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a) Data are presented as mean ± standard deviation.b) A p-value of <0.05 was considered statistically significant.2-fold from day-1 (6.33 ± 1.34 mg/dL in control groups and 6.35 ± 1.52 mg/dL in probiotic groups). On day 5, the bilirubin levels in both groups still increasing with a mean of 10.85 ± 2.18 mg/dL in the control groups and 10.49 ± 2.14 mg/dL in probi-otic groups. The increase of bilirubin level from day 1 to day 5 was found in both groups. On day 5, after the last dose of probiotics was given, the bilirubin level between probiotic and control groups showed no significant differences. Also, there are no signifi-cant differences in the increased rate of bilirubin level on day 5-day 1 and day 5-day 2 between the two groups (Table 3).All of the infants enrolled in this study didn’t have any Adverse Events (AEs), which is defined as illnesses or sign and/or symptoms that occurred or worsened during the course of the study. These were assessed based on infant’s medical record.Neonatal hyperbilirubinemia is a common problem in newborns, can be classified into physiological and pathological jaundice. Jaundice is usually a transient condition, but in pathological jaundice, the increase of bilirubin level is persistent and may reach dangerous toxic levels leading to kernicterus. Therefore, it should be treated timely. Neonatal jaundice is caused by an undeveloped intestinal Figure 2　Bilirubin trend from Day-1 to Day-5*Compared using student t-test and p-value of <0.05 was considered statistically significant.Day 5 - Day 1Day 5 - Day 2microbiome and increased enterohepatic circula-tion contributes to an increase of plasma bilirubin level in the first days of life9).The increase of enterohepatic circulation is due to the high content and activity of β-glucuronidase (β-GD). At the brush edge of the intestinal tracts, β-GD deconjugates the bound bilirubin into unbound one and glucuronide. The unbound bili-rubin is reduced by intestinal microbiota to a series of urobilinogen and reabsorbed by intestinal cells to the liver via the portal vein and this causes a boost in the enterohepatic cycle. Also, newborns lack the intestinal microbiota which helps to reduce the unconjugated bilirubin4, 10).Probiotics are a living micro-organism which potential benefits have been increasing since the last two decades8). A study showed that probiotic supplementation can affect the neonatal hyperbili-rubinemia by various potential mechanisms to balance the microbiota dysbiosis and reduce bili-rubin level: 1) Promote colonization course; 2) Suppress pathogenic; 3) Stimulate intestinal peri-stalsis and increase stool frequency which reduce the enterohepatic circulation and inhibit the activity of the enzyme β-GD which reducing the degrada-tion of bound bilirubin; 4) Enhance the tight junc-tion; 5) Increase polyamines in the gut to improve the gut maturity11).Stimulation of the intestinal peristalsis in neonates not only beneficial for lowering the bilirubin level, but gut motility also affects nutrient absorption and one of the major factor impacting the levels of propionic acid. Propionic acid is a short chain fatty acid produced by bacteria in gut, which has been studied as a potential contributing factor to autism. Increased level of propionic acid have been shown to impair brain function in rat models12).Dysbiosis of the gut microbiome can causes adverse neurological outcomes in later life including cerebral palsy, attention deficit / hyperactivity disorder (ADHD) and reduced in cognitive perfor-mance. Also, it was found that children with Autism 143Bilirubin Level (mg/dL)Table 3　Comparison of Bilirubin Levela)Probiotic (n=54)Control (n=99)7.85 ± 1.934.53 ± 1.697.45 ± 2.194.14 ± 1.93Significanceb)P > 0.05P > 0.05Discussion