The effect of prebiotics in the management of neonatal hyperbilirubinaemia

Background: Breast milk oligosaccharides such as galacto-oligosaccharides (scGOS) and fructo-oligosaccharides (lcFOS) can influence the intestinal microbial flora. The latter, in turn, can modulate several intestinal and extraintestinal functions, including bilirubin metabolism. Supplementing infant formula with a prebiotic mixture might then be a novel and safe intervention to manage mild neonatal hyperbilirubinaemia. Aim: To investigate the effect of dietary supplementation with prebiotics on moderate hyperbilirubinaemia in healthy, term infants. Methods: A prospective, double-blind, clinical trial was performed on seventy-six consecutive newborns who were randomly assigned to receive a formula containing 0.8 g/dL of a mixture from scGOS and lcFOS (ratio 9:1), or maltodextrines as placebo for 28 days. Bilirubin levels were determined by the transcutaneous bilirubin measurement within 2 h after birth (T1), at 24, 48 and 72 h and at 5, 7, 10 and 28 days of life. The number of stool per day was also recorded. Results: Neonates receiving prebiotics showed a larger number of stools over all the duration of dietary intervention compared to that of those on placebo (Repeated Measures ANOVA p <0.001; day 28 3.4 ± 0.0.9 vs 1.7 ± 0.9, respectively; Dunn test p <0.05). Neonates whose formula was supplemented with prebiotics showed a lower transcutaneous bilirubin that was statistically significant from 72 h of life (5.46 ± 1.6 vs 7.07 ± 2.49, post hoc Dunn test, p <0.05) throughout the duration of the dietary intervention (day 28 2.41 ± 0.4 vs 2.85 ± 0.5, post hoc Dunn test, p <0.05). Conclusion: The addition of prebiotics to standard infant diet might represent a novel strategy to help control neonatal hyperbilirubinaemia.