Examination for Clinical

Efficacy of Lf in Neonates
Reem Yahya Mohamed
- VLBW infants carry an enhanced risk for bacterial sepsis and
potentially devastating sequelae and are frequently unable to
tolerate feeds (thus depriving them of the protective benefits
of maternal
milk)

- Based on the significant anti-microbial and

immunomodulatory effects caused by Lf, this protein may be
particularly useful in host defense in critically ill and VLBW
neonates.
In 2007 James C. King, Jr et al A Double-Blind, Placebo-Controlled, Pilot
Study of Bovine Lactoferrin Supplementation in Bottle-fed Infants
Journal of Pediatric Gastroenterology and Nutrition, 2007; 44:245–251 :

• Study population: Healthy, formula-fed infants, >34 weeks’ gestation

and 4 weeks of age, were randomized
• Duration: 12 months
• Group 1- formula supplemented with lactoferrin
• Group 2- commercial cow milk–based formula

Outcome: Lower incidence of URTI in group A

In 2009, Manzoni’s group performed
a multicenter, double-blinded, placebo-controlled, randomized trial
in VLBW infants
• 3 Groups:
1. bLf alone (Lactoferrin 100mg)
2. bLf (100mg) in combination with Lactobacillus rhamnosus GG (LGG)
3. Placebo (2ml 5% glucose added to regular formula milk)

Duration: 4 – 6 weeks

Outcome: Significantly lower invasive infections in the treatment groups, with an effect on infection-
related mortality (0% for bLf and 0.7% for bLf plus LGG, vs. 4.8% for placebo).
A follow-up study from the same group in 2014
found that bLf supplementation alone or in
combination with LGG significantly reduced the
incidence of ≥ stage 2 NEC, and of death-and/or ≥
stage 2 NEC in VLBW neonates
In 2015, another study has also examined bovine Lf and found that treatment with bLf
led to a reduction in infection in both VLBW and 500–2500 g neonates:
- oral bLf vs placebo
- Initiation: as soon as the patient started oral or NG feeding
- Duration : 4 weeks
- Outcome : primary: decreased risk of 1st episode of LOS
secondary :- decreased frequency of culture proven sepsis
- decreased incidence of NEC
- shorter duration of hospitalization
- decreased overall mortality rate
 NB : none of these investigations noted any
adverse effects or intolerance with bovine Lf.
CONCLUSION:
• Significant evidence supporting the LF direct anti microbial and
immune boosting properties and effect on gut proliferation ,
maturation & development of beneficial bacteria .
• Lactoferrin supplementation to enteral feeding with or without
probiotics decrease late onset sepsis, NEC stage II or III in P.T infants
without adverse effects .
• LF is well tolerated by most infants
• Early supplementation may mimic the higher LF in human colostrum
& may allow for early gut proliferation.
THANK YOU