Early versus Late Lactoferrin in Prevention of Neonatal Sepsis

Abstract

SUMMARY T he present study was designed to evaluate the effectiveness of oral lactoferrin in prevention of neonatal sepsis with comparison early (1st day) versus late (48-72 hours) lactoferrin administration, Secondary aim was to study effect of lactoferrin administration on serum ferritin and follow up long term outcome (Bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis. This study was carried out on 180 preterm neonates(< 37 weeks of gestation counting from the first day of the Last Menstrual Period and confirmed by Ballard score) admitted to the Neonatal Intensive Care Units of Ain Shams University Hospitals and Shobra General Hospital in the period from August 2014 to December 2015. Enrolled subjects were further randomly subdivided into three groups according to the dose regimen of lactoferrin supplementation. • Group A: (60 preterm neonates) with mean gestational age (32.37 ± 1.31) weeks who received oral lactoferrin supplementation in a dose of 100 mg/day starting on day 1 and continue for 4–6 weeks. 25 males (41.7%) and 35 females (58.3%) • Group B: (60 preterm neonates) with mean gestational age (32.58 ± 1.54 weeks) who received oral lactoferrin supplementation in a dose of 100 mg/day starting on day 3 (48hrs-72hrs) of life and continue for 4–6 weeks. 23 males (38.3%) and 37 females (61.7%) • Group C: (60 preterm neonates) with mean gestational age (32.45 ± 1.56 weeks), 33 males (55.0%) and 27 females (45.0%) received placebo in form of distilled water on day 1 and continued for 4–6 weeks or discharge whichever comes first. The neonates included in this study were subjected to full history taking; through clinical examination laying stress on signs of sepsis according to Tollner score; and laboratory investigations, CBC with differential cell count classified according to hematological scoring system (Rodwell score), CRP, Blood culture, Arterial blood gases when clinically indicated. Serum ferritin was done on day 14 of age. Neonates with underlying gastrointestinal anomalies that prevent enteral intake, early onset sepsis, chromosomal, congenital and structural brain anomalies, family history of cow milk allergy, inability to complete the study time or parental refusal to participate were excluded from the study. The results of the current study revealed that: The incidence of late onset sepsis was significantly lower in early (10%) and late (26.7%) lactoferrin groups compared to control group (45%) where sepsis is defined as presence of clinical symptoms and signs of sepsis + (Rodwell score ≥ 3 or Tollner score > 10.5 and/or positive blood culture). In addition, there were a highly significant reduction in total days of feeding stoppage among early and late lactoferrin groups with mean values (2.14 ± 1.75 days), (3.47 ± 1.82 days) respectively compared to control group with mean value (4.92 ± 3.65 days), and among early lactoferrin group compared to late lactoferrin group. On the other hand there were no statistically significant differences between studied groups as regard type of formula taking in our consideration that none of our patients received absolute maternal milk. Also, no statistically significant differences between studied groups as regard gastric residual, vomiting and diarrhea.