Probiotic Use and Unconjugated Hyperbilirubinemia in Neonates: A Prospective Cohort Study in Sulaimani, Kurdistan region/Iraq

Volume 16 , Issue 1 , July 2026

Authors

Chenar Al Jaf

DOI logo 10.17656/jsmc.10522

Keywords

Abstract

Background: Neonatal unconjugated hyperbilirubinemia (UHB) is common and may require phototherapy (PT). This study evaluated the effect of probiotic supplementation, as an adjunct to PT, on total serum bilirubin (TSB) kinetics in neonates with UHB in Sulaimani, Kurdistan.

Method: In this prospective interventional cohort (January 2024–December 2025), 156 neonates (≥34 weeks, ≤10 days old) with predominantly UHB were allocated into four groups: PT + probiotic (n=24), PT + no probiotic (n=24), no PT + probiotic (n=70), and no PT + no probiotic (n=38). A standardized Lactobacillus preparation was used. TSB and packed cell volume (PCV) were measured on days 1, 2, 3, 5, and 7.

Result: Initial mean TSB was higher in PT groups (14.88 ± 1.41; 14.81 ± 1.25 mg/dL) than in no‑PT groups (12.20 ± 0.75; 12.60 ± 0.70 mg/dL; p<0.001). Probiotics had no significant impact on early TSB decline overall (rate difference 0.06 mg/dL/day; 95% CI – 0.08 to 0.20; p=0.385). During days 4–7, probiotics significantly increased TSB decline overall (0.32 mg/dL/day; 95% CI 0.18–0.46; p<0.001), particularly in neonates without PT (0.38 mg/dL/day; 95% CI 0.25–0.51; p<0.001), and reduced time to TSB <12 mg/dL (2.8 ± 0.6 vs. 4.1 ± 0.9 days; p<0.001). No benefit was observed among infants receiving PT.

Conclusion: In late preterm and term neonates with mild to moderate UHB managed without PT, probiotics significantly accelerate late-phase bilirubin decline and shorten time to safe TSB levels.

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  • First online2 July 2026
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