Effects of Lactobacillus Rhamnosus GG Supplementation in Reducing serum bilirubin in neonates after 35 weeks of gestation as compared to only breast milk. A tertiary care center based one year study- a randomized controlled trial.

Jaundice is one of the most common conditions requiring medical care in neonates. Neonatal jaundice is a very common condition and affects approximately 2.4- 15% of newborn babies during the first 2 weeks of life. A rise of serum bilirubin level above3 15 mg/dl increases susceptibility to irreversible neurodisability . Timely detection of hyperbilirubinemia and early intervention is of utmost importance to prevent long term neurodisability. Sufficient feeding with sunlight exposure is associated with reduced risk of hyperbilirubinemia. It is plausible that early administration of probiotics in neonates can prevent neonatal hyperbilirubinemiaas the new born intestinal microflora is not fully formed in the first days of life and this cause increase in bilirubin enterohepatic circulation. Probiotics reduce the enterohepatic circulation of bilirubin by reducing the activity of  beta-glucoronidase by thus promoting its excreation. Lactobacillus rhamnosus GG is considered safe by the united states FDA and the most sought after probiotic used worldwide. The use of probiotics in neonates  is well established in necrotising enterocolitis There have been limited number of studies in assessing its role in reducing the incidence of neonatal hyperbilirubinemia. Most number of interventional studies have been done in intensive care set up assessing  the use of probiotics as a supplement to phototherapy in preterm neonates. Probiotic supplementation can also aid in maturation of the underdeveloped gut flora reducing the incidence of gastroenteritis and promoting the growth of healthy gut flora. There is a lacuna in finding the role of probiotics as a prophylaxis to reduce serum bilirubin level in term neonates. This study will help to decipher the effectiveness of probiotics in reducing serum bilirubin levels thus reducing the need for phototherapy which leads to prolongation of hospital stay and separation from mother.