Impact of lactoferrin supplementation on microbiota development in preterm infants receiving probiotics

Preterm infants are increasingly receiving probiotics in order to decrease NEC. Probiotic supplementation is supported by meta-analyses that showed a relative risk reduction for the development of NEC in premature, preterm infants receiving probiotics versus placebo. Lactoferrin is the major whey protein in mammalian milk and is important in innate immune host defenses. With anti-inflammatory, bacteriostatic and bactericidal properties, there is interest in bovine lactoferrin's use in premature infants. However, there are few studies of the effects of lactoferrin on the intestinal microbiota of premature infants using culture independent methods.We thus leveraged patient recruitment from a randomized blinded single center trial (the LACUNA trial [ISRCTN66482337]), designed to assess bovine lactoferrin safety. These subjects were randomized to receive either probiotic supplements or probiotics supplemented with 100 mg bovine lactoferrin mixed with daily feeds. Weekly stools were collected from enrolled infants for one month and the microbiota characterized using V6-16S rRNA gene amplicon profiling.