ORAL LACTOFERRIN SUPPLEMENTATION FOR PREVENTION OF SEPSIS IN PRETERM NEONATE

Abstract

Background: Sepsis related morbidity and mortality is a concern in neonatal intensive care units (NICUs) specially in preterm and Low birth weight (LBW) infants who are more vulnerable due to immaturity of immune defenses and protective barriers. Lactoferrin is an iron binding glycoprotein presents in mammalian milk and involved in innate immunity. Recent data suggest that bovine lactoferrin (BLF) might prevent late onset sepsis in preterm and LBW neonates. Objective: To evaluate the effectiveness of oral bovine lacoferrin in prevention of neonatal sepsis in preterm neonates with comparison of two dose regimens of lactoferrin supplementation, secondary aim was to study effect of lactoferrin supplementation on serum iron stores and follow up long term outcome (bronchpulmonary dysplasia, retinopathy of prematurity and necrotizing enterocollitis). Patients & Methods: A randomized clinical trial, double blind, placebo-controlled study was conducted on 180 preterm neonates (born before 37 weeks of gestation) admitted to the NICUs of of Ain Shams University and Manshiet El Bakry Hospitals from February 2013 to January 2015. Infants were randomly sub-divided into three groups: Placebo group (90) infants neonates received placebo in the form of distilled water twice daily. Once daily lactoferrin group (45) infants received oral BLF supplementation (100 mg/day) within a day of starting feeds for 30 days. Tice daily lactoferrin group (45) infants received oral BLF supplementation (150 mg/kg/ twice daily) within a day of starting feeds for 30 days. History and physical examination were carried out laying stress on signs of sepsis, severity (classified according to Töllner score), laboratory investigations were done: CBC with blood film (classified according to hematological scoring system), CRP, Blood culture upon admission and on suspicion of sepsis, other cultures and arterial blood gases when clinically indicated. Radiological investigation were done when clinically indicated, Data were analyzed using the Statistical Package for Social Sciences (SPSS).