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

被引：152

作者：

Manzoni, Paolo ^{[1
]}

Meyer, Michael ^{[2
]}

Stolfi, Ilaria ^{[3
]}

Rinaldi, Matteo ^{[4
]}

Cattani, Silvia ^{[5
]}

Pugni, Lorenza ^{[6
]}

Romeo, Mario Giovanni ^{[7
]}

Messner, Hubert ^{[8
]}

Decembrino, Lidia ^{[9
]}

Laforgia, Nicola ^{[10
]}

Vagnarelli, Federica ^{[11
]}

Memo, Luigi ^{[12
]}

Bordignon, Linda ^{[12
]}

Maule, Milena ^{[13
,14
]}

Gallo, Elena ^{[1
]}

Mostert, Michael ^{[15
]}

Quercia, Michele ^{[10
]}

Bollani, Lina ^{[9
]}

Pedicino, Roberto ^{[3
]}

Renzullo, Livia ^{[8
]}

Betta, Pasqua ^{[7
]}

Ferrari, Fabrizio ^{[5
]}

Alexander, Tanith ^{[2
]}

Magaldi, Rosario ^{[4
]}

Farina, Daniele ^{[1
]}

Mosca, Fabio ^{[6
]}

Stronati, Mauro ^{[9
]}

机构：

[1] St Anna Hosp, Neonatol & NICU, Turin, Italy

[2] Middlemore Hosp, Neonatol & NICU, Auckland, New Zealand

[3] Policlin Umberto, Neonatol & NICU, Rome, Italy

[4] Ospedali Riuniti, Neonatol & NICU, Foggia, Italy

[5] Univ Modena, Neonatol & NICU, I-41100 Modena, Italy

[6] Univ Milan, Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Clin Sci & Community Hlth, NICU, Milan, Italy

[7] Azienda Osped Univ Policlin, Neonatol & NICU, Catania, Italy

[8] Osped Reg, Neonatol & NICU, Bolzano, Italy

[9] Fdn IRCCS Policlin, Neonatol & NICU, Pavia, Italy

[10] Policlin Univ Hosp, Neonatol & NICU, Bari, Italy

[11] Arcispedale SM Nuova, Neonatol & NICU, Reggio Emilia, Italy

[12] Ca Foncello Hosp, Neonatol & NICU, Treviso, Italy

[13] Univ Turin, Dept Biomed Sci, Turin, Italy

[14] Univ Turin, Human Oncol Canc Epidemiol Unit, Turin, Italy

[15] Univ Turin, Dept Pediat, Turin, Italy

来源：

EARLY HUMAN DEVELOPMENT | 2014年 / 90卷

关键词：

Neonate; Lactoferrin; Necrotising enterocolitis; Preterm; Sepsis; Probiotics; PRETERM INFANTS; MODULATION; PROBIOTICS; SEPSIS;

D O I：

10.1016/S0378-3782(14)70020-9

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

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 6x 109 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/orNEC 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% Cl: 0.19-0.80; p = 0.008. RR= 0.37; 95% Cl: 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. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

引用

页码：S60 / S65

页数：6

共 13 条

[1] Mother's Milk, Feeding Strategies, and Lactoferrin to Prevent Necrotizing Enterocolitis [J].