LTF and Sepsis: The 2020 Pammi meta-analysis [73], which incorporated the large ELFIN trial (n = 2203) [38], reversed the 2017 conclusion that lactoferrin reduced late-onset sepsis (RR 0.80 vs. prior 0.59) and eliminated the apparent benefit for NEC (RR 1.10 vs. prior 0.40), demonstrating how definitive trials can correct overoptimistic estimates from smaller studies