The best type of probiotic for the prevention and treatment of neonatal physiological jaundice: A systematic review and meta-analysis

Abstract

Background: Gut microbiota play an important role in bilirubin metabolism and may influence the course of neonatal physiological jaundice. This systematic review and meta-analysis aimed to evaluate the strain-specific efficacy of probiotics in the prevention and adjunctive treatment of neonatal physiological jaundice. Materials and Methods: A comprehensive search of PubMed, Scopus, Embase, Web of Science, Google Scholar, Cochrane Library, World Health Organization databases, and Persian databases (Scientific information database SID and Magiran) for studies published up to 2024 was conducted. Randomized controlled trials (RCTs) evaluating probiotics in term and late-preterm neonates (>= 35 weeks) with physiological jaundice were included. Data extraction, quality assessment, and meta-analysis were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using a random-effects model. Results: Nineteen RCTs (13 therapeutic and 6 prophylactic) were included. Prophylactic probiotic administration was associated with a reduced need for phototherapy (odds ratio OR =0.60; 95% confidence interval CI: 0.37-0.96). As an adjunct to phototherapy, probiotics were associated with lower bilirubin levels (mean difference MD = -1.61; 95% CI: -3.10--0.11), shorter phototherapy duration (similar to 5 h), and reduced hospitalization (0.3 days). Reduction in bilirubin was more evident during the 2nd and 3rd days of treatment. Strain-specific differences were observed; Clostridium butyricum and Lactobacillus reuteri demonstrated larger pooled effect sizes for bilirubin reduction, whereas Saccharomyces boulardii showed greater protective effect against phototherapy. Conclusion: Probiotics may serve as beneficial adjuncts in the prevention and management of neonatal physiological jaundice, with potential strain-dependent differences. Given heterogeneity and limited data for some strains, findings should be interpreted cautiously. Further well-designed, adequately powered RCTs are warranted.