Lactoferrin for the postoperative management of term neonates after gastrointestinal surgery

Summary & key facts

Researchers looked for carefully controlled trials that randomly gave lactoferrin — a protein in milk that can fight germs and help the gut — to full-term newborns after gastrointestinal surgery. They searched many medical databases and trial registries up to February 2023 but found no published trials that tested this. Because of that, we do not have evidence to say whether lactoferrin helps, harms, or makes no difference for these babies, and the authors say proper trials are needed.

Key facts:

• Lactoferrin is a protein found in milk that is reported to have antimicrobial (germ-fighting) and anti-inflammatory effects and to help establish healthy gut bacteria.
• The review focused on full-term newborns, meaning babies born at 37 weeks of pregnancy or later, who had gastrointestinal surgery within the first 28 days of life.
• The main question was whether giving lactoferrin after surgery would lower the chance of sepsis (a serious blood infection) or death in these babies.
• The researchers searched multiple medical databases and clinical trial registries up to February 2023 for carefully controlled trials that randomly assigned babies to receive lactoferrin or a placebo.
• They found no published randomized trials testing lactoferrin for postoperative care in full-term newborns after gut surgery.
• Because there are no trials, there is currently no evidence to show whether lactoferrin is effective or ineffective in this situation, and the authors recommend that randomized trials should be done.

Abstract

BACKGROUND: Neonates who have undergone gastrointestinal surgery are particularly susceptible to infectious complications in the postoperative period. This may be due in part to disruption of the integrity of the gut and its altered intestinal microflora. Lactoferrin is a whey protein found in milk and is an important innate mammalian defence mechanism. Lactoferrin has been reported to have antimicrobial and anti-inflammatory properties. It has also been reported to help establish a healthy gut microflora and aid in the intestinal immune system. Lactoferrin supplementation has been reported to decrease sepsis in preterm infants. There may be a role for lactoferrin to reduce the incidence of sepsis, thus reducing morbidity and mortality and improving enteral feeding in postoperative term neonates. OBJECTIVES: The primary objective of this review was to evaluate the efficacy of administering lactoferrin on the incidence of sepsis and mortality in term neonates after gastrointestinal surgery. The secondary objective was to assess the impact of administering lactoferrin on time to full enteral feeds, the intestinal microflora, duration of hospital stay, and mortality before discharge in the same population. SEARCH METHODS: The Cochrane Neonatal Information Specialist searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase Ovid, CINAHL, the WHO ICTRP and ClinicalTrials.gov trials registries. The date of the last search was February 2023. There were no restrictions to language, publication year or publication type. We checked references of potentially relevant studies and systematic reviews. SELECTION CRITERIA: We planned to include randomised controlled trials that studied infants born at 37 or more weeks of gestation who had one or more episodes of gastrointestinal surgery within 28 days of birth, and compared administration of lactoferrin with a placebo. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. We planned to use the GRADE approach to assess the certainty of evidence for each outcome. MAIN RESULTS: We identified no published randomised controlled studies that assessed the efficacy of lactoferrin for the postoperative management of term neonates following gastrointestinal surgery. AUTHORS' CONCLUSIONS: There is currently no evidence available from randomised controlled trials to show whether lactoferrin is effective or ineffective for the postoperative management of term neonates after gastrointestinal surgery. There is a need for randomised controlled trials to be performed to assess the role of lactoferrin in this setting.

Topics

Clinical Nutrition and Gastroenterology Infant Development and Preterm Care Infant Nutrition and Health

Categories

Health Sciences Nursing Nutrition and Dietetics

Tags

Biochemistry Biology Lactoferrin Medicine Physics Quantum mechanics Term (time)