Enteral administration of agar as an effective adjunct to phototherapy of neonatal hyperbilirubinemia

Phototherapy increases the biliary excretion of unconjugated bilirubin. In this form, bilirubin would be subject to enterohepatic circulation, and the true efficacy of phototherapy would be blunted. We tested the hypothesis that sequestration of lumenal unconjugated bilirubin by enteral agar administration would enhance the efficacy of phototherapy in jaundiced infants. Fifty-two infants were studied, 21 control and 31 agar-supplemented. The birth weights, sex distribution, and postnatal age at onset of phototherapy did not differ between the two groups of infants; pre- and postphototherapy bilirubin concentrations also did not differ between the groups. The bile acid concentrations and bilirubin saturation indices were also similar. The rate of declination of the plasma bilirubin concentrations after 24 h of phototherapy was greater and significantly more uniform in the agar-supplemented infants (—1.59 ± 2.3 versus —2.51 ± 1.44). Stool frequencies were greater in control infants (5.5 versus 4.3 per 24 h) whereas fecal bilirubin excretions were greater in agar-supplemented infants during the second day of phototherapy (1.32 versus 3.29 mg•kg^-1•24 h^-1). Agar supplementation reduced the duration of phototherapy by 23% (37.6 ± 3.2 versus 48.1 ± 5.0 h).