Sherman Michael P, Miller Mindy M, Sherman Jan, Niklas Victoria
aDepartment of Child Health bDepartment of Molecular Microbiology and Immunology, School of Medicine cSinclair School of Nursing, University of Missouri, Columbia, Missouri dDivision of Neonatal Medicine, Nemours Children's Hospital, Orlando, Florida, USA.
Curr Opin Pediatr. 2014 Apr;26(2):146-50. doi: 10.1097/MOP.0000000000000068.
There is an intense interest among neonatal caregivers as to whether lactoferrin given enterally may reduce the incidence of necrotizing enterocolitis in preterm infants. This review presents scientific and clinical evidence that lactoferrin alleviates or prevents this life-threatening disease.
Preclinical studies in neonatal rats showed that lactoferrin given orally before enteral infection with pathogenic Escherichia coli reduced bacteremia and mortality. A multicentered clinical trial found that very low-birth weight preterm infants given bovine lactoferrin had a significant reduction in late-onset sepsis; there was also a trend towards a diminished incidence of necrotizing enterocolitis. Although multicentered trials of lactoferrin use in preterm infants are near completion, regulatory burdens required to bring lactoferrin to the bedside may limit its availability.
Extremely preterm infants should receive colostrum, a natural lactoferrin concentrate, immediately after birth and, ideally, continue on breast milk throughout the hospital stay. This practice appears well tolerated, but additional experience will tell us whether this practice reduces the prevalence of necrotizing enterocolitis.
新生儿护理人员对经肠道给予乳铁蛋白是否可降低早产儿坏死性小肠结肠炎的发病率极为关注。本综述展示了乳铁蛋白减轻或预防这种危及生命疾病的科学和临床证据。
对新生大鼠的临床前研究表明，在经肠道感染致病性大肠杆菌之前口服乳铁蛋白可降低菌血症和死亡率。一项多中心临床试验发现，给予牛乳铁蛋白的极低出生体重早产儿晚发性败血症显著减少；坏死性小肠结肠炎的发病率也有降低趋势。尽管乳铁蛋白用于早产儿的多中心试验即将完成，但将乳铁蛋白应用于临床所需的监管负担可能会限制其可用性。
极早早产儿出生后应立即接受初乳（一种天然乳铁蛋白浓缩物），理想情况下，在住院期间持续母乳喂养。这种做法似乎耐受性良好，但更多经验将告诉我们这种做法是否能降低坏死性小肠结肠炎的患病率。
