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Published on: January 27, 2019
Comparative effectiveness of different probiotics combined with phototherapy for neonatal hyperbilirubinemia: a
Xiangmiao Li1, Yeyang Feng1, Wanting Zhao1
1Department of Neonatology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Insights
Adding probiotics to phototherapy for neonatal hyperbilirubinemia reduced hospital stays and prevented bilirubin rebound. This adjuvant therapy shows promise for improving infant care outcomes.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Pharmacology
Background:
- Neonatal hyperbilirubinemia is common, with phototherapy as standard treatment.
- Clinical challenges include bilirubin rebound and prolonged hospital stays.
- Novel adjuvant therapies are needed to optimize treatment efficacy and safety.
Purpose of the Study:
- To compare the clinical efficacy and safety of two probiotic regimens as adjuvant therapy to phototherapy for neonatal hyperbilirubinemia.
- To evaluate the impact of probiotics on bilirubin levels, duration of phototherapy, hospital stay, and adverse reactions.
Main Methods:
- Retrospective cohort study of 377 infants with neonatal hyperbilirubinemia.
- Three groups: phototherapy alone, phototherapy + Bifidobacterium quadruple viable tablets, or phototherapy + Bacillus subtilis and Enterococcus faecium viable granules.
- Outcome measures included transcutaneous bilirubin trends, phototherapy duration, hospital stay, and adverse events.
Main Results:
- Probiotic groups showed shorter hospital stays and fewer adverse reactions compared to phototherapy alone.
- Significant reductions in transcutaneous bilirubin were observed in both probiotic groups by day 3.
- Bilirubin rebound occurred in the phototherapy-only group, but not in probiotic groups.
Conclusions:
- Phototherapy combined with probiotics, especially Bacillus subtilis and Enterococcus faecium, accelerates bilirubin reduction and prevents rebound.
- This combination therapy shortens hospital stays, offering a potentially beneficial strategy for neonatal hyperbilirubinemia.
- Further research may validate probiotics as a safe and effective adjuvant for neonatal jaundice management.
Objective:
This is a retrospective cohort study, not a clinical trial. No randomization, allocation concealment, or trial registration was performed. Phototherapy serves as the standard treatment for neonatal hyperbilirubinemia, yet clinical issues such as bilirubin rebound and prolonged hospital stay remain unresolved. This study compares the clinical efficacy and safety of two different probiotic regimens as adjuvant therapy to phototherapy.
Methods:
A retrospective analysis was conducted on 377 infants diagnosed with neonatal hyperbilirubinemia who were hospitalized in the Department of Neonatology, The Fifth Affiliated Hospital of Guangzhou Medical University between January 2021 and December 2023. Patients were divided into three groups according to the actual treatment received (phototherapy alone, phototherapy + Bifidobacterium quadruple viable tablets, or phototherapy + Bacillus subtilis and Enterococcus faecium viable granules). No randomization or blinding was applied due to the retrospective design. No trial registration was performed. Outcome measures included the dynamic trend of transcutaneous bilirubin, duration of phototherapy, length of hospital stay, total medical cost, and incidence of adverse reactions.
Results:
Both probiotic groups had shorter stays and fewer adverse reactions than phototherapy alone. After multivariable adjustment, Group B vs. A: hospital stay -0.52 days (95% CI: 0.24-0.80; P < 0.001); Group C vs. A: -0.29 days (95% CI: 0.01-0.56; P = 0.043); B vs. C: 0.24 days (95% CI: -0.04-0.51; P = 0.88). On day 3, estimated marginal mean transcutaneous bilirubin: B vs. A -2.83 mg/dL (95% CI: -3.63 to -2.03; P < 0.001); C vs. A -4.28 mg/dL (-5.07 to -3.50; P < 0.001); C vs. B -1.45 mg/dL (-2.24 to -0.67; P < 0.001). Bilirubin rebounded in Group A on day 3, while probiotic groups showed steady decline. Total serum bilirubin change and total cost did not differ among groups.
Conclusions:
Phototherapy combined with probiotics, particularly *Bacillus subtilis* and Enterococcus faecium viable granules, was associated with faster and sustained bilirubin reduction, helps prevent bilirubin rebound in the mid-treatment stage and shortens hospital stay, which may represent a potentially beneficial strategy for neonatal hyperbilirubinemia.