Role of Prebiotics in Preventing Phototherapy-range Hyperbilirubinemia in Preterm Neonates: An Open-labelled Randomised Controlled Trial

Introduction Prebiotics help develop early microbiota and increase stool frequency, reducing enterohepatic circulation, a vital mechanism in managing neonatal hyperbilirubinemia. Objectives The aim of this study was to evaluate role of prebiotics in preventing phototherapy-range hyperbilirubinemia in preterm neonates. Secondary objectives were to assess 24-hour transcutaneous bilirubin (TCB) levels, peak TCB levels, stool frequency and side effects of prebiotics. This study also assessed 24-hour serum bilirubin levels and duration of phototherapy in all those requiring phototherapy. Materials and Methods An open-label randomised controlled trial conducted at a tertiary-care centre from Nov-2019 to Oct-2021 in exclusively breastfed/expressed breast milk-fed preterm (32-37 weeks) neonates. Babies having respiratory distress, perinatal asphyxia, formula-fed, haemodynamically unstable, inborn errors of metabolism, gastrointestinal congenital anomalies, severe neonatal sepsis and those whose mothers could not express at least 10 mL of breast milk were excluded from the trial. Those randomised to the prebiotic group received 0.5 gm/kg/day of fructo-oligosaccharide powder mixed in expressed breast milk in three divided doses for seven days or omission of phototherapy (if required), whichever later and standard preterm care was provided to control group. The primary outcome measure was to assess whether prebiotic administration prevents phototherapy-range hyperbilirubinemia in preterm neonates. Results Baseline characteristics were comparable between prebiotic and control groups. In prebiotic group, 23.25% (10 out of 43) required phototherapy, and 35.7% (15 out of 42) required phototherapy in control group ( P = .30). Twenty-four-hour TCB and peak TCB levels were significantly lower in the prebiotic group than in the control group after 24 hours of enrolment. Moreover, frequency of stools was substantially higher in the prebiotic group than in control group after 24 hours of enrolment with no adverse effects. Though 12-hour serum bilirubin levels amongst those who required phototherapy were comparable between the groups, the duration of phototherapy in the prebiotic group was less. Conclusion Enteral supplementation with prebiotics at a dose of 0.5 gm/kg/day in preterm (32-37 weeks) neonates leads to increased stool frequency and lower TCB levels but does not prevent phototherapy-range hyperbilirubinemia. Prebiotic supplementation may help reduce the phototherapy duration in preterm neonates with phototherapy-range hyperbilirubinemia.