The study by Manzoni and colleagues1 in this issue of JAMA represents an important step toward preventing infections that currently pose a major hurdle for preterm infants. The findings give insight into the role of lactoferrin in preventing infection, helping to define its importance in breast milk as well as the effect of daily supplementation with bovine lactoferrin (BLF) in preterm infants.
The incidence of late-onset (>72 hours of age) bloodstream infections in very low-birth-weight (VLBW) infants (<1500 g) is approximately 20% and is complicated by high mortality and neurodevelopmental impairment.2,3 In the United States, nearly 65 000 VLBW infants are born each year, which translates into approximately 13 000 infections, 2300 deaths, and neurodevelopmental impairment in 3000 survivors.4 For the smallest infants of extremely low birth weight (ELBW) (<1000 g), neurodevelopmental impairment occurs in 45% of those who survive bacteremia and 57% of those who survive fungemia.3 For VLBW infants, bloodstream infections increase hospital treatment costs and length of stay.5
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