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Published on: January 27, 2019
Probiotics for the management of neonatal hyperbilirubinemia: a systematic review of randomized controlled trials
Janki Deshmukh1, Mangesh Deshmukh2,3, Sanjay Patole4
1a Department of Paediatrics , Princess Margaret Hospital for Children , Subiaco , Australia.
Insights
Probiotic supplementation may shorten phototherapy duration for neonatal jaundice, but evidence quality is low. More research is needed to confirm benefits and safety for treating infant jaundice.
Area of Science:
- Neonatal Medicine
- Gastroenterology
- Microbiology
Background:
- Neonatal jaundice requiring phototherapy imposes a significant socioeconomic burden.
- This includes increased hospital readmissions, prolonged hospital stays, and maternal-infant separation.
Purpose of the Study:
- To evaluate the efficacy and safety of probiotics in reducing the need for and duration of phototherapy in neonatal hyperbilirubinemia.
- To assess the impact of probiotics on total serum bilirubin (TSB) levels and hospital stay.
Main Methods:
- A systematic review of randomized controlled trials (RCTs) was conducted using Cochrane methodology.
- The review focused on probiotic supplementation for preventing or treating jaundice in neonates.
- Primary outcome was phototherapy duration; secondary outcomes included TSB levels, hospital stay, and adverse effects.
Main Results:
- Nine RCTs (N=2040) with varying risk of bias were analyzed.
- Probiotic supplementation significantly reduced phototherapy duration (mean difference: -11.80 hours) with low-level evidence.
- Total serum bilirubin levels were also reduced at 96 hours and 7 days post-treatment.
Conclusions:
- Limited, low-quality evidence suggests probiotics may reduce phototherapy duration in jaundiced neonates.
- Routine use of probiotics for prevention or treatment of neonatal jaundice is not currently recommended.
- Large, well-designed trials are necessary to validate these preliminary findings.
Background:
Neonatal jaundice requiring phototherapy is associated with significant socioeconomic burden including hospital readmission, prolonged hospital stay, and separation of the baby from mother.
Objectives:
To assess the efficacy and safety of probiotics in reducing the need for phototherapy and its duration in neonatal hyperbilirubinemia.
Methods:
A systematic review of randomized controlled trials (RCTs) of probiotic supplementation for prevention or treatment of jaundice in neonates (any gestation or weight) using the Cochrane methodology. Primary outcome was the duration of phototherapy. Secondary outcomes included incidence of jaundice, total serum bilirubin (TSB) level at 24, 48, 72, 96 h, and day 7, duration of hospital stay, and adverse effects (e.g. probiotic sepsis). Results were summarized as per GRADE guidelines.
Results:
Nine RCTs (prophylactic: six trials, N = 1761; therapeutic: three trials, N = 279) with low to high risk of bias were included. Meta-analysis (random-effects model) showed probiotic supplementation reduced duration of phototherapy [N = 415, mean difference (MD): -11.80 (-17.47, -6.13); p < .0001; level of evidence (LOE): low]. TSB was significantly reduced at 96 h [MD: -1.74 (-2.92, -0.57); p = .004] and 7 d [MD: -1.71 (-2.25, -1.17); p < .00001; LOE: low] after probiotic treatment. Prophylactic probiotics did not reduce the incidence of jaundice significantly [N = 1582, relative risk (RR): 0.56 (0.25, 1.27); p = .16; LOE: low]. There were no probiotic-related adverse effects.
Conclusion:
Limited low-quality evidence indicates that probiotic supplementation may reduce the duration of phototherapy in neonates with jaundice. Routine use of probiotics to prevent or treat neonatal jaundice cannot be recommended. Large well-designed trials are essential to confirm these findings.
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