medicine
- Clinical Nutrition
- Infectious Disease
Background:
- Preterm neonates are vulnerable to infections and complications.
- Enteral lactoferrin is a protein with potential immunomodulatory and antimicrobial properties.
- Evidence on its efficacy in preterm infants requires synthesis.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs) on enteral lactoferrin supplementation in preterm neonates.
- To assess the clinical benefits and safety of lactoferrin in this population.
Main Methods:
- Systematic review and meta-analysis of 12 RCTs.
- Inclusion of studies from diverse global settings.
- Assessment of outcomes including sepsis, infections, necrotizing enterocolitis, mortality, and neurodevelopmental impairment.
Main Results:
- Enteral lactoferrin supplementation significantly decreased late-onset sepsis, late-onset fungal sepsis, urinary tract infections, and length of hospital stay.
- No adverse effects were reported.
- No statistically significant reduction was observed for necrotizing enterocolitis, mortality, or neurodevelopmental impairment.
Conclusions:
- Enteral lactoferrin supplementation appears beneficial for reducing specific infections and hospital stay in preterm infants.
- Further research is needed to address heterogeneity in sepsis outcomes and optimize lactoferrin use.
Abstract:
In this commentary, we summarize the current evidence from randomized controlled trials on enteral lactoferrin supplementation in preterm neonates. Our recently completed systematic review includes 12 randomized controlled trials performed all over the world. Our meta-analysis suggests clinical benefit in decreasing late-onset sepsis, late-onset fungal sepsis, length of stay in the hospital and urinary tract infections. There were no adverse effects. There was no statistically significant decrease in necrotizing enterocolitis, mortality or neurodevelopmental impairment in lactoferrin supplemented preterm infants. There was significant statistical heterogeneity in the effects of lactoferrin on late-onset sepsis between larger and smaller studies, which may reflect either small study biases, differences in the effectiveness, dose or duration of supplemental lactoferrin products, or differences in underlying population risk, or any or all of these.
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