title: Neonatal hyperbilirubinemia increases intestinal protein permeability and the prevalence of cow's milk protein intolerance.
abstract: OBJECTIVE
  Bilirubin is a newly discovered modulator of the gut barrier in vitro and in vivo. We studied the effect of bilirubin on the serosal to mucosal intestinal permeability in vivo. We also investigated the prevalence of cow's milk protein intolerance (CMPI) in infants with moderate hyperbilirubinemia versus matched controls.
  
  
  METHODS
  Faecal alpha 1 antitrypsin (a1AT) was used to monitor intestinal protein loss; a large cohort was prospectively followed for 12 months for sign and symptoms of CMPI.
  
  
  RESULTS
  Neonates with hyperbilirubinemia had higher stool excretion of a1AT than controls (0.68 +/- 0.28 mg/g vs. 0.25 +/- 0.11 mg/g; p < 0.01). Faecal a1AT correlates with total serum bilirubin (TSB) (r = 0.85; p < 0.01). Also, in the first 12 months of life, formerly hyperbilirubinemic infants had an higher prevalence of CMPI (14/353 vs. 4/339; chi2= 4.018, p = 0.045).
  
  
  CONCLUSIONS
  Neonatal hyperbilirubinemia increases stool protein loss and is also a mild risk factor for CMPI.
authors.affiliation: Department of Pediatrics, Division of Neonatology, Università Federico II, Napoli, Italy. raimondi@unina.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Raimondi
authors.forename: Flavia
authors.initials: F
authors.lastname: Indrio
authors.forename: Valeria
authors.initials: V
authors.lastname: Crivaro
authors.forename: Gabriella
authors.initials: G
authors.lastname: Araimo
authors.forename: Letizia
authors.initials: L
authors.lastname: Capasso
authors.forename: Roberto
authors.initials: R
authors.lastname: Paludetto
mesh_terms: D000818:Animals; D001663:Bilirubin / Q000097:blood*; D016022:Case-Control Studies; D002417:Cattle; D005260:Female; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000150:complications* / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D007408:Intestinal Absorption; D007558:Italy / Q000453:epidemiology; D007787:Lactose Intolerance / Q000209:etiology; D008297:Male; D016269:Milk Hypersensitivity / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008894:Milk Proteins / Q000009:adverse effects*; D010539:Permeability; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D000515:alpha 1-Antitrypsin / Q000378:metabolism*
chemical_list: D008894:Milk Proteins; D000515:alpha 1-Antitrypsin; D001663:Bilirubin