Comparative Effects of Zinc and Probiotics on Neonatal Indirect Hyperbilirubinemia Undergoing Phototherapy

Background Neonatal indirect hyperbilirubinemia remains a frequent cause of admission to neonatal units in Pakistan. Although phototherapy is effective, prolonged treatment increases hospital stay, parental anxiety, and healthcare burden. Adjunctive therapies such as zinc and probiotics have been evaluated to enhance bilirubin reduction, but comparative local evidence is limited and inconsistent. Objectives To compare the effects of zinc and probiotics as adjuncts to phototherapy on bilirubin decline and selected clinical outcomes in neonates with indirect hyperbilirubinemia. Methods A single-center, parallel-group randomized controlled trial was conducted in the Department of Neonatology, Quaid-e-Azam Medical College, Bahawalpur, for six months. A total of 130 neonates requiring phototherapy were randomized equally to receive either oral zinc (5 mg once daily) or oral probiotics (1×10⁹ colony-forming units once daily). This was done in addition to standard phototherapy. The primary outcome was the rate of decline in total serum bilirubin. Secondary outcomes included the duration of phototherapy, length of hospital stay, rebound hyperbilirubinemia, and adverse events. Results Baseline demographic and clinical characteristics were comparable between groups. A higher mean bilirubin reduction at 24 hours was observed in the zinc group compared with the probiotic group. A greater proportion of neonates receiving zinc achieved a bilirubin decline of at least 0.2 mg/dL per hour. The median duration of phototherapy and length of hospital stay were shorter in the zinc group. Rebound hyperbilirubinemia and adverse events were infrequent and did not differ significantly between groups. No exchange transfusion was required. Conclusions Bilirubin decrease was faster, and the duration of phototherapy was shorter when zinc supplements were added than when probiotics were taken. The findings of these observations support the possible usefulness of zinc in the context of neonatal indirect hyperbilirubinemia management in low-resource environments.