Bovine lactoferrin supplementation for prevention of necrotizing enterocolitis in very-low-birth-weight neonates: a randomized clinical trial.

Abstract

IMPORTANCE:

NEC is a common and severe complication in premature neonates, particularly those with very-low-birth-weight (VLBW, <1500 g at birth). Probiotics including lactobacillus rhamnosus GG (LGG) proved effective in preventing NEC in preterm infants in several RCTs.

OBJECTIVE:

Lactoferrin, a mammalian milk glycoprotein involved in innate immune host defences, can reduce the incidence of NEC in animal models, and its action is enhanced by LGG. We tried to assess whether bovine lactoferrin (BLF), alone or with the probiotic LGG, has a similar effect in human infants, something that has not yet been studied.

DESIGN:

An international, multicenter, randomized, double-blind, placebo-controlled trial conducted from October 1st, 2007 through July 31st, 2010.

SETTING:

Thirteen Italian and New Zealand tertiary neonatal intensive care units.

PARTICIPANTS:

743 VLBW neonates were assessed until discharge for development of NEC.

INTERVENTION:

Infants were randomly assigned to receive orally either BLF (100 mg/day) alone (group LF; n = 247) or with LGG (at 6×10(9) CFU/day; group BLF + LGG; n = 238), or placebo (Control group; n = 258) from birth until day 30 of life (45 for neonates <1000 g at birth).

MAIN OUTCOME MEASURES:

≥ stage 2 NEC; death-and/or-≥ stage 2 NEC prior to discharge.

RESULTS:

Demographics, clinical and management characteristics of the 3 groups were similar, including type of feeding and maternal milk intakes. NEC incidence was significantly lower in groups BLF and BLF + LGG [5/247 (2.0%)] and 0/238 (0%), respectively] than in controls [14/258 (5.4%)] (RR = 0.37; 95% CI: 0.136-1.005; p = 0.055 for BLF vs. control; RR = 0.00; p < 0.001 for BLF + LGG vs. control). The incidence of death-and/or-NEC was significantly lower in both treatment groups (4.0% and 3.8% in BLF and BLF + LGG vs. 10.1% in control; RR = 0.39; 95% CI: 0.19-0.80; p = 0.008. RR = 0.37; 95% CI: 0.18-0.77; p = 0.006, respectively). No adverse effects or intolerances to treatment occurred.

CONCLUSIONS AND RELEVANCE:

Compared with placebo, BLF supplementation alone or in combination with LGG reduced the incidence of ≥ stage 2 NEC and of death-and/or ≥ stage 2 NEC in VLBW neonates. BLF might be a promising strategy to prevent NEC in NICU settings. Further data on larger sample sizes are warranted before BLF can be widespreadly used in clinical settings.

TRIAL REGISTRATION:

ISRCTN53107700-http://www.controlled-_trials.com/ISRCTN53107700.

• Authors: Paolo Manzoni, Michael Meyer, Ilaria Stolfi, Matteo Rinaldi, Silvia Cattani, Lorenza Pugni, Mario Giovanni Romeo, Hubert Messner, Lidia Decembrino, Nicola Laforgia, Federica Vagnarelli, Luigi Memo, Linda Bordignon, Milena Maule, Elena Gallo, Michael Mostert, Michele Quercia, Lina Bollani, Roberto Pedicino, Livia Renzullo, Pasqua Betta, Fabrizio Ferrari, Tanith Alexander, Rosario Magaldi, Daniele Farina, Fabio Mosca, Mauro Stronati
• Journal: Early human development (Early Hum Dev) Vol. 90 Suppl 1 Pg. S60-5 (Mar 2014) ISSN: 1872-6232 [Electronic] Ireland
• PMID: 24709463 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Anti-Infective Agents
• Lactoferrin

Topics

• Animals
• Anti-Infective Agents (therapeutic use)
• Cattle
• Enterocolitis, Necrotizing (drug therapy, prevention & control)
• Female
• Humans
• Infant, Newborn
• Infant, Very Low Birth Weight
• Lactoferrin (therapeutic use)
• Male