Nicholas Embleton, MD, FRCPCH and Eric Gibson, MD
Can the administration of bovine lactoferrin to preterm neonates prevent the incidence of late-onset sepsis? Dr. Embleton reports findings from the ELFIN trial and the potential implications for future research.
Sepsis is a common and severe complication in premature neonates. Lactoferrin, a mammalian milk glycoprotein involved in innate immune host defenses, has been found to potentially reduce the incidence of late-onset sepsis in premature neonates. These benefits may result from a number of functions, including immune modifier effects, pathogen suppression, and impact on epithelium and cell signaling. Prior studies from animal models have suggested that compared with placebo, bovine lactoferrin supplementation reduced the incidence of late-onset sepsis in premature neonates. In the ELFIN trial (Enteral Lactoferrin in Neonates) of over 2,000 infants, Dr. Embleton reports no significant change in the rates of late-onset sepsis in preterm neonates with the administration of bovine lactoferrin, despite a significant modification in the gut microbiome of these infants. This may be related to the subtle variations in structure and bioactivity of bovine versus human lactoferrin, as well as the variations within the different commercially available lactoferrin products. Overall, the most beneficial intervention is a this time is to continue to increase the intake of human milk for our most preterm neonates while further research is undertaken to investigate this product.