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Alikamali M, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Gharehbaghi MM, Homayouni-Rad A, Fardiazar Z, Shahnazi M. Effect of probiotic administration to breastfeeding mothers with very low birthweight neonates on some neonatal and maternal outcomes: study protocol for a randomised, double-blind, placebo-controlled trial. BMJ Open 2024; 14:e079526. [PMID: 39209790 DOI: 10.1136/bmjopen-2023-079526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Premature birth and very low birth weight (VLBW) are leading causes of neonatal mortality. Almost all premature infants experience hyperbilirubinaemia. Administering probiotics to breastfeeding mothers may positively affect infant outcomes. This trial aims to investigate whether probiotic supplementation for mothers with VLBW infants affects total serum bilirubin levels and postpartum depression scores (primary outcomes), as well as some other neonatal and maternal outcomes (secondary outcomes). METHODS AND ANALYSIS This is a randomised, double-blind, placebo-controlled superiority trial with two parallel arms. Participants, caregivers and outcome assessors will be blinded. A total of 122 breastfeeding mothers of neonates with a birth weight of 1000-1500 g, along with their infants within 48 hours of birth, will be assigned to either the probiotic or placebo group in a 1:1 ratio through block randomisation, stratified by singleton and twin births. The intervention will involve oral administration of probiotics containing Lactobacillus paracasei 431 and Bifidobacterium lactis BB-12, or an indistinguishable placebo, for 42-45 days. Outcomes will be assessed through daily observations, laboratory assessments and the Edinburgh Postpartum Depression Scale. Adverse events will also be documented. Modified intention-to-treat analyses will be employed for the primary and secondary outcomes, excluding participants lost to follow-up from all postintervention assessments. ETHICS AND DISSEMINATION This study protocol has been approved by the Medical University of Tabriz Ethics Committee (IR.TBZMED.REC.1401.735). Findings will be disseminated through publication in a peer-reviewed journal and presentations at relevant conferences. TRIAL REGISTRATION NUMBER IRCT20100414003706N42.
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Affiliation(s)
- Maryam Alikamali
- Student Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Sakineh Mohammad-Alizadeh-Charandabi
- Faculty of Nursing and Midwifery, Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Mojgan Mirghafourvand
- Faculty of Nursing and Midwifery, Social Determinants of Health Research Center, Department of Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Manizheh Mostafa Gharehbaghi
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran (the Islamic Republic of)
| | - Aziz Homayouni-Rad
- Faculty of Nutrition and Food Science, Department of Food Science and Technology, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Zahra Fardiazar
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran (the Islamic Republic of)
| | - Mahnaz Shahnazi
- Faculty of Nursing and Midwifery, Department of Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
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Su H, Yang S, Chen S, Chen X, Guo M, Zhu L, Xu W, Liu H. What Happens in the Gut during the Formation of Neonatal Jaundice-Underhand Manipulation of Gut Microbiota? Int J Mol Sci 2024; 25:8582. [PMID: 39201270 PMCID: PMC11354725 DOI: 10.3390/ijms25168582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/27/2024] [Accepted: 08/02/2024] [Indexed: 09/02/2024] Open
Abstract
Jaundice is a symptom of high blood bilirubin levels affecting about 80% of neonates. In neonates fed with breast milk, jaundice is particularly prevalent and severe, which is likely multifactorial. With the development of genomics and metagenomics, a deeper understanding of the neonatal gut microbiota has been achieved. We find there are accumulating evidence to indicate the importance of the gut microbiota in the mechanism of jaundice. In this paper, we present new comprehensive insight into the relationship between the microbiota and jaundice. In the new perspective, the gut is a crucial crossroad of bilirubin excretion, and bacteria colonizing the gut could play different roles in the excretion of bilirubin, including Escherichia coli as the main traffic jam causers, some Clostridium and Bacteroides strains as the traffic police, and most probiotic Bifidobacterium and Lactobacillus strains as bystanders with no effect or only a secondary indirect effect on the metabolism of bilirubin. This insight could explain why breast milk jaundice causes a longer duration of blood bilirubin and why most probiotics have limited effects on neonatal jaundice. With the encouragement of breastmilk feeding, our perspective could guide the development of new therapy methods to prevent this side effect of breastfeeding.
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Affiliation(s)
- Hongfei Su
- Key Laboratory of Geriatric Nutrition and Health, Ministry of Education, Beijing Technology and Business University, Beijing 100048, China; (H.S.); (S.C.); (X.C.); (H.L.)
| | - Shuran Yang
- NHC Key Laboratory of Food Safety Risk Assessment, Chinese Academy of Medical Science Research Unit, China National Center for Food Safety Risk Assessment, Beijing 100022, China;
| | - Shijing Chen
- Key Laboratory of Geriatric Nutrition and Health, Ministry of Education, Beijing Technology and Business University, Beijing 100048, China; (H.S.); (S.C.); (X.C.); (H.L.)
| | - Xiaolin Chen
- Key Laboratory of Geriatric Nutrition and Health, Ministry of Education, Beijing Technology and Business University, Beijing 100048, China; (H.S.); (S.C.); (X.C.); (H.L.)
| | - Mingzhang Guo
- Key Laboratory of Geriatric Nutrition and Health, Ministry of Education, Beijing Technology and Business University, Beijing 100048, China; (H.S.); (S.C.); (X.C.); (H.L.)
| | - Longjiao Zhu
- Food Laboratory of Zhongyuan, Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing 100193, China;
| | - Wentao Xu
- Food Laboratory of Zhongyuan, Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing 100193, China;
| | - Huilin Liu
- Key Laboratory of Geriatric Nutrition and Health, Ministry of Education, Beijing Technology and Business University, Beijing 100048, China; (H.S.); (S.C.); (X.C.); (H.L.)
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Alemu BK, Lee MW, Leung MBW, Lee WF, Wang Y, Wang CC, Lau SL. Preventive effect of prenatal maternal oral probiotic supplementation on neonatal jaundice (POPS Study): A protocol for the randomised double-blind placebo-controlled clinical trial. BMJ Open 2024; 14:e083641. [PMID: 38851232 PMCID: PMC11163667 DOI: 10.1136/bmjopen-2023-083641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 05/21/2024] [Indexed: 06/10/2024] Open
Abstract
INTRODUCTION Neonatal jaundice is a common and life-threatening health problem in neonates due to overaccumulation of circulating unconjugated bilirubin. Gut flora has a potential influence on bilirubin metabolism. The infant gut microbiome is commonly copied from the maternal gut. During pregnancy, due to changes in dietary habits, hormones and body weight, maternal gut dysbiosis is common, which can be stabilised by probiotics supplementation. However, whether probiotic supplements can reach the baby through the mother and reduce the incidence of neonatal jaundice has not been studied yet. Therefore, we aim to evaluate the effect of prenatal maternal probiotic supplementation on the incidence of neonatal jaundice. METHODS AND ANALYSIS This is a randomised double-blind placebo-controlled clinical trial among 94 pregnant women (47 in each group) in a tertiary hospital in Hong Kong. Voluntary eligible participants will be recruited between 28 and 35 weeks of gestation. Computer-generated randomisation and allocation to either the intervention or control group will be carried out. Participants will take either one sachet of Vivomixx (450 billion colony-forming units per sachet) or a placebo per day until 1 week post partum. Neither the study participants nor researchers will know the randomisation and allocation. The intervention will be initiated at 36 weeks of gestation. Neonatal bilirubin level will be measured to determine the primary outcome (hyperbilirubinaemia) while the metagenomic microbiome profile of breast milk and maternal and infant stool samples as well as pregnancy outcomes will be secondary outcomes. Binary logistic and linear regressions will be carried out to assess the association of the microbiome data with different clinical outcomes. ETHICS AND DISSEMINATION Ethics approval is obtained from the Joint CUHK-NTEC Clinical Research Ethics Committee, Hong Kong (CREC Ref: 2023.100-T). Findings will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER NCT06087874.
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Affiliation(s)
- Bekalu Kassie Alemu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
- Department of Midwifery, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - May Wing Lee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Maran Bo Wah Leung
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Wing Fong Lee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Yao Wang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
- Institute of Health Sciences, The Chinese University, Hong Kong, Hong Kong SAR
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
- School of Biomedical Sciences, Joint Laboratory for Reproductive Medicine, The Chinese University, Hong Kong, Hong Kong SAR
| | - So Ling Lau
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
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Jiayi C, Jinying W, Yanhan Y, Tianyu L, Juanjuan C, Feng Z, Xiaohui F, Jinping Z. Probiotics' effects on gut microbiota in jaundiced neonates: a randomized controlled trial protocol. Front Pediatr 2024; 12:1296517. [PMID: 38523836 PMCID: PMC10957549 DOI: 10.3389/fped.2024.1296517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/16/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Recent evidence suggests that blue-light phototherapy impacts gut microbiota composition in jaundiced newborns, leading to disturbances closely related to the therapy's side effects. As a result, gut microbiota may serve as a potential intervention target to mitigate these side effects. In this study, we aim to examine the effects of AB-GG (Lactobacillus rhamnosus LGG), Bb-12 (Bifidobacterium animalis Bb-12) and M-16V (Bifidobacterium breve M-16V) and their combination on the intestinal microbiota, metabolomics and phototherapy-related side effects in neonates with jaundice. Methods and analysis A total of 100 jaundiced newborns aged two weeks or younger will be included in this randomized, single-blind (the parents knew, but the neonatologists did not know), single-center controlled trial to receive either 109 colony-forming units of AB-GG, Bb-12, M-16V, a combination of the three probiotics with blue-light phototherapy, or blue-light phototherapy alone. The experimental group will be treated with oral probiotics once daily for 30 days, while the control group will receive only blue-light phototherapy. The follow-up duration will last 30 days. The primary outcomes include changes in gut microbiota, metabolomics, and the incidence of phototherapy side effects, assessed after each phototherapy session, as well as on days 10, 20, and 30. Ethics and dissemination The study protocol has been approved by the Ethics Committee of our institution. The findings of this trial will be submitted to a peer-reviewed pediatric journal. Its abstracts will be submitted to relevant national and international conferences. Clinical Trial Registration http://www.chictr.org.cn/index.aspx, identifer (ChiCTR2000036013).
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Affiliation(s)
- Chen Jiayi
- Pediatrics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Jinying
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
| | - Yuan Yanhan
- Pediatrics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liu Tianyu
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
| | - Chen Juanjuan
- Pediatrics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhang Feng
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
| | - Fang Xiaohui
- Pediatrics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhang Jinping
- Pediatrics, Shanghai Sixth People’s Hospital, Shanghai, China
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Matin M, Homayouni-Rad A, Mostafa-Gharehbaghi M, Mirghafourvand M, Mohammad-Alizadeh-Charandabi S. Maternal and infant probiotic administration for morbidity of very low birth weight infants: a three-arm randomized placebo-controlled trial. Eur J Nutr 2022; 61:3637-3648. [PMID: 35639151 DOI: 10.1007/s00394-022-02905-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine whether oral probiotic administration (1.5 × 109 CFU/g Lacticaseibacillus paracasei subsp. paracasei) to breastfeeding mothers or to their very low birth weight (VLBW) infants reduces total serum bilirubin (TSB) level and increases weight gain of the infants. METHODS In this double-blind trial, breastfeeding mothers and their VLBW infants at 48-72 h of age were allocated into three groups using stratified block randomization; administrating probiotic to the mothers and placebo to their infants, probiotic to the infants and placebo to their mothers, or placebo to the both. The intervention continued for 28 days. RESULTS All 25 mothers and their 26 infants allocated into each group were fully followed up. There were three positive blood culture only in the placebo group. On the 3rd day of intervention, TSB level was not significantly different among the groups but on the 7th day, it was significantly lower in the both probiotic groups compared with the placebo group (mean difference -2.4 mg/dL [95% confidence interval -3.6 to -1.2] in the both comparisons). Mean rank of infant weight gain during the first 7 days of intervention was significantly higher in the both maternal and infant probiotic groups compared with the placebo group (p = 0.007 and p = 0.003, respectively), but there was no statistically significant difference among the groups during the 8th-28th days. CONCLUSION Administration of Lacticaseibacillus paracasei to breastfeeding mothers of VLBW infants or to their infants reduces infant TSB level but has no significant effect on weight gain after the first week of the intervention. TRIAL REGISTRATION The Iranian Clinical Trials Registry IRCT20100414003706N38. protrospectively registered 24/01/2021.
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Affiliation(s)
- Mahtab Matin
- Student Research Committee, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aziz Homayouni-Rad
- Department of Food Science and Technology, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mojgan Mirghafourvand
- Clinical Research Development Unit, Imam Reza General Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Mohammad-Alizadeh-Charandabi
- Social Determinants of Health Research Center, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Shariati Ave, Tabriz, Iran.
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SANTOSA IRENA, SHOJI HIROMICHI, ITOH SHIGERU, SHIMIZU TOSHIAKI. Roles of Probiotics in Reduction of Neonatal Jaundice in Term Newborns. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2022; 68:140-146. [PMID: 38912278 PMCID: PMC11189792 DOI: 10.14789/jmj.jmj21-0044-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/24/2021] [Indexed: 06/25/2024]
Abstract
Objective the primary objective was to examine the effect of Bifidobacterium on decreasing the bilirubin level in term neonates delivered by Caesarean Section (CS). Materials and Methods A total of 153 healthy term neonates delivered by CS were included in this study and were divided into the non-probiotic group (n=99) and probiotic group (n=54) based on the history of probiotics administration. There were no infants who underwent phototherapy. A total of 20 doses of probiotics were given orally from the first day of life. The transcutaneous bilirubin (TcB) levels were measured every day for the first 5 days of life. Data of each infant and mother were gathered from medical records. Results The bilirubin level per day (day-1 to day-5) in the non-probiotic group was no different from the probiotic group. Differences in bilirubin level between day-5 and day-1, and also between day-5 and day-2 were not different between the two groups. There was a significant (p = 0.03) body weight gain in the probiotic groups with a mean of 36.09 ± 8.23 gram/day. No obvious adverse reactions were seen in both the non-probiotic group and probiotic group. Conclusions Our findings suggest no significant effects of probiotics on lowering bilirubin levels in the first five days of life. Also, probiotics have a positive effect on body weight gain in healthy term infants, and it is safe to be given to newborns.
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Affiliation(s)
| | - HIROMICHI SHOJI
- Corresponding author: Hiromichi Shoji, Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan, TEL: +81-3-3813-3111 FAX: +81-3-5800-0216 E-mail:
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Fan S, Zhang K, Zhang J, Zhang L, Liu L, Lv A, Ma Y, Fang X, Zheng F, Wu Z, Zhang J. Analysis of the effect of phototherapy on intestinal probiotics and metabolism in newborns with jaundice. Front Pediatr 2022; 10:878473. [PMID: 36275061 PMCID: PMC9583402 DOI: 10.3389/fped.2022.878473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In clinical practice, oral probiotics are often given to children with hyperbilirubinaemia who receive phototherapy, but the exact mechanism of the action of the probiotics on hyperbilirubinaemia remains unclear. It is unclear how the effects of phototherapy on the probiotic flora in the neonatal gut, in particular. MATERIALS AND METHODS Fifty newborns who needed phototherapy from June 2018 to June 2020 were selected as the study subjects, and five healthy newborns in the same period were used as controls to analyse the changes in probiotic bacteria in their faeces. RESULTS 1. In the intestinal tracts of newborns, Bifidobacterium is the main probiotic strain, with a small amount of Lactobacillus. There were probiotic species changes in the neonatal intestinal microbiota after phototherapy for 24 and 48 h. The amount of Bifidobacterium and Lactobacillus decreased significantly (P < 0.05). 2. A correlation analysis of probiotic species and bile acid metabolism indexes showed that Bifidobacterium was positively correlated with many metabolites (P < 0.05), such as chenodeoxycholic acid, hyodeoxycholic acid, cholic acid, allocholic acid, and β-cholic acid. It was also negatively correlated with many metabolites (P < 0.05), such as glycocholic acid, sodium, sodium tudca, and chenodeoxycholic acid. Lactobacillus was negatively correlated with metabolites (P < 0.05) such as α-sodium cholate and β-cholic acid. 3. A correlation analysis between the changes in probiotics and intestinal short-chain fatty acid metabolites after phototherapy showed that acetic acid, butyric acid, caproic acid, and propionic acid decreased and were significantly correlated with Bifidobacterium (P < 0.05). 4. After phototherapy, 17 metabolites changed significantly (P < 0.05). This correlated with many probiotics (P < 0.05). The significantly changed probiotics in this study showed a significant correlation with some intestinal metabolites (P < 0.05). CONCLUSION It was found that phototherapy can significantly affect the intestinal probiotic flora and the metabolic indicators of newborns, which may be an important reason for the side effects of phototherapy, and also provides the theoretical basis for the provision of probiotics to newborns with jaundice.
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Affiliation(s)
- Sainan Fan
- 1Department of Pediatrics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Zhang
- 1Department of Pediatrics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiahui Zhang
- 1Department of Pediatrics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Pediatrics, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Lixiao Liu
- Department of Pediatrics, Shanghai Pudong Hospital, Shanghai, China
| | - Anping Lv
- 1Department of Pediatrics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanan Ma
- 1Department of Pediatrics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohui Fang
- 1Department of Pediatrics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Zheng
- 1Department of Pediatrics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhimin Wu
- 1Department of Pediatrics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinping Zhang
- 1Department of Pediatrics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Duan M, Han Z, Huang N. Changes of intestinal microflora in neonatal necrotizing enterocolitis: a single-center study. J Int Med Res 2021; 48:300060520957804. [PMID: 32967507 PMCID: PMC7520936 DOI: 10.1177/0300060520957804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the changes in the diversity and dynamics of intestinal microflora in patients with neonatal necrotizing enterocolitis (NEC) in a single center in China. Methods In this prospective study conducted between 2016 and 2019, feces were collected from 28 neonates with NEC and 30 control neonates to analyze the species richness and Shannon’s diversity index of the bands, which were also sequenced via PCR-denaturing gradient gel electrophoresis. Results The species richness and Shannon’s diversity index were significantly lower in the NEC group than in the control group, indicating that the diversity of intestinal flora was reduced in NEC. The numbers of samples positive for Bacteroides and Klebsiella were higher in the NEC group, whereas Escherichia coli, Bifidobacterium, and Lactobacillus were less frequently detected in patients with NEC than in controls. The prevalence of intestinal bacteria normalized after the resolution of NEC. Conclusion The decrease of intestinal flora diversity in neonates with NEC, especially the decreased prevalence of probiotic bacteria, may be an important factor in the pathogenesis of NEC.
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Affiliation(s)
- Miao Duan
- Department of Neonate, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, Guizhou Province, China
| | - Zunhua Han
- Department of Emergency, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, Guizhou Province, China
| | - Nanqu Huang
- Drug Clinical Trial Institution, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, Guizhou Province, China
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Chen K, Yuan T. The role of microbiota in neonatal hyperbilirubinemia. Am J Transl Res 2020; 12:7459-7474. [PMID: 33312382 PMCID: PMC7724329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/24/2020] [Indexed: 06/12/2023]
Abstract
Hyperbilirubinemia accounts for about 60% of full-term and 80% of preterm neonates globally, which is characterized by physiologically elevated unconjugated bilirubin in serum, but abnormally high levels of bilirubin have potential neurotoxic effects. Several factors contribute to the development of neonatal hyperbilirubinemia, including isoimmunization, dysregulated gut flora, genetic alteration and environmental factors. Animal studies have pinpointed the causal roles of several bacteria in bilirubin metabolism. Human studies have revealed microbiota composition in hyperbilirubinemia and found that gut microbiota affect newborns with different severity of hyperbilirubinemia. However, dysbiosis and subsequent changes in microbiota-related metabolic processes are not always considered. This review aims to describe the critical microbiota signatures for neonatal hyperbilirubinemia and focus on the underlying pathogenetic mechanism. These scientific bases give a new and accurate therapeutic strategy for the application of gut microbiota.
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Affiliation(s)
- Kewei Chen
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health Zhejiang, PR China
| | - Tianming Yuan
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health Zhejiang, PR China
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Tang W, Lu HY, Sun Q, Xu WM. [Effectiveness of Saccharomyces boulardii combined with phototherapy in the treatment of hyperbilirubinemia in neonates: a prospective randomized controlled trial]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1149-1153. [PMID: 33172546 PMCID: PMC7666384 DOI: 10.7499/j.issn.1008-8830.2007062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the effectiveness of Saccharomyces boulardii combined with phototherapy in the treatment of hyperbilirubinemia in neonates. METHODS The neonates with hyperbilirubinemia who were hospitalized from January to December 2018 were enrolled and randomly divided into an observation group (n=61) and a control group (n=63). The neonates in the observation group were treated with phototherapy combined with Saccharomyces boulardii, and those in the control group were treated with phototherapy combined with placebo. Treatment outcomes were compared between the two groups. Fecal samples were collected 72 hours after treatment and 16s rRNA high-throughput sequencing was used to compare the features of gut microbiota between the two groups. RESULTS There was no significant difference in the total serum bilirubin level between the two groups before treatment (P>0.05). At 24, 48, and 72 hours after treatment, the observation group had a significantly lower level of total serum bilirubin than the control group (P<0.05). Compared with the control group, the observation group had a significantly lower proportion of neonates requiring phototherapy again [20% (12/61) vs 75% (47/63), P<0.05]. Compared with the control group, the observation group had a significantly higher abundance of Bacteroides (P<0.05) and a significantly lower abundance of Escherichia coli and Staphylococcus in the intestine at 72 hours after treatment (P<0.05). CONCLUSIONS In neonates with hyperbilirubinemia, phototherapy combined with Saccharomyces boulardii can effectively reduce bilirubin level and prevent the recurrence of jaundice. Saccharomyces boulardii can favour the treatment outcome by regulating the gut microbiota of neonates.
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Affiliation(s)
- Wei Tang
- Department of Pediatrics, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, China.
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Tang W, Lu HY, Sun Q, Xu WM. [Effectiveness of Saccharomyces boulardii combined with phototherapy in the treatment of hyperbilirubinemia in neonates: a prospective randomized controlled trial]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1149-1153. [PMID: 33172546 PMCID: PMC7666384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/21/2020] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To study the effectiveness of Saccharomyces boulardii combined with phototherapy in the treatment of hyperbilirubinemia in neonates. METHODS The neonates with hyperbilirubinemia who were hospitalized from January to December 2018 were enrolled and randomly divided into an observation group (n=61) and a control group (n=63). The neonates in the observation group were treated with phototherapy combined with Saccharomyces boulardii, and those in the control group were treated with phototherapy combined with placebo. Treatment outcomes were compared between the two groups. Fecal samples were collected 72 hours after treatment and 16s rRNA high-throughput sequencing was used to compare the features of gut microbiota between the two groups. RESULTS There was no significant difference in the total serum bilirubin level between the two groups before treatment (P>0.05). At 24, 48, and 72 hours after treatment, the observation group had a significantly lower level of total serum bilirubin than the control group (P<0.05). Compared with the control group, the observation group had a significantly lower proportion of neonates requiring phototherapy again [20% (12/61) vs 75% (47/63), P<0.05]. Compared with the control group, the observation group had a significantly higher abundance of Bacteroides (P<0.05) and a significantly lower abundance of Escherichia coli and Staphylococcus in the intestine at 72 hours after treatment (P<0.05). CONCLUSIONS In neonates with hyperbilirubinemia, phototherapy combined with Saccharomyces boulardii can effectively reduce bilirubin level and prevent the recurrence of jaundice. Saccharomyces boulardii can favour the treatment outcome by regulating the gut microbiota of neonates.
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Affiliation(s)
- Wei Tang
- Department of Pediatrics, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, China.
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12
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Walker M. Novel Innovations and Recent Findings in Lactation Support. CLINICAL LACTATION 2019. [DOI: 10.1891/2158-0782.10.4.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RationaleStaying current with the burgeoning amount of breastfeeding research can be a daunting task. It is incumbent upon the IBCLC and other lactation care providers to be cognizant of new research and innovations in lactation support.MethodRecent products and findings regarding neonatal jaundice, hypoglycemia, mastitis, and therapeutic taping are presented.FindingsNew research findings, techniques, and products have been gathered to augment the provider's knowledge and skill set regarding a broad range of items relevant to clinical lactation practice. Most are affordable options for practitioners and parents, and represent safe and effective options for screening and treatment.
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Deshmukh J, Deshmukh M, Patole S. Probiotics for the management of neonatal hyperbilirubinemia: a systematic review of randomized controlled trials. J Matern Fetal Neonatal Med 2017; 32:154-163. [DOI: 10.1080/14767058.2017.1369520] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Janki Deshmukh
- Department of Paediatrics, Princess Margaret Hospital for Children, Subiaco, Australia
| | - Mangesh Deshmukh
- Department of Neonatal Paediatrics, Fiona Stanley Hospital, Perth, Australia
- St John of God Hospital, Subiaco, Australia
| | - Sanjay Patole
- Department of Neonatal Paediatrics, King Edward Memorial Hospital, Subiaco, Australia
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Chen Z, Zhang L, Zeng L, Yang X, Jiang L, Gui G, Zhang Z. Probiotics Supplementation Therapy for Pathological Neonatal Jaundice: A Systematic Review and Meta-Analysis. Front Pharmacol 2017; 8:432. [PMID: 28713275 PMCID: PMC5491971 DOI: 10.3389/fphar.2017.00432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/16/2017] [Indexed: 12/11/2022] Open
Abstract
Background: Neonatal jaundice is a relatively prevalent disease and affects approximately 2.4-15% newborns. Probiotics supplementation therapy could assist to improve the recovery of neonatal jaundice, through enhancing immunity mainly by regulating bacterial colonies. However, there is limited evidence regarding the effect of probiotics on bilirubin level in neonates. Therefore, this study aims at systematically evaluating the efficacy and safety of probiotics supplement therapy for pathological neonatal jaundice. Methods: Databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database (Wan Fang), Chinese Biomedical Literature Database (CBM), VIP Database for Chinese Technical Periodicals (VIP) were searched and the deadline is December 2016. Randomized controlled trials (RCTs) of probiotics supplementation for pathological neonatal jaundice in publications were extracted by two reviewers. The cochrane tool was applied to assessing the risk of bias of the trials. The extracted information of RCTs should include efficacy rate, serum total bilirubin level, time of jaundice fading, duration of phototherapy, duration of hospitalization, adverse reactions. The main outcomes of the trials were analyzed by Review Manager 5.3 software. The relative risks (RR) or mean difference (MD) with a 95% confidence interval (CI) was used to measure the effect. Results: 13 RCTs involving 1067 neonatal with jaundice were included in the meta-analysis. Probiotics supplementation treatment showed efficacy [RR: 1.19, 95% CI (1.12, 1.26), P < 0.00001] in neonatal jaundice. It not only decreased the total serum bilirubin level after 3day [MD: -18.05, 95% CI (-25.51, -10.58), P < 0.00001], 5day [MD: -23.49, 95% CI (-32.80, -14.18), P < 0.00001], 7day [MD: -33.01, 95% CI (-37.31, -28.70), P < 0.00001] treatment, but also decreased time of jaundice fading [MD: -1.91, 95% CI (-2.06, -1.75), P < 0.00001], as well as the duration of phototherapy [MD: -0.64, 95% CI (-0.84, -0.44), P < 0.00001] and hospitalization [MD: -2.68, 95% CI (-3.18, -2.17), P < 0.00001], when compared with the control group. Additionally, no serious adverse reaction was reported. Conclusion: This meta-analysis shows that probiotics supplementation therapy is an effective and safe treatment for pathological neonatal jaundice.
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Affiliation(s)
- Zhe Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan UniversityChengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan UniversityChengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of EducationChengdu, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan UniversityChengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan UniversityChengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of EducationChengdu, China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan UniversityChengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan UniversityChengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of EducationChengdu, China
| | - Xiaoyan Yang
- Department of Neonatology, West China Second University Hospital, Sichuan UniversityChengdu, China
| | - Lucan Jiang
- Department of Pharmacy, West China Second University Hospital, Sichuan UniversityChengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan UniversityChengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of EducationChengdu, China
- West China School of Pharmacy, Sichuan UniversityChengdu, China
| | - Ge Gui
- Department of Pharmacy, West China Second University Hospital, Sichuan UniversityChengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan UniversityChengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of EducationChengdu, China
- West China School of Pharmacy, Sichuan UniversityChengdu, China
| | - Zuojie Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan UniversityChengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan UniversityChengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of EducationChengdu, China
- West China School of Pharmacy, Sichuan UniversityChengdu, China
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Suganthi V, Das AG. Role of Saccharomyces boulardii in Reduction of Neonatal Hyperbilirubinemia. J Clin Diagn Res 2017; 10:SC12-SC15. [PMID: 28050461 DOI: 10.7860/jcdr/2016/20115.8878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 09/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Probiotics are known to reduce the severity of hyperbilirubinemia. AIM This study was done to evaluate the effect of probiotic on neonatal hyperbilirubinemia in term neonates. MATERIALS AND METHODS A total of 181 healthy term neonates after birth were divided into a control group (n=95) and a treatment group (n=86) randomly and treated with placebo and probiotic (Saccharomyces boulardii) respectively. A total of two doses were given orally in the first two consecutive days. The serum bilirubin levels were detected on day three of life. Babies were exclusively breastfed, clinical outcome was recorded. Comparison between groups was made by the non-parametric Mann-Whitney test. Analysis of Variance (ANOVA) was used to assess the quantitative variables. A p-value of <0.05 using a two-tailed test was taken as being of significance for all statistical tests. RESULTS On day 3, mean total serum bilirubin in control group among patient who has not developed clinical jaundice is 6.5mg% and in the treatment group is 5mg%. In patient with clinical jaundice, it is 13.6mg% in control group and 10.7mg% in the treatment group. The p-value was found to be <0.05 which is statistically significant. No obvious adverse reactions noted in either group. CONCLUSION Probiotics lowered the serum bilirubin level of healthy neonate with jaundice safely and significantly without any adverse reaction.
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Affiliation(s)
- V Suganthi
- Head of Department, Department of Pediatrics, Coimbatore Medical College Hospital , Coimbatore, Tamil Nadu, India
| | - A Gokul Das
- Paediatrician, Taluk Hospital , Pattambi, Kerala, India
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