Prebiotics for the management of hyperbilirubinemia in preterm neonates

Objective: We evaluated if prebiotics have benefits for the management of hyperbilirubinemia in preterm neonates. Methods: Preterm neonates were entered into the study when enteral feeding volume met 30 mL/kg/day. They randomly received a mixture of short-chain galacto-oligosacarids/long-chain fructo-oligosacarids or distilled water (placebo) for 1 week. Total serum bilirubin level was measured by transcutaneous bilirubinometry. Stool frequency and meeting full enteral feeding during the study period were considered as secondary outcomes. Results: Twenty-five neonates in each group completed the trial. Bilirubin level was decreased with the prebiotic (-1.3 +/- 1.8 mg/dL, p = 0.004), but not placebo (-0.1 +/- 3.3 mg/dL, p = 0.416). Peak bilirubin level was lower with the prebiotic than placebo (8.3 +/- 1.7 versus 10.1 +/- 2.2 mg/dL, p = 0.003). Stool frequency was increased with the prebiotic (0.7 +/- 1.9 defecation/day, p = 0.014), but not with placebo (0.6 +/- 1.5 defecation/day, p = 0.133). Average stool frequency (2.4 +/- 0.4 versus 1.9 +/- 0.5 defecation/day, p = 0.003) and frequently of meeting full enteral feeding (60% versus 16%, p = 0.002) were higher with the prebiotic than placebo. Conclusions: Prebiotic oligosaccharides increase stool frequency, improve feeding tolerance and reduce bilirubin level in preterm neonates and therefore can be efficacious for the management of neonatal hyperbilirubinemia.