الفهرس 
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Abstract
Neonates are at risk to acquire infections, especially preterm and low-birth-weight newborn. In addition to the high morbidity and mortality associated with neonatal sepsis, these patients are at high risk for long-term disabilities, particularly neurodevelopmental impairment. Necrotizing enterocolitis (NEC) and sepsis are increasingly important contributors to mortality because of more preterm infants surviving the first week of life. NEC is the most common serious acquired disease of the gastrointestinal tract in preterm infants. It is characterized by ischemic necrosis of the intestinal mucosa, with an excessive inflammatory process and invasion of enteric gas-forming organisms, and is a leading cause of morbidity and mortality among preterm infants, with the risk of developing NEC inversely proportional to birth weight.
Lactoferrin (LF), a normal component of human colostrum and milk, can enhance host defenses and may be effective for prevention of sepsis and necrotizing enterocolitis (NEC) in preterm neonates. The first trial testing LF for the prevention of late-onset sepsis was performed by Manzoni et al. in Italy. They found that the incidence of sepsis and death from sepsis were significantly lower in the LF-treated groups compared with the placebo.
During the 12-month period, the period from October 2018 to September 2019, there were 86 newborns babies were admitted in NICU at Sohag University hospital, 43 of them were case group and 43 of them were control group.
As regard signs of sepsis in cases and control groups, we found that there were statistically significant difference in frequent apnea; control had significantly more apnea and hepatomegaly. We found that no statistically significant difference in the clinical diagnosis of studied babies on admission, as regard laboratory and radiological findings, we found that no statistically significant difference in proven sepsis during hospital stay and laboratory suspected sepsis: there were statistically significant difference in hemoglobin level, hematocrit value; cases had higher hemoglobin and hematocrit level than control. As regard outcomes, we found that there were statistically difference in types of antibiotics, necrotizing enterocolitis, duration of total hospital stay and the number of deaths; controls had longer duration of total hospital stay and more deaths.
A total of 13 newborns died during the study period. We found that the most common cause of death was neonatal sepsis, necrotizing enterocolitis and pulmonary hemorrhage. All 13 babies were with feeding intolerance.
As regard signs of sepsis in low and high lactoferrin doses groups, we found that no statistically significant difference in frequent apnea, reflexes, hepatomegaly, respiratory distress, jaundice, poor perfusion, abdominal distention, lethargy and scleremia. While there were statistically significant difference in vomiting e.g high dose group had significant more vomiting than low dose group.
In the present study, we found that no statistically significant difference in the clinical diagnosis on admission between low and high lactoferrin doses groups, as regard laboratory and radiological findings, we found that no statistically significant difference in proven sepsis during hospital stay, laboratory suspected sepsis, X ray finding, echocardiography, culture growth, culture organisms.
As regard outcomes, we found that no statistically significant difference in antibiotic duration, in types of antibiotics, duration of NICU stay and duration of total hospital stay, while there was statistically significant difference in feeding intolerance; high dose lactoferrin group had more feeding intolerance than low dose group.
Study Limitation:
• Study duration: only one year.
• Number of patient: we conducted 86 preterm neonates in our study.
Recommendation:
1- Enteral lactoferrin supplementation is recommended for all preterm newborn babies with gestational age < 36 weeks and/ or birth weight < 1500 g (VLBW infants).
2- Lactoferrin reduces the risk of neonatal sepsis, necrotizing enterocolitis and feeding intolerance.
3- Lactoferrin is recommended for a dose 100mg/kg/day for 4 weeks postnatal.