Prophylactic probiotic combinations and their effect on the course of neonatal jaundice: A comparative cohort study

BackgroundNeonatal hyperbilirubinemia is one of the most common conditions in the early neonatal period. Recent evidence suggests that intestinal microbiota plays a key role in bilirubin metabolism, and probiotic supplementation may influence its regulation.ObjectiveTo evaluate the effect of prophylactic administration of different probiotic combinations on transcutaneous bilirubin levels and clinical outcomes in term neonates.MethodsA total of 255 full-term neonates born at the Neonatology Department of University Hospital Medica Ruse Ltd, Bulgaria, throughout 2022 were included. Infants were divided into four groups according to the administered probiotic combination: (1) Group A (n = 25): L. lactis, B. lactis, B. bifidum; (2) Group B (n = 25): L. acidophilus, B. longum, L. reuteri; (3) Group C (n = 42): L. rhamnosus, L. reuteri, L. acidophilus; (4) Group D (n = 163): control group without probiotic supplementation. Probiotic intake began between the 6th and 12th postnatal hour and continued until Day 14. Transcutaneous bilirubin levels were measured daily until Day 5 (in-hospital) and on Day 14 (outpatient).ResultsNo significant baseline differences were observed between groups. Probiotic groups (A, B, and C) showed significantly lower mean bilirubin levels compared with controls (<i>p</i> < 0.05). Phototherapy in groups A, B, and C was initiated later (<i>p</i> < 0.001) and lasted for a shorter period (<i>p</i> = 0.080), which was associated with a reduced hospital stay (<i>p</i> = 0.001) compared with the control group. No adverse events were reported.ConclusionProphylactic probiotic supplementation during the early neonatal period was associated with lower bilirubin levels, reduced need for phototherapy, and shorter hospital stays. Combinations containing Bifidobacterium showed the strongest effect, suggesting their role in bilirubin elimination and intestinal stabilization.