Necrotising enterocolitis prevention in preterm infants

Necrotising enterocolitis (NEC) is severe inflammatory and ischaemic bowel injury in newborns, predominantly very-low-birth-weight (<1500 g) preterm infants. NEC mortality reaches 20–30% and survivors often develop short-bowel syndrome. Proven prophylaxis: feeding with maternal or donor human milk, standardised enteral feeding protocols, careful antibiotic stewardship and Lactobacillus and Bifidobacterium probiotics in several European neonatal units. The Cochrane Pammi review (2020) pooled 12 RCTs of bovine lactoferrin in preterm infants under 1500 g: 100–300 mg/day orally reduced stage II-III NEC (RR about 0.40) and late-onset sepsis. The effect rested largely on smaller trials, while the large UK ELFIN trial 2019 (2200 infants) did not replicate it. The decision to use lactoferrin in a neonatal unit is made by the unit head and neonatologist together.

ICD-10 P771 drug

Also known as: NEC prevention, Necrotizing enterocolitis, Preterm gut injury, VLBW gut prophylaxis, Bowel injury in preterm

Drugs used for this condition

BLactoferrinAdd-on therapy · Bovine colostrum and human-milk glycoprotein supplement marketed as «immune modulator», «iron support» and «antiviral»Lactoferrin has its only indication with serious evidence. The Cochrane Pammi review (2020) pooled 12 RCTs of bovine lactoferrin in preterm infants under 1500 g: 100–300 mg/day orally reduced stage II-III necrotising enterocolitis (RR about 0.40, 95% CI 0.28–0.57) and late-onset sepsis. The effect was stronger in earlier smaller trials. The large UK ELFIN RCT 2019 (2200 infants under 1500 g, 150 mg/kg/day to 34 weeks corrected age) did not show a reduction in mortality or severe late sepsis – the result split the neonatal community. The decision in a unit is made jointly by the head of the unit and the neonatologist. No comparable data exist in term infants or adults, so analogies should not be extended. If parents of a preterm infant are offered lactoferrin, discuss with the unit neonatologist what the local protocol shows and which alternatives (donor human milk, probiotics, feeding protocol) are already in place.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit