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Shirazinia R, Golabchifar AA, Fazeli MR. Efficacy of probiotics for managing infantile colic due to their anti-inflammatory properties: a meta-analysis and systematic review. Clin Exp Pediatr 2021; 64:642-651. [PMID: 33848417 PMCID: PMC8650819 DOI: 10.3345/cep.2020.01676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/06/2021] [Accepted: 03/29/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Infantile colic (IC) is excessive crying in otherwise healthy children. Despite vast research efforts, its etiology remains unknown. PURPOSE Most treatments for IC carry various side effects. The collection of evidence may inform researchers of new strategies for the management and treatment of IC as well as new clues for understanding its pathogenesis. This review and meta-analysis aimed to evaluate the efficacy and possible mechanisms of probiotics for mananaging IC. METHODS Ten papers met the study inclusion and exclusion criteria, and the meta-analysis was conducted using Review Manager (RevMan) software and a random-effects model. RESULTS This meta-analysis revealed that probiotics are effective for treating infantile colic, while the review showed that this efficacy may be due to their anti-inflammatory effects. CONCLUSION Probiotics may be an important treatment option for managing infantile colic due to their anti-inflammatory properties.
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Affiliation(s)
- Reza Shirazinia
- Department of Comparative Biosciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Ali Akbar Golabchifar
- Department of Comparative Biosciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Mohammad Reza Fazeli
- Pharmaceutical Quality Assurance Research Center, The institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
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2
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Park ES, Freeborn J, Venna VR, Roos S, Rhoads JM, Liu Y. Lactobacillus reuteri effects on maternal separation stress in newborn mice. Pediatr Res 2021; 90:980-988. [PMID: 33531679 DOI: 10.1038/s41390-021-01374-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Probiotic Lactobacillus reuteri DSM 17938 (LR 17938) is beneficial to infants with colic. To understand its mechanism of action, we assessed ultrasonic vocalizations (USV) and brain pain/stress genes in newborn mice exposed to maternal separation stress. METHODS Pups were exposed to unpredictable maternal separation (MSU or SEP) or MSU combined with unpredictable maternal stress (MSU + MSUS or S + S), from postnatal days 5 to 14. USV calls and pain/stress/neuroinflammation-related genes in the brain were analyzed. RESULTS We defined 10 different neonatal call patterns, none of which increased after MSU. Stress reduced overall USV calls. Orally feeding LR 17938 also did not change USV calls after MSU. However, LR 17938 markedly increased vocalizations in mice allowed to stay with their dams. Even though LR 17938 did not change MSU-related calls, LR 17938 modulated brain genes related to stress and pain. Up-regulated genes following LR 17938 treatment were opioid peptides, kappa-opioid receptor 1 genes, and CD200, important in anti-inflammatory signaling. LR 17938 down-regulated CCR2 transcripts, a chemokine receptor, in the stressed neonatal brain. CONCLUSIONS USV calls in newborn mice are interpreted as "physiological calls" instead of "cries." Feeding LR 17938 after MSU did not change USV calls but modulated cerebral genes favoring pain and stress reduction and anti-inflammatory signaling. IMPACT We defined mouse ultrasonic vocalization (USV) call patterns in this study, which will be important in guiding future studies in other mouse strains. Newborn mice with maternal separation stress have reduced USVs, compared to newborn mice without stress, indicating USV calls may represent "physiological calling" instead of "crying." Oral feeding of probiotic Lactobacillus reuteri DSM 17938 raised the number of calls when newborn mice continued to suckle on their dams, but not when mice were under stress. The probiotic bacteria had a dampening effect on monocyte activation and on epinephrine and glutamate-related stress gene expression in the mouse brain.
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Affiliation(s)
- Evelyn S Park
- Departments of Pediatrics at McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jasmin Freeborn
- Departments of Pediatrics at McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Venugopal Reddy Venna
- Departments of Neurology at McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stefan Roos
- Department of Molecular Sciences, Uppsala BioCenter, Swedish University of Agricultural Sciences, Uppsala, Sweden
- BioGaia AB, Stockholm, Sweden
| | - J Marc Rhoads
- Departments of Pediatrics at McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yuying Liu
- Departments of Pediatrics at McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, TX, USA.
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3
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Bagherian B, Mehdipour-Rabori R, Nematollahi M. How Do Mothers Take Care of Their Infants with Colic Pain? A Mixed-Method Study. Ethiop J Health Sci 2021; 31:761-770. [PMID: 34703175 PMCID: PMC8512939 DOI: 10.4314/ejhs.v31i4.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Colic pain is one of the main reasons for stress and anxiety in infants' parents, especially mothers, and there is still no specific treatment. Thus, mothers always try their best to relieve their infants' pain. The researchers attempted to investigate how mothers take care of their infants with colic. Methods This study was conducted with a mixed-method approach and a sequential explanatory design. In the quantitative phase, a cross-sectional study was conducted to assess how to control pain. One hundred fifty mothers of infants with colic living in Kerman, Iran, were chosen by convenience sampling. In the qualitative phase, the researchers interviewed 18 mothers using semi-structured in-depth, and face-to-face approaches. These participants were selected by purposive sampling method. The interviews were analyzed by the conventional content analysis method. Results In the quantitative phase, the mothers' most common methods to relieve colic pain were herbal medicines (3.55±0.51) and the change of position (3.35±0.67). The least methods used were probiotics (1.4±0.2) and acupuncture (0). In the qualitative phase, the main theme was “mothers support needs for care,” which includes the following subcategories: “lack of trust in doctor”; “full-time care”; “feeling of inadequacy,” “persistent anxiety, “care without help,” and “looking for ways to control pain.” Conclusion Mothers need support to relieve their infants' colic. The provision of educational and psychological supportive packages can be helpful for the mothers. In addition, nurses can help mothers improve their quality of care.
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Affiliation(s)
- Behnaz Bagherian
- Assistant Professor, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Monirsadat Nematollahi
- Assistant Professor, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
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4
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Chen K, Liu C, Li H, Lei Y, Zeng C, Xu S, Li J, Savino F. Infantile Colic Treated With Bifidobacterium longum CECT7894 and Pediococcus pentosaceus CECT8330: A Randomized, Double-Blind, Placebo-Controlled Trial. Front Pediatr 2021; 9:635176. [PMID: 34568236 PMCID: PMC8461252 DOI: 10.3389/fped.2021.635176] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Colic is a common condition in infants <4 months of age. Attempts to treat infantile colic with probiotics have shown variable efficacy and overall low evidence of success. In this work, we tested the hypothesis that oral administration of Bifidobacterium longum CECT7894 (KABP042) and Pediococcus pentosaceus CECT8330 (KABP041) mix (1 × 109 colony forming units) would improve the symptoms of infantile colic. Methods: A total of 112 exclusively breastfed or mixed fed infants aged <2 months and meeting the ROME IV criteria for infantile colic were recruited. The infants were randomized in a double-blind, placebo-controlled trial to receive orally administered probiotics (intervention group, IG, n = 48) or placebo (placebo group, PG, n = 42) daily for 21 days. Results: Infants in the IG had significantly shorter crying time (p < 0.001) on day 7 [IG vs. PG, median (25-75th percentile): 38 (3.5-40.5) vs. 62 (40-108) min/day], day 14 [IG vs. PG: 20 (0-40) vs. 50 (30-75) min/day], and day 21 [IG vs. PG: 14 (0-33) vs. 40 (28-62) min/day]. Higher responder ratio and fewer crying/fussing episodes on days 7, 14, and 21 and better stool consistency on day 21 were observed in the IG (p < 0.01) as compared to the PG. Conversely, no significant effects on stool frequency or quality of life were observed. Conclusions: In summary, daily oral administration of B. longum CECT7894 (KABP042) and P. pentosaceus CECT8330 (KABP041) was an effective treatment for shortening crying time due to infantile colic and for improving fecal consistency. This trial was registered retrospectively in December 2019 with a trial number of ISRCTN92431452.
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Affiliation(s)
- Ke Chen
- Department of Nutrition, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.,Department of Child Health Care, Angel Children's Hospital, Chengdu, China
| | - Changqi Liu
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
| | - Hua Li
- Department of Child Health Care, Qingbaijiang Maternal and Child Health Hospital, Chengdu, China
| | - Yuehua Lei
- Department of Child Health Care, Qingbaijiang Maternal and Child Health Hospital, Chengdu, China
| | - Chenggui Zeng
- Department of Child Health Care, Chengdu Caojiaxiang Community Healthcare Center, Chengdu, China
| | - Shuhong Xu
- Department of Child Health Care, Huili Maternity and Child Care Center, Huili, China
| | - Jianqiu Li
- Department of Child Health Care, Angel Children's Hospital, Chengdu, China
| | - Francesco Savino
- Department of Paediatrics, S.S.D. Subintensive Neonatal Care, Children Hospital 'Regina Margherita', Turin, Italy
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Ravikumar S, Srinivasaraghavan R, Gunasekaran D, Sundar S, Soundararajan P. Vestibular stimulation with Indian hammock versus music intervention in the prevention of infantile colic in term infants: An open-labelled, randomized controlled trial. Int J Pediatr Adolesc Med 2020; 7:191-195. [PMID: 33319018 PMCID: PMC7729235 DOI: 10.1016/j.ijpam.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 11/20/2019] [Accepted: 12/17/2019] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVES To determine whether vestibular stimulation offered by Indian hammock and music intervention are useful in reducing the occurrence of infantile colic in term infants. METHODS This open-labelled randomized clinical trial was conducted among 465 term neonates who were randomly assigned to one of three groups: music group, hammock group and control group. The music intervention was given for a cumulative duration of at least 4 h a day with one stretch of at least 1 h. In the hammock group, babies were put to sleep inside the Indian hammock and were swung gently until they sleep, and were allowed to sleep in it, until they wake up. For the control group, routine pre-discharge counselling was given. All parents were provided a cry log and were instructed to record the log of cry events and duration. The primary outcome measure was occurrence of infantile colic episode as defined by ROME IV criteria. The infants were followed up from birth until the age of 3.5 months, and the cry log was collected during each follow-up visit. RESULTS Of the 435 term neonates who completed follow-up, 59 infants developed infantile colic (13.6%). The prevalence of infantile colic in the control group, music group and the Indian hammock group was 25.6%, 5.4% and 9.6% respectively; there was a significant reduction in the prevalence of infantile colic in the intervention groups as compared to the control group. CONCLUSIONS Vestibular stimulation by Indian hammock and music intervention individually reduced the occurrence of infantile colic.
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Affiliation(s)
- Senthikumaran Ravikumar
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | | | - Dhandapany Gunasekaran
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Sumathy Sundar
- Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Palanisamy Soundararajan
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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Levinsky Y, Eidlitz-Markus T. Comparison of the Prevalence of Infantile Colic Between Pediatric Migraine and Other Types of Pediatric Headache. J Child Neurol 2020; 35:607-611. [PMID: 32493097 DOI: 10.1177/0883073820924264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND/OBJECTIVE The International Headache Society lists infantile colic under "episodic syndromes that may be associated with migraine" in the ICHD3-beta version of its classification of headache disorders. The aim of this study was to examine whether this association is specific to migraine or applies to all pediatric headache types. METHODS A cross-sectional historical study was conducted including 219 patients aged 3-18 years who presented to a tertiary pediatric headache clinic in 2016-2017. Parents were asked a series of questions to determine if their child had had infantile colic as defined in the ICHD3-beta version. The prevalence of a positive history of colic was compared between children diagnosed with migraine or other primary headache types. RESULTS There were 132 girls (60.2%) and 87 boys (39.8%) of mean age 12.8 ± 3.48 years at presentation. Migraine headache was diagnosed in 170 patients (77.6%) and other types primary of headache (9 in total) in 49 patients (22.3%). Fifty-one patients had a history of infantile colic. They included 45 patients in the migraine group (26.5%) and 5 in the comparison groups (10.2%); the difference in the rate of colic was statistically significant (P = .0196; OR 3.17, 95% CI 0.1.17-6.17). There was no association of specific migraine parameters or symptoms with infantile colic. CONCLUSION There appears to be an association of infantile colic with pediatric migraine but not with other types of pediatric headache. These findings reinforce the theory that infantile colic has common pathogenic roots with migraine.
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Affiliation(s)
- Yoel Levinsky
- Pediatric Headache Clinic, Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Eidlitz-Markus
- Pediatric Headache Clinic, Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Oflu A, Bukulmez A, Gorel O, Acar B, Can Y, Ilgaz NC, Yenioglu I, Uygun S, Sulecik S. Complementary and alternative medicine experiences of mothers in the treatment of infantile colic. Sudan J Paediatr 2020; 20:49-57. [PMID: 32528201 DOI: 10.24911/sjp.106-1568897690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lack of effective medical treatment in infantile colic (IC) causes desperate mothers to apply for complementary and alternative medicine (CAM) treatments. Due to the possibility of benefits, the risks that may be incurred by these methods are often ignored by the parents. Therefore, information on the use of CAM methods in IC is needed. The aim of this study is to reveal the CAM experiences of mothers in IC treatment and the demographic characteristics that affect them. Mothers whose children were diagnosed as IC by a physician in the past were included in the study. The sociodemographic characteristics of the mothers, IC-diagnosed baby characteristics and CAM experiences were investigated face to face with a structured questionnaire. Sixty-six of 96 mothers who participated in the study used the CAM method. There was a statistically significant difference between the use of CAM and the education level of mothers (p < 0.05). We determined that 74% of mothers informed their doctors before starting treatments, and 82% do not believe if the CAM method could cause any harm that they would not notice by observing. The results showed that CAM methods are commonly used in IC treatment. According to these findings, mothers who use these methods believe that they are always harmless and have no side effects. For this reason, physicians should be careful about the adverse effects that may occur due to the CAM methods, which are widely used.
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Affiliation(s)
- Ayse Oflu
- Department of Pediatrics, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Aysegul Bukulmez
- Department of Pediatrics, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Oya Gorel
- Sixth Semester Medical Student, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Busegul Acar
- Sixth Semester Medical Student, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Yusuf Can
- Sixth Semester Medical Student, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Nihat Cem Ilgaz
- Sixth Semester Medical Student, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Ibrahim Yenioglu
- Sixth Semester Medical Student, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Serkan Uygun
- Sixth Semester Medical Student, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Sultan Sulecik
- Sixth Semester Medical Student, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Nocerino R, De Filippis F, Cecere G, Marino A, Micillo M, Di Scala C, de Caro C, Calignano A, Bruno C, Paparo L, Iannicelli AM, Cosenza L, Maddalena Y, Della Gatta G, Coppola S, Carucci L, Ercolini D, Berni Canani R. Editorial: interventions in infantile colic - can efficacy be attributed to treatment or to time? Authors' reply. Aliment Pharmacol Ther 2020; 51:398-399. [PMID: 31943267 DOI: 10.1111/apt.15627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Francesca De Filippis
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Italy.,Task Force on Microbiome Studies, University of Naples Federico II, Naples, Italy
| | - Gaetano Cecere
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Antonio Marino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Maria Micillo
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Carmen Di Scala
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Carmen de Caro
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Antonio Calignano
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Cristina Bruno
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Lorella Paparo
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Anna Maria Iannicelli
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Linda Cosenza
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Ylenia Maddalena
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Giusy Della Gatta
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Serena Coppola
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Danilo Ercolini
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Italy.,Task Force on Microbiome Studies, University of Naples Federico II, Naples, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy.,Task Force on Microbiome Studies, University of Naples Federico II, Naples, Italy.,European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
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Di Gaspero NC, Razlog R, Patel R, Pellow J. Perceived effectiveness of complementary medicine by mothers of infants with colic in Gauteng. Health SA 2020; 24:1175. [PMID: 31934429 PMCID: PMC6917380 DOI: 10.4102/hsag.v24i0.1175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 10/17/2018] [Indexed: 11/28/2022] Open
Abstract
Background Infantile colic is a self-limiting condition, characterised by spasmodic, excessive and inconsolable crying without apparent cause. Although common, there is no widely accepted conventional treatment approach for colic. Complementary medicine is often promoted as an alternative therapeutic option for infantile colic; however, there is limited research available on its use, safety and effectiveness. Aim The aim of this study was to determine the perceived effectiveness of complementary medicine by mothers of infants with colic by means of the Infantile Colic Questionnaire. Setting Mothers of infants who had colic were recruited from complementary medicine pharmacies, schools, baby clinics and various businesses in Gauteng, South Africa. Methods A quantitative-descriptive design was used whereby data was collected through a randomised, cross-sectional questionnaire. The research sample consisted of 152 participants (mothers), aged between 18 and 45 years, with one or more children who suffered from symptoms of infantile colic, who had used complementary medicine as a form of treatment. Results Results indicated that most participants made use of both complementary and conventional medicines for their infant’s colic; the most commonly used complementary medicine products were homeopathic remedies, probiotics and herbal medicines. Some participants were, however, unfamiliar with the term ‘complementary medicine’, indicating a need for further patient education. Conclusions The participants perceived complementary medicines as safe and effective forms of treatment for infantile colic. However, further, larger scale studies should be conducted to validate this finding.
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Affiliation(s)
| | - Radmila Razlog
- Department of Homoeopathy, University of Johannesburg, South Africa
| | - Reshma Patel
- Department of Homoeopathy, University of Johannesburg, South Africa
| | - Janice Pellow
- Department of Homoeopathy, University of Johannesburg, South Africa
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Abstract
BACKGROUND Infantile colic has an effect on both infants and their parents, who become exhausted and concerned as they attempt to comfort their child. Common approaches have focused upon physical treatments to reduce symptoms, with inconclusive evidence as to their effectiveness. An alternative approach seeks to provide training, support and psychological interventions for parents. This approach is known as parent training programmes. Programmes can include soothing techniques, advice on feeding or normalisation material in any form. The teaching format can vary including face-to-face courses, online learning, printed materials, home visits and remote support and counselling. Here, we aim to collate the evidence on the effectiveness of these interventions and examine their effectiveness at reducing infantile colic symptoms and parental anxiety levels, and their safety. OBJECTIVES 1. To evaluate the effectiveness and safety of parent training programmes for managing colic in infants under four months of age. 2. To identify the educational content and attributes of such published programmes. SEARCH METHODS In June 2019 we searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers. We also handsearched conference abstracts, inspected the references of included studies and contacted leaders in the field for more trials. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs investigating the effectiveness of any form of parental training programmes, alone or in combination, versus another intervention(s) or control, on infantile colic. DATA COLLECTION AND ANALYSIS Two authors independently selected studies for inclusion, extracted data, and assessed the risk of bias within the included studies. We used Review Manager 5 to analyse the data. We assessed the certainty of the evidence using GRADE methodology. MAIN RESULTS Our search found 6064 records from which we selected 20 for full-text review. From these, we identified seven studies with 1187 participants that met our inclusion criteria. All of the studies included infants under the age of four months suffering from infantile colic. Four studies were conducted in the USA, one in Canada, one in the Netherlands and one in Iran. Four studies stated their funding sources, which included national research institutes, foundations and nutritional companies. Five studies assessed parent training versus a control group that received reassurance or routine care; and of these, one study was three-armed and also examined the effectiveness of using a specialised baby seat. One study examined parent training programmes against a milk-exclusion diet and one study assessed a parent training programme versus the same parent training programme plus swaddling. The duration of the interventions varied, with the shortest being six days and the longest being three months. Generally, most studies had low participant numbers and were at high risk of bias, prone to selection bias, performance bias, and the placebo effect. We could not complete the planned qualitative analysis (objective 2) due to lack of data in study reports and no further information being supplied by authors on request. Instead, we completed a descriptive content analysis with the limited information available. The parent training interventions were found to focus on one or a combination of the following: soothing techniques for crying infants (six studies); general care advice, including sleep (four studies); feeding advice (two studies); stress reduction and empathic programme for parents (two studies); and positive play interaction advice (one study). One study taught 'kangaroo care', a specific form of skin-to-skin cuddling. The control groups consisted of reassurance (two studies), advice to rock the infant in the crib (one study), or no intervention (two studies). Parent training versus control We conducted a meta-analysis using data from three studies (157 infants) that assessed the primary outcome of 'crying time at completion of study period'. Parent training was more effective than control: mean difference (MD) -113.58 m/d, 95% confidence interval (CI) -144.19 m/d to -82.96 m/d; low-certainty evidence (downgraded due to imprecision and some concerns with risk of bias). Parent training versus specialised baby seat One study (38 participants) found no difference in mean crying time at completion between the parent training group and the specialised baby seat group, but did not report specific figures. Parent training versus a milk-exclusion/soy milk formula One study (20 participants) comparing parent training with a milk-exclusion/soy milk formula found crying time at completion of the study to be 2.03 hours versus 1.08 hours, respectively. Parent training versus parent training plus swaddling One study (398 participants) comparing parental training with the same intervention plus training on how to swaddle an infant did not report separate data for each group. No adverse effects were reported, but these were not explicitly reported in any study. AUTHORS' CONCLUSIONS There is limited evidence on the effectiveness and safety of parent training programmes for managing infantile colic. Despite a single meta-analysis showing that parent training may reduce crying times for infants, compared to control, the certainty of the evidence was low. Evidence for other comparisons was sparse. We were unable to identify comprehensively the educational content and attributes of the included programmes due to a lack of information in study reports. Further RCTs are needed: they should define interventions clearly to ensure replicability, address all appropriate outcome measures, and minimise risk of bias in order to assess definitively the role of parent training programmes in managing infantile colic.
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Affiliation(s)
- Morris Gordon
- University of Central LancashireSchool of MedicinePrestonLancashireUK
| | - Jesal Gohil
- University of Central LancashireSchool of MedicinePrestonLancashireUK
| | - Shel SC Banks
- Blackpool Victoria HospitalFamilies DivisionBlackpoolUK
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11
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Abstract
BACKGROUND Infantile colic is typically defined as full-force crying for at least three hours per day, on at least three days per week, for at least three weeks. Infantile colic affects a large number of infants and their families worldwide. Its symptoms are broad and general, and while not indicative of disease, may represent a serious underlying condition in a small percentage of infants who may need a medical assessment. Probiotics are live microorganisms that alter the microflora of the host and provide beneficial health effects. The most common probiotics used are of Lactobacillus, Bifidobacterium and Streptococcus. There is growing evidence to suggest that intestinal flora in colicky infants differ from those in healthy infants, and it is suggested that probiotics can redress this balance and provide a healthier intestinal microbiota landscape. The low cost and easy availability of probiotics makes them a potential prophylactic solution to reduce the incidence and prevalence of infantile colic. OBJECTIVES To evaluate the efficacy and safety of prophylactic probiotics in preventing or reducing severity of infantile colic. SEARCH METHODS In January 2018 we searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, 10 other databases and two trials registers. In addition, we handsearched the abstracts of relevant meetings, searched reference lists, ran citation searches of included studies, and contacted authors and experts in the field, including the manufacturers of probiotics, to identify unpublished trials. SELECTION CRITERIA Randomised control trials (RCTs) of newborn infants less than one month of age without the diagnosis of infantile colic at recruitment. We included any probiotic, alone or in combination with a prebiotic (also known as synbiotics), versus no intervention, another intervention(s) or placebo, where the focus of the study was the effect of the intervention on infantile colic. DATA COLLECTION AND ANALYSIS We used standard methodological procedures of Cochrane. MAIN RESULTS Our search yielded 3284 records, and of these, we selected 21 reports for full-text review. Six studies with 1886 participants met our inclusion criteria, comparing probiotics with placebo. Two studies examined Lactobacillus reuteri DSM, two examined multi-strain probiotics, one examined Lactobacillus rhamnosus, and one examined Lactobacillus paracasei and Bifidobacterium animalis. Two studies began probiotics during pregnancy and continued administering them to the baby after birth.We considered the risk of bias for randomisation as low for all six trials; for allocation concealment as low in two studies and unclear in four others. All studies were blinded, and at low risk of attrition and reporting bias.A random-effects meta-analysis of three studies (1148 participants) found no difference between the groups in relation to occurrence of new cases of colic: risk ratio (RR) 0.46, 95% confidence interval (CI) 0.18 to 1.19; low-certainty evidence; I2 = 72%.A random-effects meta-analysis of all six studies (1851 participants) found no difference between the groups in relation to serious adverse effects (RR 1.02, 95% CI 0.14 to 7.21; low-certainty evidence; I2 not calculable (only four serious events for one comparison, two in each group: meconium plug obstruction, patent ductus arteriosus and neonatal hepatitis).A random-effects meta-analysis of three studies (707 participants) found a mean difference (MD) of -32.57 minutes per day (95% CI -55.60 to -9.54; low-certainty evidence; I2 = 93%) in crying time at study end in favour of probiotics.A subgroup analysis of the most studied agent, Lactobacillus reuteri, showed a reduction of 44.26 minutes in daily crying with a random-effects model (95% CI -66.6 to -21.9; I2 = 92%), in favour of probiotics. AUTHORS' CONCLUSIONS There is no clear evidence that probiotics are more effective than placebo at preventing infantile colic; however, daily crying time appeared to reduce with probiotic use compared to placebo. There were no clear differences in adverse effects.We are limited in our ability to draw conclusions by the certainty of the evidence, which we assessed as being low across all three outcomes, meaning that we are not confident that these results would not change with the addition of further research.
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Affiliation(s)
- Teck Guan Ong
- Blackpool Victoria HospitalChild Health DepartmentWhinney Heys RoadBlackpoolLancashireUKFY3 8NR
| | - Morris Gordon
- University of Central LancashireSchool of MedicinePrestonLancashireUK
- Blackpool Victoria HospitalFamilies DivisionBlackpoolUK
| | - Shel SC Banks
- Blackpool Teaching Hospitals NHS Foundation TrustDepartment of Child HealthWhinney Heys RoadBlackpoolUKFY3 8NR
| | - Megan R Thomas
- Blackpool Teaching Hospitals NHS Foundation TrustDepartment of Child HealthWhinney Heys RoadBlackpoolUKFY3 8NR
- Lancaster UniversityFaculty of Health and MedicineFurness CollegeLancasterUKLA1 4YG
| | - Anthony K Akobeng
- Sidra MedicinePO Box 26999DohaQatar
- Cornell UniversityWeill Cornell MedicineDohaQatar
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Vandenplas Y, Savino F. Probiotics and Prebiotics in Pediatrics: What Is New? Nutrients 2019; 11:nu11020431. [PMID: 30791429 PMCID: PMC6412752 DOI: 10.3390/nu11020431] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/15/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
| | - Francesco Savino
- Department of Pediatrics, Ospedale Infantile Regina Margherita, Azienda Ospedaliera, Universitaria Città della Salute e della Scienza di Torino, Piazza Polonia, 94, 10126 Turin, Italy.
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Mai T, Fatheree NY, Gleason W, Liu Y, Rhoads JM. Infantile Colic: New Insights into an Old Problem. Gastroenterol Clin North Am 2018; 47:829-844. [PMID: 30337035 PMCID: PMC6659398 DOI: 10.1016/j.gtc.2018.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Infant colic is a characteristic group of behaviors seen in young infants. The most prominent feature is prolonged crying. Additional characteristics, including clenching of the fists and flexion of the hips, have led to the suggestion that these behaviors are related to abdominal discomfort. In this article, we show emerging evidence to support the concept that infant colic could represent gut inflammation and microbial dysbiosis that impacts brain function and even brain development.
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Affiliation(s)
| | | | | | | | - Jon Marc Rhoads
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, The University of Texas Health Science Center at Houston McGovern Medical School, 6431 Fannin Street, MSB 3.137, Houston, TX 77030, USA.
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Gordon M, Biagioli E, Sorrenti M, Lingua C, Moja L, Banks SSC, Ceratto S, Savino F. Dietary modifications for infantile colic. Cochrane Database Syst Rev 2018; 10:CD011029. [PMID: 30306546 PMCID: PMC6394439 DOI: 10.1002/14651858.cd011029.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Infantile colic is typically defined as full-force crying for at least three hours per day, on at least three days per week, for at least three weeks. This condition appears to be more frequent in the first six weeks of life (prevalence range of 17% to 25%), depending on the specific location reported and definitions used, and it usually resolves by three months of age. The aetiopathogenesis of infantile colic is unclear but most likely multifactorial. A number of psychological, behavioural and biological components (food hypersensitivity, allergy or both; gut microflora and dysmotility) are thought to contribute to its manifestation. The role of diet as a component in infantile colic remains controversial. OBJECTIVES To assess the effects of dietary modifications for reducing colic in infants less than four months of age. SEARCH METHODS In July 2018 we searched CENTRAL, MEDLINE, Embase , 17 other databases and 2 trials registers. We also searched Google, checked and handsearched references and contacted study authors. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs evaluating the effects of dietary modifications, alone or in combination, for colicky infants younger than four months of age versus another intervention or placebo. We used specific definitions for colic, age of onset and the methods for performing the intervention. We defined 'modified diet' as any diet altered to include or exclude certain components. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcome was duration of crying, and secondary outcomes were response to intervention, frequency of crying episodes, parental/family quality of life, infant sleep duration, parental satisfaction and adverse effects. MAIN RESULTS We included 15 RCTs involving 1121 infants (balanced numbers of boys and girls) aged 2 to 16 weeks. All studies were small and at high risk of bias across multiple design factors (e.g. selection, attrition). The studies covered a wide range of dietary interventions, and there was limited scope for meta-analysis. Using the GRADE approach, we assessed the quality of the evidence as very low.Low-allergen maternal diet versus a diet containing known potential allergens: one study (90 infants) found that 35/47 (74%) of infants responded to a low-allergen maternal diet, compared with 16/43 (37%) of infants on a diet containing known potential allergens.Low-allergen diet or soy milk formula versus dicyclomine hydrochloride: one study (120 infants) found that 10/15 (66.6%) breastfed babies responded to dicyclomine hydrochloride, compared with 24/45 (53.3%) formula-fed babies. There was little difference in response between breastfed babies whose mother changed their diet (10/16; 62.5%) and babies who received soy milk formula (29/44; 65.9%).Hydrolysed formula versus standard formula: two studies (64 infants) found no difference in duration of crying, reported as a dichotomous outcome: risk ratio 2.03, 95% confidence interval (CI) 0.81 to 5.10; very low-quality evidence. The author of one study confirmed there were no adverse effects. One study (43 infants) reported a greater reduction in crying time postintervention with hydrolysed formula (104 min/d, 95% CI 55 to 155) than with standard formula (3 min/d, 95% CI -63 to 67).Hydrolysed formula versus another hydrolysed formula: one study (22 infants) found that two types of hydrolysed formula were equally effective in resolving symptoms for babies who commenced with standard formula (Alimentum reduced crying to 2.21 h/d (standard deviation (SD) 0.40) and Nutramigen to 2.93 h/d (SD 0.70)).Hydrolysed formula or dairy- and soy-free maternal diet versus addition of parental education or counselling: one study (21 infants) found that crying time decreased to 2.03 h/d (SD 1.03) in the hydrolysed or dairy- and soy-free group compared with 1.08 h/d (SD 0.7) in the parent education or counselling group, nine days into the intervention.Partially hydrolysed, lower lactose, whey-based formulae containing oligosaccharide versus standard formula with simethicone: one study (267 infants) found that both groups experienced a decrease in colic episodes (secondary outcome) after seven days (partially hydrolysed formula: from 5.99 episodes (SD 1.84) to 2.47 episodes (SD 1.94); standard formula: from 5.41 episodes (SD 1.88) to 3.72 episodes (SD 1.98)). After two weeks the difference between the two groups was significant (partially hydrolysed: 1.76 episodes (SD 1.60); standard formula: 3.32 episodes (SD 2.06)). The study author confirmed there were no adverse effects.Lactase enzyme supplementation versus placebo: three studies (138 infants) assessed this comparison, but none reported data amenable to analysis for any outcome. There were no adverse effects in any of the studies.Extract of Foeniculum vulgare, Matricariae recutita, and Melissa officinalis versus placebo: one study (93 infants) found that average daily crying time was lower for infants given the extract (76.9 min/d (SD 23.5), than infants given placebo (169.9 min/d (SD 23.1), at the end of the one-week study. There were no adverse effects.Soy protein-based formula versus standard cows' milk protein-based formula: one study (19 infants) reported a mean crying time of 12.7 h/week (SD 16.4) in the soy formula group versus 17.3 h/week (SD 6.9) in the standard cows' milk group, and that 5/10 (50%) responded in the soy formula group versus 0/9 (0%) in the standard cows' milk group.Soy protein formula with polysaccharide versus standard soy protein formula: one study (27 infants) assessed this comparison but did not provide disaggregated data for the number of responders in each group after treatment.No study reported on our secondary outcomes of parental or family quality of life, infant sleep duration per 24 h, or parental satisfaction. AUTHORS' CONCLUSIONS Currently, evidence of the effectiveness of dietary modifications for the treatment of infantile colic is sparse and at significant risk of bias. The few available studies had small sample sizes, and most had serious limitations. There were insufficient studies, thus limiting the use of meta-analysis. Benefits reported for hydrolysed formulas were inconsistent.Based on available evidence, we are unable to recommend any intervention. Future studies of single interventions, using clinically significant outcome measures, and appropriate design and power are needed.
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Affiliation(s)
- Morris Gordon
- University of Central LancashireSchool of MedicinePrestonLancashireUK
| | - Elena Biagioli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCSLaboratory Methodology for Clinical ResearchVia La Masa, 19MilanItaly
| | - Miriam Sorrenti
- Regina Margherita Children's HospitalDepartment of PediatricsP.zza Polonia 94TurinItaly10126
| | - Carla Lingua
- University of TurinDepartment of Public and Pediatric Health SciencesPiazza Polonia 94TurinTurinItaly10126
| | - Lorenzo Moja
- University of MilanDepartment of Biomedical Sciences for HealthVia Pascal 36MilanSwitzerland20133
| | - Shel SC Banks
- Blackpool Teaching Hospitals NHS Foundation TrustDepartment of Child HealthWhinney Heys RoadBlackpoolUKFY3 8NR
| | - Simone Ceratto
- Regina Margherita Children's HospitalDepartment of PediatricsP.zza Polonia 94TurinItaly10126
- University of Turin, Regina Margherita Children's HospitalDepartment of Sciences of Public Health and PediatricsPiazza Polonia 94TurinItaly10126
| | - Francesco Savino
- Regina Margherita Children's HospitalDepartment of PediatricsP.zza Polonia 94TurinItaly10126
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Common gastrointestinal distress among infants: Role of optimal nutritional interventions. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2018. [DOI: 10.1016/j.cegh.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Indrio F, Miqdady M, Al Aql F, Haddad J, Karima B, Khatami K, Mouane N, Rahmani A, Alsaad S, Salah M, Samy G, Tafuri S. Knowledge, attitudes, and practices of pediatricians on infantile colic in the Middle East and North Africa region. BMC Pediatr 2017; 17:187. [PMID: 29058577 PMCID: PMC5651634 DOI: 10.1186/s12887-017-0939-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/12/2017] [Indexed: 12/27/2022] Open
Abstract
Background Regional evidence-based guidelines for the prophylaxis and management of infantile colic are not available for the Middle East and North Africa (MENA) region. The Allied Against Infantile Functional GI Disorders (ACT) Working Group was created in January, 2015 to determine the knowledge gaps and the current management practices of infantile colic by physicians in the MENA region. The ACT group determined the need for a survey to address these questions. The objectives of the survey were to highlight current clinical practices on the management of infantile colic and to raise awareness on colic severity in the MENA region. Methods The ACT working group developed the survey which included respondent characteristics and closed questions on practice in colic prevention. The survey was subject to validation and ethics committee approval in all countries. Results A total of 1628 physicians (mostly pediatricians (75.4%), neonatologists (2.4%) and general practitioners (19.8%)) responded to the survey. The 5 most represented countries were KSA (27.9%), Kuwait (22.1%), Morocco (13.8%), Lebanon (10.6%), and Iraq (7.4%). Most of the respondents (77.8%) practiced in governmental settings. A majority of respondents (91.7%) reported that colic is diagnosed predominantly by clinical examination. Above 63%, of pediatricians surveyed, believed that the colic prevalence rate was >40%, which is greater than the 20% rate reported in worldwide surveys. Yet, most of the responding physicians (73%) prefer to simply reassure parents rather than prescribe a therapeutic agent. Most physicians were either neutral (58%) or did not endorse (18.4%) colic prophylaxis. Of those who prescribed formulae for non-breastfed children, a majority (64.3%) chose “Comfort” formulae over hydrolyzed or lactose-free formulae or formulae with probiotics. Conclusions The results of this survey suggest that a substantial proportion of responding physicians from the selected MENA countries do not advocate for prophylaxis of colic. The findings of this survey suggest that more educational efforts are required to increase awareness of the strong body of evidence supporting the efficacy of probiotics in the prevention and management of infantile colic. Electronic supplementary material The online version of this article (10.1186/s12887-017-0939-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Flavia Indrio
- Department of Pediatric University of Bari Ospedale Pediatrico Giovanni XXIII Hospital, Via Amendola 270, 70126, Bari, Italy.
| | - Mohamad Miqdady
- Hepatology & Nutrition Division, Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Fahd Al Aql
- King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Joseph Haddad
- Department of Pediatrics, Saint George University Hospital, Balamand University, Beirut, Lebanon
| | - Berkouk Karima
- Department of Pediatrics, Bab El Oued Hospital, Algiers, Algeria
| | - Katayoun Khatami
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nehza Mouane
- Gastroenterology Nutrition Department, Children Hospital Ibn Sina, University Mohammed V Faculty of Medicine, Rabat, Morocco
| | | | | | | | - Gamal Samy
- Department of Child Health and Nutrition, Institute of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt
| | - Silvio Tafuri
- Department of Pediatric University of Bari Ospedale Pediatrico Giovanni XXIII Hospital, Via Amendola 270, 70126, Bari, Italy
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Pham VT, Lacroix C, Braegger CP, Chassard C. Lactate-utilizing community is associated with gut microbiota dysbiosis in colicky infants. Sci Rep 2017; 7:11176. [PMID: 28894218 PMCID: PMC5593888 DOI: 10.1038/s41598-017-11509-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/25/2017] [Indexed: 12/12/2022] Open
Abstract
The aetiology of colic, a functional gastrointestinal disorder in infants, is not yet resolved. Different mechanisms have been suggested involving the gut microbiota and intermediate metabolites such as lactate. Lactate can be metabolized by lactate-utilizing bacteria (LUB) to form different end-products. Using a functional approach, we hypothesized that H2 production and accumulation by LUB is associated with the development of colic. The LUB communities in the feces of forty infants, including eight colicky infants, were characterized using a combination of culture- and molecular-based methods, and metabolite concentrations were measured by HPLC. Interactions among LUB strains isolated from feces were investigated with pure and mixed cultures using anaerobic techniques. We emphasized high prevalence of crying, flatulence, colic and positive correlations thereof in the first 3 months of life. Crying infants showed significantly higher ratio of LUB non-sulfate-reducing bacteria (LUB non-SRB) (H2-producer), to LUB SRB (H2-utilizer) at 3 months. Colicky infants had significantly higher number of H2-producing Eubacterium hallii at 2 weeks compared to non-colicky infants. We revealed the function of Desulfovibrio piger and Eubacterium limosum to reduce H2 accumulation in co-cultures with H2-producing Veillonella ratti. Our data suggest that the balance between H2-producing and H2-utilizing LUB might contribute to colic symptoms.
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Affiliation(s)
- Van T Pham
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.,Division of Gastroenterology and Nutrition, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christophe Lacroix
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.
| | - Christian P Braegger
- Division of Gastroenterology and Nutrition, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christophe Chassard
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.,Université Clermont Auvergne, INRA, UMRF, F-1500, Aurillac, France
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Becerra-Granados LM, Bejarano-Roncancio JJ, Bages-Mesa MC. Interdisciplinary management of infantile colic. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n3.55920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
El cólico del lactante es uno de los principales motivos de consulta en los servicios de pediatría, gastroenterología y nutrición pediátrica. Esta patología posee múltiples características etiológicas como disfunción de la mecánica familiar, alteraciones gastrointestinales, alergias o intolerancias alimentarias, desbalance alimentario e inadecuados hábitos alimenticios. Es de carácter agudo, con inicio súbito que tiende a desaparecer entre los 3 y 6 meses de edad. Hasta el momento no existe un consenso sobre los protocolos de manejo de esta condición o sobre sus indicadores de eficacia terapéutica. Desde hace algunos años se han desarrollado fármacos, regímenes dietarios y complementos alimentarios específicos para esta patología (anticólico). Este trabajo es una revisión de la evidencia sobre los fundamentos y avances en el tratamiento del cólico del lactante en el que se recopilan las características de esta patología, las medidas terapéuticas médicas y nutricionales, el abordaje clínico y las técnicas para ayudar al paciente y su entorno familiar. El presente estudio busca brindar herramientas técnicas al profesional de la salud cuya población objeto de atención es menor de 2 años.
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Xinias I, Analitis A, Mavroudi A, Roilides I, Lykogeorgou M, Delivoria V, Milingos V, Mylonopoulou M, Vandenplas Y. Innovative Dietary Intervention Answers to Baby Colic. Pediatr Gastroenterol Hepatol Nutr 2017; 20:100-106. [PMID: 28730134 PMCID: PMC5517376 DOI: 10.5223/pghn.2017.20.2.100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/04/2017] [Accepted: 02/14/2017] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The purpose of this paper is to evaluate the efficacy of a lactose- reduced synbiotic partial whey hydrolysate in formula fed infants presenting with colic and the impact of this dietary intervention in mean crying time and quality of life. METHODS Forty infants with infantile colic were treated during one month with parental reassurance and the intervention formula (partial whey hydrolysate, reduced lactose, Bifidobacterium lactis BB12 and galacto-oligosaccharides) and were compared to a control group of 20 infants with infantile colic treated with parental reassurance and a standard infant formula. Parents completed a quality of life (QoL) questionnaire assessing the burden of infantile colic. Wilcoxon test, t-test and Mann-Whitney test were used to compare QoL scores before and after intervention as well as between the intervention and control group. RESULTS At inclusion, duration of crying did not differ between both groups. Crying duration decreased with 2.7 hours (from 3.2 to 0.5 hours) in the intervention group while duration of crying decreased only with 1.2 hours in the control group (p<0.001). Stool composition became looser in the intervention group, but defecation frequency did not change. The median scores of the QoL questionnaire improved significantly in the intervention group for all parameters. In the control group, parameters improved significantly also but not for the parent-child and social interaction. The score changes were significantly greater in the intervention than in the control group. CONCLUSION The intervention formula (partial whey hydrolysate, synbiotic, reduced lactose) significantly reduced the duration of crying and improved QoL of the parents and infants.
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Affiliation(s)
- Ioannis Xinias
- 3rd Pediatric Department, Hippocration Hospital, Thessaloniki, Greece
| | - A Analitis
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antigoni Mavroudi
- 3rd Pediatric Department, Hippocration Hospital, Thessaloniki, Greece
| | - Ioannis Roilides
- 3rd Pediatric Department, Hippocration Hospital, Thessaloniki, Greece
| | - Maria Lykogeorgou
- 3rd Pediatric Department, Hippocration Hospital, Thessaloniki, Greece
| | - Varvara Delivoria
- 3rd Pediatric Department, Hippocration Hospital, Thessaloniki, Greece
| | - Vasilis Milingos
- 3rd Pediatric Department, Hippocration Hospital, Thessaloniki, Greece
| | | | - Yvan Vandenplas
- Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Banks SSC, Thomas MR, Gordon M, Wallace C, Akobeng AK. Probiotics to prevent infantile colic. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Shel SC Banks
- Blackpool Teaching Hospitals NHS Foundation Trust; Department of Child Health; Whinney Heys Road Blackpool UK FY3 8NR
| | - Megan R Thomas
- Blackpool Teaching Hospitals NHS Foundation Trust; Department of Child Health; Whinney Heys Road Blackpool UK FY3 8NR
| | - Morris Gordon
- University of Central Lancashire; School of Medicine; Preston UK
- Blackpool Victoria Hospital; Families Division; Blackpool UK
| | - Chris Wallace
- Blackpool Victoria Hospital; Postgraduate Department; Whinney Heys Road Blackpool Lancs UK FY38NR
| | - Anthony K Akobeng
- Sidra Medical & Research Center; PO Box 26999 Doha Qatar
- Weill Cornell Medical College; Doha Qatar
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Thomas MR, Gordon M, Banks SSC, Wallace C. Parent training programmes for managing infantile colic. Hippokratia 2016. [DOI: 10.1002/14651858.cd012459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Megan R Thomas
- Blackpool Teaching Hospitals NHS Foundation Trust; Department of Child Health; Whinney Heys Road Blackpool Lancashire UK FY3 8NR
| | - Morris Gordon
- University of Central Lancashire; School of Medicine; Preston UK
- Blackpool Victoria Hospital; Families Division; Blackpool UK
| | - Shel SC Banks
- Blackpool Teaching Hospitals NHS Foundation Trust; Department of Child Health; Whinney Heys Road Blackpool Lancashire UK FY3 8NR
| | - Chris Wallace
- Blackpool Victoria Hospital; Postgraduate Department; Whinney Heys Road Blackpool Lancs UK FY38NR
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Abstract
BACKGROUND Infantile colic is a common disorder in the first months of life, affecting somewhere between 4% and 28% of infants worldwide, depending on geography and definitions used. Although it is self limiting and resolves by four months of age, colic is perceived by parents as a problem that requires action. Pain-relieving agents, such as drugs, sugars and herbal remedies, have been suggested as interventions to reduce crying episodes and severity of symptoms. OBJECTIVES To assess the effectiveness and safety of pain-relieving agents for reducing colic in infants younger than four months of age. SEARCH METHODS We searched the following databases in March 2015 and again in May 2016: CENTRAL, Ovid MEDLINE, Embase and PsycINFO, along with 11 other databases. We also searched two trial registers, four thesis repositories and the reference lists of relevant studies to identify unpublished and ongoing studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs evaluating the effects of pain-relieving agents given to infants with colic. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures of The Cochrane Collaboration. MAIN RESULTS We included 18 RCTs involving 1014 infants. All studies were small and at high risk of bias, often presenting major shortcomings across multiple design factors (e.g. selection, performance, attrition, lack of washout period).Three studies compared simethicone with placebo, and one with Mentha piperita; four studies compared herbal agents with placebo; two compared sucrose or glucose with placebo; five compared dicyclomine with placebo; and two compared cimetropium - one against placebo and the other at two different dosages. One multiple-arm study compared sucrose and herbal tea versus no treatment. Simethicone. Comparison with placebo revealed no difference in daily hours of crying reported for simethicone at the end of treatment in one small, low-quality study involving 27 infants. A meta-analysis of data from two cross-over studies comparing simethicone with placebo showed no difference in the number of of infants who responded positively to treatment (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.73 to 1.23; 110 infants, low-quality evidence).One small study (30 participants) compared simethicone with Mentha piperita and found no difference in crying duration, number of crying episodes or number of responders. Herbal agents. We found low-quality evidence suggesting that herbal agents reduce the duration of crying compared with placebo (mean difference (MD) 1.33, 95% CI 0.71 to 1.96; three studies, 279 infants), with different magnitude of benefit noted across studies (I² = 96%). We found moderate-quality evidence indicating that herbal agents increase response over placebo (RR 2.05, 95% CI 1.56 to 2.70; three studies, 277 infants). Sucrose. One very low-quality study involving 35 infants reported that sucrose reduced hours spent crying compared with placebo (MD 1.72, 95% CI 1.38 to 2.06). Dicyclomine. We could consider only one of the five studies of dicyclomine (48 infants) for the primary comparison. In this study, more of the infants given dicyclomine responded than than those given placebo (RR 2.50, 95% CI 1.17 to 5.34). Cimetropium bromide. Data from one very low-quality study comparing cimetropium bromide with placebo showed reduced crying duration among infants treated with cimetropium bromide (MD -30.20 minutes per crisis, 95% CI -39.51 to -20.89; 86 infants). The same study reported that cimetropium increased the number of responders (RR 2.29, 95% CI 1.44 to 3.64).No serious adverse events were reported for all of the agents considered, with the exception of dicyclomine, for which two of five studies reported relevant adverse effects (longer sleep 4%, wide-eyed state 4%, drowsiness 13%). AUTHORS' CONCLUSIONS At the present time, evidence of the effectiveness of pain-relieving agents for the treatment of infantile colic is sparse and prone to bias. The few available studies included small sample sizes, and most had serious limitations. Benefits, when reported, were inconsistent.We found no evidence to support the use of simethicone as a pain-relieving agent for infantile colic.Available evidence shows that herbal agents, sugar, dicyclomine and cimetropium bromide cannot be recommended for infants with colic.Investigators must conduct RCTs using standardised measures that allow comparisons among pain-relieving agents and pooling of results across studies. Parents, who most often provide the intervention and assess the outcome, should always be blinded.
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Affiliation(s)
- Elena Biagioli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCSLaboratory Methodology for Clinical ResearchVia La Masa, 19MilanItaly
| | - Valentina Tarasco
- Cardinal Massaia HospitalPediatric UnitCorso Dante Alighieri 202AstiAstiItaly14100
| | - Carla Lingua
- University of TurinDepartment of Public and Pediatric Health SciencesPiazza Polonia 94TurinTurinItaly10126
| | - Lorenzo Moja
- University of MilanDepartment of Biomedical Sciences for HealthVia Pascal 36MilanItaly20133
- IRCCS Galeazzi Orthopaedic InstituteClinical Epidemiology UnitMilanItaly
| | - Francesco Savino
- Regina Margherita Children's HospitalDepartment of PediatricsCittà del Salute e della Scienza di Torino Piazza Polonia, 94TorinoItaly10126
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Abstract
OBJECTIVES To determine the strength of evidence for commonly used interventions for colic in breast-fed and mixed-fed infants younger than 6 months. METHODS Searches of PubMed, CINAHL, Embase, AMED, and Web of Science databases were conducted from July 2014 to July 2015. Included studies were randomised controlled trials involving mothers and their colicky infants younger than 6 months; assessed colic against the Wessel or modified Wessel criteria; and included phytotherapies, prescription medicines, and maternal dietary interventions. Studies with <16 participants were excluded. Meta-analyses were conducted where data were sufficient to enable pooling. Quality was assessed against the Cochrane Risk Bias Assessment Tool. RESULTS A total of 17 articles met the inclusion criteria for this review. The 6 studies included for subgroup meta-analysis on probiotic treatment, notably Lactobacillus reuteri, demonstrated that probiotics appear an effective treatment, with an overall mean difference in crying time at day 21 of -55.8 min/day (95% CI -64.4 to -47.3, P = 0.001). The 3 studies included for subgroup meta-analysis on preparations containing fennel suggest it to be effective, with an overall mean difference of -72.1 min/day (95% CI -126.4 to -17.7, P < 0.001). CONCLUSIONS Probiotics, in particular L reuteri, and preparations containing fennel oil appear effective for reducing colic, although there are limitations to these findings. The evidence for maternal dietary manipulation, lactase, sucrose, glucose, and simethicone is weak. Further well-designed clinical trials are required to strengthen the evidence for all of these interventions.
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Savino F, Ceratto S, Poggi E, Cartosio ME, Cordero di Montezemolo L, Giannattasio A. Preventive effects of oral probiotic on infantile colic: a prospective, randomised, blinded, controlled trial using Lactobacillus reuteri DSM 17938. Benef Microbes 2016; 6:245-51. [PMID: 25488262 DOI: 10.3920/bm2014.0090] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Infants were recruited in four centres in North-West Italy. 138 infants were assessed for eligibility, 113 ones underwent randomisation and 105 completed the study. Newborns aged less than 10 days of life, with gestational age between 37 and 42 weeks, birth weight from 2,500 to 4,300 g and normal physical examination were recruitable. Premature infants and infants affected by outcomes of perinatal hypoxia or necrotising enterocolitis have been excluded. Patients were randomly assigned to receive five drops containing Lactobacillus reuteri DSM 17938 (108 cfu) with 400 UI of vitamin D3 or only 400 UI of vitamin D3 daily. The primary endpoints concern the administration of pain relieving agents (cimetropium bromide at least three times per week or simethicone at least five times per week) from baseline to 12 weeks. Additional analyses were done on the percentage of infants that switched from an exclusive breastfeeding to a partial or exclusive formula feeding from baseline to 12 weeks. Data concerning the number of calls to the paediatricians and the number of visits at paediatricians' ambulatories due to infantile colic have been collected by paediatrician and analysed. Comparing the two groups, the relative risk was 0.04 (95% confidence interval (CI)=0.01-0.31) for cimetropium bromide, 0.24 (95% CI=0.14-0.41) for simethicone and 0.37 (95% CI=0.17-0.80) for the administration of infant formula, showing a protective action of L. reuteri. The treatment group showed a lower number of paediatric consultations related to episodes of infant colic than the control group (P<0.0001). L. reuteri DSM 17938 supplementation at the tested dosage could reduce parental discomfort due to infantile colic. The consumption of this probiotic is associated with a reduction of paediatric consultations for infantile colic, as well as use of pain relieving agents and of infant formula.
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Affiliation(s)
- F Savino
- Città della Salute e della Scienza di Torino, Regina Margherita Children Hospital, Dipartimento di Scienze della Sanità Pubblica e Pediatriche, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
| | - S Ceratto
- Città della Salute e della Scienza di Torino, Regina Margherita Children Hospital, Dipartimento di Scienze della Sanità Pubblica e Pediatriche, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
| | - E Poggi
- Department of Paediatrics, University of Genova, Largo Gerolamo Gaslini 5, 16147 Genova, Italy
| | | | - L Cordero di Montezemolo
- Città della Salute e della Scienza di Torino, Regina Margherita Children Hospital, Dipartimento di Scienze della Sanità Pubblica e Pediatriche, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
| | - A Giannattasio
- General Paediatrician, Genova, Italy University of Genova, Via Balbi 5, 16126 Genova, Italy
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Schreck Bird A, Gregory PJ, Jalloh MA, Risoldi Cochrane Z, Hein DJ. Probiotics for the Treatment of Infantile Colic: A Systematic Review. J Pharm Pract 2016; 30:366-374. [PMID: 26940647 DOI: 10.1177/0897190016634516] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate whether clinical data support the safety and efficacy of probiotics for the management of infantile colic. BACKGROUND Probiotics have been suggested as a potential strategy for infantile colic, and the specific species that have been studied in healthy infants are considered to be safe. METHODOLOGY A systematic review was conducted to identify randomized controlled trials (RCTs) evaluating the use of probiotic supplementation in infants with colic. RCTs with a primary end point assessing crying or fussing time were selected. A meta-analysis comparing "responders" to "nonresponders" in infants receiving probiotic versus control was conducted. The quality of trials selected was assessed. RESULTS Five RCTs assessing 2 different strains of the probiotic Lactobacillus reuteri in mostly breastfed infants were identified. Analysis of response rates showed that infants receiving probiotics had a 2.3-fold greater chance of having a 50% or greater decrease in crying/fussing time compared to controls ( P = .01). Probiotic supplementation was not associated with any adverse events. CONCLUSION Supplementation with the probiotic L. reuteri in breastfed infants appears to be safe and effective for the management of infantile colic. Further research is needed to determine the role of probiotics in infants who are formula-fed.
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Affiliation(s)
- Anna Schreck Bird
- 1 Center for Drug Information & Evidence-Based Practice, Creighton University, Omaha, NE, USA
| | - Philip J Gregory
- 1 Center for Drug Information & Evidence-Based Practice, Creighton University, Omaha, NE, USA
- 2 Center for Clinical and Translational Science, Creighton University, Omaha, NE, USA
| | - Mohamed A Jalloh
- 1 Center for Drug Information & Evidence-Based Practice, Creighton University, Omaha, NE, USA
| | - Zara Risoldi Cochrane
- 1 Center for Drug Information & Evidence-Based Practice, Creighton University, Omaha, NE, USA
| | - Darren J Hein
- 1 Center for Drug Information & Evidence-Based Practice, Creighton University, Omaha, NE, USA
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Bertelsen RJ, Jensen ET, Ringel-Kulka T. Use of probiotics and prebiotics in infant feeding. Best Pract Res Clin Gastroenterol 2016; 30:39-48. [PMID: 27048895 DOI: 10.1016/j.bpg.2016.01.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/21/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023]
Abstract
Gut colonization by beneficial bacteria in early life is necessary for establishing the gut mucosal barrier, maturation of the immune system and preventing infections with enteric pathogens. Mode of delivery, prematurity, breastfeeding, and use of antibiotics are some of many factors that have been described to influence early life colonization. Dysbiosis, the absence of normal colonization, is associated with many disease conditions. Pre- and probiotics are commonly used as supplementation in infant formula, such as prebiotic oligosaccharides for stimulation of Bifidobacterium growth aiming to mimic the high levels of these commensal bacteria in the gut of breastfed infants. Studies suggest that probiotic supplementation may be beneficial in prevention and management of disease (e.g., reducing the risk of necrotizing enterocolitis in preterm infants and treatment of acute gastroenteritis in children). Although these studies show promising beneficial effects, the long-term risks or health benefits of pre- and probiotic supplementation are not clear.
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Affiliation(s)
- Randi J Bertelsen
- Department of Clinical Science, University of Bergen, P.O. Box 7804, N-5020 Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, P.O. Box 1400, N-5021 Bergen, Norway.
| | - Elizabeth T Jensen
- Wake Forest School of Medicine, Division of Public Health Sciences, Department of Epidemiology & Prevention, Medical Center Boulevard, Winston-Salem, NC 27157, USA; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7445, USA.
| | - Tamar Ringel-Kulka
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7445, 404A Rosenau Hall, 421 Pittsboro Street, Chapel Hill, NC 27599-7445, USA.
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Degenaar H, Kritzinger A. Suck, swallow and breathing coordination in infants with infantile colic. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2015; 62:e1-e10. [PMID: 26809157 PMCID: PMC5843038 DOI: 10.4102/sajcd.v62i1.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 05/18/2015] [Accepted: 04/27/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There appears to be a perception amongst parents and in popular literature that infantile colic is caused by feeding difficulties. Limited support for this perception is found in scientific literature. Whilst there is scientific evidence that suck, swallow and breathing are key components of successful feeding, these components and the coordination thereof in infants with colic have not been extensively researched. OBJECTIVE The objective of the study was to explore the suck, swallow and breathing coordination in infants with infantile colic and compare it with infants without the condition. METHOD An assessment protocol for suck, swallow and breathing coordination was compiled from literature. This protocol was performed on a research group of 50 infants, independently diagnosed with infantile colic, and a control group of 28 infants without the condition. All participants were from two rural towns in the North–West province, South Africa, selected with a snowball selection method and strict selection criteria. The study followed a static comparison group design. RESULTS A significant difference in the key components of feeding and the presence of colic in participants of four age categories were found. The correlation between postural control and the presence of infantile colic were sustained in participants from 2–19 weeks old. CONCLUSION Suck, swallow and breathing were found to be significantly associated with infantile colic. The findings should be investigated further. It appears that speech-language therapists may play an expanding role in infantile colic.
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Affiliation(s)
- Hanlie Degenaar
- Institute of Psychology and Wellbeing, North-West University, Potchefstroom Campus, South Africa
| | - Alta Kritzinger
- Department of Speech-language Pathology and Audiology, University of Pretoria, South Africa
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Xu M, Wang J, Wang N, Sun F, Wang L, Liu XH. The Efficacy and Safety of the Probiotic Bacterium Lactobacillus reuteri DSM 17938 for Infantile Colic: A Meta-Analysis of Randomized Controlled Trials. PLoS One 2015; 10:e0141445. [PMID: 26509502 PMCID: PMC4624960 DOI: 10.1371/journal.pone.0141445] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/07/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of Lactobacillus reuteri DSM 17938 for treating infantile colic. METHODS A systematic literature retrieval was carried out to obtain randomized controlled trials of L. reuteri DSM 17938 for infantile colic. Trials were performed before May 2015 and retrieved from the PubMed, EMBASE, Cochrane library, CNKI, WanFang, VIP, and CBM databases. Data extraction and quality evaluation of the trials were performed independently by two investigators. A meta-analysis was performed using STATA version 12.0. RESULTS Six randomized controlled trials of 423 infants with colic were included. Of these subjects, 213 were in the L. reuteri group, and 210 were in the placebo group. Lactobacillus reuteri increased colic treatment effectiveness at two weeks (RR = 2.84; 95% CI: 1.24-6.50; p = 0.014) and three weeks (relative risk [RR] = 2.33; 95% CI: 1.38-3.93; P = 0.002) but not at four weeks (RR = 1.41; 95% CI: 0.52-3.82; P = 0.498). Lactobacillus reuteri decreased crying time (min/d) at two weeks (weighted mean difference [WMD] = -42.89; 95% CI: -60.50 to -25.29; P = 0.000) and three weeks (WMD = -45.83; 95% CI: -59.45 to -32.21; P = 0.000). In addition, L. reuteri did not influence infants' weight, length or head circumference and was not associated with serious adverse events. CONCLUSIONS Lactobacillus reuteri possibly increased the effectiveness of treatment for infantile colic and decreased crying time at two to three weeks without causing adverse events. However, these protective roles are usurped by gradual physiological improvements. The study is limited by the heterogeneity of the trials and should be considered with caution. Higher quality, multicenter randomized controlled trials with larger samples are needed.
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Affiliation(s)
- Man Xu
- Department of Pediatrics, the First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Jiao Wang
- Department of Pediatrics, the First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Ning Wang
- Department of Pediatrics, the First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Fei Sun
- Department of Pediatrics, the First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Lin Wang
- Department of Pediatrics, the First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Xiao-Hong Liu
- Department of Pediatrics, the First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
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Morgan AR, Han DY, Wickens K, Barthow C, Mitchell EA, Stanley TV, Dekker J, Crane J, Ferguson LR. Differential modification of genetic susceptibility to childhood eczema by two probiotics. Clin Exp Allergy 2015; 44:1255-65. [PMID: 25146491 DOI: 10.1111/cea.12394] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/09/2014] [Accepted: 07/14/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND In a double-blind, randomized, placebo-controlled birth cohort, we have recently shown a beneficial effect of Lactobacillus rhamnosus HN001 (HN001) for the prevention of eczema in children through to 6 years of age but no effect of Bifidobacterium animalis subsp lactis HN019 (HN019). OBJECTIVE Among this cohort of children, we aim to investigate whether these probiotics could modify the expression of genetic predisposition to eczema conferred by genetic variation in susceptibility genes. METHODS Thirty-three eczema susceptibility SNPs (in eleven genes) were genotyped in 331 children of European ancestry. RESULTS Children who carried a genetic variant that put them at a high risk of developing eczema were less likely to develop eczema if they had been randomized to the HN001 intervention group compared to those in the placebo group. HN019 was also able to protect against the effects of some SNPs. As well as modifying genetic susceptibility to childhood eczema, HN001 was also found to modify genetic susceptibility to eczema severity and atopy risk. CONCLUSION AND CLINICAL RELEVANCE This is the first study to show an effect of a probiotic on reducing eczema risk amongst those with particular eczema-associated genotypes. Our findings suggest that Lactobacillus rhamnosus HN001 may be particularly effective in preventing eczema in children with specific high-risk genotypes.
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Affiliation(s)
- A R Morgan
- Discipline of Nutrition, FM&HS, The University of Auckland, Auckland, New Zealand
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The controversial role of food allergy in infantile colic: evidence and clinical management. Nutrients 2015; 7:2015-25. [PMID: 25808260 PMCID: PMC4377897 DOI: 10.3390/nu7032015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/16/2015] [Accepted: 03/11/2015] [Indexed: 12/13/2022] Open
Abstract
Food allergies (FAs) are an increasing problem in Western countries, affecting up to 10% of young children. FAs are frequently associated with gastrointestinal manifestations. The role of FAs as a potential causative factor for infantile colic (IC) is still controversial. We report the most recent evidence on the pathogenesis, clinical and diagnostic aspects of FA-induced infantile colic (IC) and suggest a stepwise diagnostic approach. We selected articles on clinical and immunologic features, pathogenesis and management of FAs and IC from of 1981 to 2015. Original and review articles were identified through selective searches performed on PubMed, using the following terms: colic, infantile colic, food allergy and infantile colic, infantile colic treatment. The possible relationship between FAs and IC derives from the presence of dysmotility with visceral hypersensitivity and dysbiosis, demonstrated in both conditions, and the clinical response to dietary interventions. Unfortunately, the design of the studies, poor characterization of atopy and different dietary approaches limit the understanding of the importance of FAs in subjects with IC. The role of FAs in IC subjects without other symptoms of atopy remains controversial. However, where there is a suspicion of FAs, a short trial with an extensively hydrolyzed cow's proteins formula or, if breast fed, with maternal elimination diet may be considered a reasonable option.
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Kaur R, Bharti B, Saini SK. A randomized controlled trial of burping for the prevention of colic and regurgitation in healthy infants. Child Care Health Dev 2015; 41:52-6. [PMID: 24910161 DOI: 10.1111/cch.12166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Efficacy of burping in lowering colic and regurgitation episodes in healthy term babies lacks evidence in literature. METHODS We conducted a randomized controlled trial to compare efficacy of burping versus no-burping in 71 mother-baby dyads in community setting. Primary outcome was reduction in event rates of colic and regurgitation episodes over 3 months. RESULTS Baseline characteristics were similar in two groups. Difference in incidence rates of colic between the control and burping group was 1.57 episodes/infant/100 weeks [95% confidence interval (CI): -0.63 to 3.76]. There was statistically no significant reduction in colic episodes between burping and non-burping study subjects during 3 months of follow-up (adjusted relative risk 0.64; 95% CI: 0.22-1.86, P-value 0.41). Incidence rate difference of regurgitation episodes/infant/week between burping and control group was 4.36 (95% CI: 4.04 to 4.69) and there was statistically significant increase in burping group (adjusted relative risk 2.05; 95% CI: 1.92-2.18, P-value < 0.0001). CONCLUSIONS Although burping is a rite of passage, our study showed that burping did not significantly lower colic events and there was significant increase in regurgitation episodes in healthy term infants up to 3 months of follow-up.
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Affiliation(s)
- R Kaur
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Capability of the two microorganisms Bifidobacterium breve B632 and Bifidobacterium breve BR03 to colonize the intestinal microbiota of children. J Clin Gastroenterol 2014; 48 Suppl 1:S37-9. [PMID: 25291125 DOI: 10.1097/mcg.0000000000000234] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The total number of bacteria present in the gut microbiota of a newborn is consistently lower than the average found in adults, with the extent of this difference being directly related to body weight and age. It could be assumed that a lower number of viable probiotic cells is necessary to achieve significant gut colonization in infants and children. This study assessed the capability of Bifidobacterium breve B632 (DSM 24706) and Bifidobacterium breve BR03 (DSM 16604), 2 strains able to significantly inhibit some gram-negative bacteria in vitro, to integrate into the intestinal microbiota of children. MATERIALS AND METHODS Ten healthy children aged an average of 5.7±2.6 were given an oily suspension containing B. breve B632 and B. breve BR03 for 21 consecutive days. The daily dose was 100 million live cells of each strain. Fecal specimens were collected and analyzed at the beginning (d0) and at the end of the study (d21). Total fecal bifidobacteria and coliforms have been quantified by microbiological plate counts. RESULTS A significant increase in total fecal bifidobacteria (from 8.99 to 9.47 log10 CFU/g, P=0.042) and a parallel decrease in total coliforms (from 8.60 to 7.93 log10 CFU/g, P=0.048) was recorded after 21 days of supplementation. CONCLUSIONS An oily suspension has proved an effective way of providing probiotics to children. A lower viable cells concentration was sufficient to mediate this effect in the light of the fact that the intestinal microbiota of children harbors a considerably smaller amount of total bacteria compared with adults. In addition to gut colonization in healthy children, B. breve B632 and B. breve BR03 were able to decrease total fecal coliforms, therefore supporting their potential specific use in colicky infants.
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Probiotics in human milk and probiotic supplementation in infant nutrition: a workshop report. Br J Nutr 2014; 112:1119-28. [PMID: 25160058 DOI: 10.1017/s0007114514001949] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Probiotics in human milk are a very recent field of research, as the existence of the human milk microbiome was discovered only about a decade ago. Current research is focusing on bacterial diversity and the influence of the maternal environment as well as the mode of delivery on human milk microbiota, the pathways of bacterial transfer to milk ducts, possible benefits of specific bacterial strains for the treatment of mastitis in mothers, and disease prevention in children. Recent advances in the assessment of early host-microbe interactions suggest that early colonisation may have an impact on later health. This review article summarises a scientific workshop on probiotics in human milk and their implications for infant health as well as future perspectives for infant feeding.
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Savino F, Ceratto S, De Marco A, Cordero di Montezemolo L. Looking for new treatments of Infantile Colic. Ital J Pediatr 2014; 40:53. [PMID: 24898541 PMCID: PMC4050441 DOI: 10.1186/1824-7288-40-53] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/29/2014] [Indexed: 12/27/2022] Open
Abstract
Infantile colic is a common disturbance occurring in the first three months of life. It is a benign condition and one of the main causes of pediatric consultation in the early part of life because of its great impact on family life. Some pediatricians are prone to undervalue this issue mainly because of the lack of evidence based medicine guidelines. Up to now, there is no consensus concerning management and treatment. Literature reports growing evidence about the effectiveness of dietary, pharmacological, complementary and behavioral therapies as options for the management of infantile colic. Dietary approach, usually based on the avoidance of cow's milk proteins in breast-feeding mothers and bottle-fed infants, more recently has seen the rise of new special formulas, such as partially hydrolyzed proteins and low lactose added with prebiotics or probiotics: their efficacy needs to be further documented. Investigated pharmacological agents are Simethicone and Cimetropium Bromide: the first is able to reduce bloating while the second could reduce fussing crying, but it has been tested only for severe infantile colic. No other pain relieving agents have been proposed until now, but some clinical trials are ongoing for new drugs.There is limited evidence supporting the use of complementary and alternative treatments (herbal supplements, manipulative approach and acupuncture) or behavioral interventions.Recent studies have focused the role of microbiota in the pathogenesis of this disturb and so new treatments, such as probiotics, have been proposed, but only few strains have been tested.Further investigations are needed in order to provide evidence-based guidelines.
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Affiliation(s)
- Francesco Savino
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università di Torino, Ospedale Infantile Regina Margherita - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Simone Ceratto
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università di Torino, Ospedale Infantile Regina Margherita - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Angela De Marco
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università di Torino, Ospedale Infantile Regina Margherita - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luca Cordero di Montezemolo
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università di Torino, Ospedale Infantile Regina Margherita - Città della Salute e della Scienza di Torino, Turin, Italy
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Akhnikh S, Engelberts AC, van Sleuwen BE, L'Hoir MP, Benninga MA. The excessively crying infant: etiology and treatment. Pediatr Ann 2014; 43:e69-75. [PMID: 24716561 DOI: 10.3928/00904481-20140325-07] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Excessive crying, often described as infantile colic, is the cause of 10% to 20% of all early pediatrician visits of infants aged 2 weeks to 3 months. Although usually benign and self-limiting, excessive crying is associated with parental exhaustion and stress. However, an underlying organic cause is found in less than 5% of these infants. In the majority of cases, treatment consists not of "curing the colic," although usually it is possible to reduce crying, but of helping the parents to get through this challenging period in their baby's development. The aims of this review are to discuss definition, etiology, and evaluate different treatment regimes in infants who cry excessively.
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Skjeie H, Skonnord T, Fetveit A, Brekke M. Acupuncture for infantile colic: a blinding-validated, randomized controlled multicentre trial in general practice. Scand J Prim Health Care 2013; 31:190-6. [PMID: 24228748 PMCID: PMC3860294 DOI: 10.3109/02813432.2013.862915] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE Infantile colic is a painful condition in the first months of infancy. Acupuncture is used in Scandinavia as a treatment for infantile colic. A randomized controlled trial was carried out with the aim of testing the hypothesis that acupuncture treatment has a clinically relevant effect for this condition. DESIGN A prospective, blinding-validated, randomized controlled multicentre trial in general practice. Research assistants and parents were blinded. SETTING 13 GPs' offices in Southern Norway. INTERVENTION Three days of bilateral needling of the acupuncture point ST36, with no treatment as control. SUBJECTS 113 patients were recruited; 23 patients were excluded, and 90 randomized; 79 diaries and 84 interviews were analysed. MAIN OUTCOME MEASURES Difference in changes in crying time during the trial period between the intervention and control group. RESULTS The blinding validation questions showed a random distribution with p = 0.41 and 0.60, indicating true blinding. We found no statistically significant difference in crying time reduction between acupuncture and control group at any of the measured intervals, nor in the main analysis of differences in changes over time (p = 0.26). There was a tendency in favour of the acupuncture group, with a non-significant total baseline-corrected mean of 13 minutes (95% CI -24 to + 51) difference in crying time between the groups. This was not considered clinically relevant, according to protocol. CONCLUSION This trial of acupuncture treatment for infantile colic showed no statistically significant or clinically relevant effect. With the current evidence, the authors suggest that acupuncture for infantile colic should be restricted to clinical trials.
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Affiliation(s)
- Holgeir Skjeie
- Department of General Practice, Institute of Health and Society , University of Oslo , Norway
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Anabrees J, Indrio F, Paes B, AlFaleh K. Probiotics for infantile colic: a systematic review. BMC Pediatr 2013; 13:186. [PMID: 24238101 PMCID: PMC4225660 DOI: 10.1186/1471-2431-13-186] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 11/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infantile colic is a common paediatric condition which causes significant parental distress. Increased intestinal coliform colonization in addition to alteration in Lactobacillus abundance and distribution may play an important role in its pathogenesis. The objectives of this systematic review are to evaluate the efficacy of probiotic supplementation in the reduction of crying time and successful treatment of infantile colic. METHODS Literature searches were conducted of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. Only randomized controlled trials enrolling term, healthy infants with colic were included. A meta-analysis of included trials was performed utilizing the Cochrane Collaboration methodology. RESULTS Three trials that enrolled 220 breastfed infants met inclusion criteria, of which 209 infants were available for analysis. Two of the studies were assessed as good quality. Lactobacillus reuteri (strains-American Type Culture Collection Strain 55730 and DSM 17 938) was the only species utilized in the therapeutic intervention. Two of the trials were industry funded. Probiotic supplementation compared to simethicone or placebo significantly and progressively shortened crying times to 7 days reaching a plateau at three weeks post initiation of therapy [mean difference -56.03 minutes; 95% CI (-59.92, -52.15)]. Similarly, probiotics compared to placebo significantly increased the treatment success of infantile colic with a relative risk (RR) of 0.06; 95% CI (0.01, 0.25) and a number needed to treat of 2. CONCLUSIONS Although L. reuteri may be effective as a treatment strategy for crying in exclusively breastfed infants with colic, the evidence supporting probiotic use for the treatment of infant colic or crying in formula-fed infants remains unresolved. Results from larger rigorously designed studies will help draw more definitive conclusions.
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Affiliation(s)
- Jasim Anabrees
- Neonatal Care, Sulaiman Al Habib Medical Group, Arrayan Hospital, P,O, Box 272069, Riyadh, 11352, Saudi Arabia.
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Roos S, Dicksved J, Tarasco V, Locatelli E, Ricceri F, Grandin U, Savino F. 454 pyrosequencing analysis on faecal samples from a randomized DBPC trial of colicky infants treated with Lactobacillus reuteri DSM 17938. PLoS One 2013; 8:e56710. [PMID: 23468874 PMCID: PMC3585302 DOI: 10.1371/journal.pone.0056710] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 01/16/2013] [Indexed: 01/22/2023] Open
Abstract
Objective To analyze the global microbial composition, using large-scale DNA sequencing of 16 S rRNA genes, in faecal samples from colicky infants given L. reuteri DSM 17938 or placebo. Methods Twenty-nine colicky infants (age 10–60 days) were enrolled and randomly assigned to receive either Lactobacillus reuteri (108 cfu) or a placebo once daily for 21 days. Responders were defined as subjects with a decrease of 50% in daily crying time at day 21 compared with the starting point. The microbiota of faecal samples from day 1 and 21 were analyzed using 454 pyrosequencing. The primers: Bakt_341F and Bakt_805R, complemented with 454 adapters and sample specific barcodes were used for PCR amplification of the 16 S rRNA genes. The structure of the data was explored by using permutational multivariate analysis of variance and effects of different variables were visualized with ordination analysis. Results The infants’ faecal microbiota were composed of Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes as the four main phyla. The composition of the microbiota in infants with colic had very high inter-individual variability with Firmicutes/Bacteroidetes ratios varying from 4000 to 0.025. On an individual basis, the microbiota was, however, relatively stable over time. Treatment with L. reuteri DSM 17938 did not change the global composition of the microbiota, but when comparing responders with non-responders the group responders had an increased relative abundance of the phyla Bacteroidetes and genus Bacteroides at day 21 compared with day 0. Furthermore, the phyla composition of the infants at day 21 could be divided into three enterotype groups, dominated by Firmicutes, Bacteroidetes, and Actinobacteria, respectively. Conclusion L. reuteri DSM 17938 did not affect the global composition of the microbiota. However, the increase of Bacteroidetes in the responder infants indicated that a decrease in colicky symptoms was linked to changes of the microbiota. Trial Registration ClinicalTrials.gov NCT00893711
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Affiliation(s)
- Stefan Roos
- Department of Microbiology, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Szajewska H, Gyrczuk E, Horvath A. Lactobacillus reuteri DSM 17938 for the management of infantile colic in breastfed infants: a randomized, double-blind, placebo-controlled trial. J Pediatr 2013; 162:257-62. [PMID: 22981952 DOI: 10.1016/j.jpeds.2012.08.004] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 07/13/2012] [Accepted: 08/02/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether administration of Lactobacillus reuteri (L reuteri) DSM 17938 is beneficial in breastfed infants with infantile colic. STUDY DESIGN Eighty infants aged <5 months with infantile colic (defined as crying episodes lasting 3 or more hours per day and occurring at least 3 days per week within 7 days prior to enrollment), who were exclusively or predominantly (>50%) breastfed were randomly assigned to receive L reuteri DSM 17938 (10(8) colony-forming units) (n = 40) or an identically appearing and tasting placebo (n = 40), both orally, in 5 drops, 1 time daily, for 21 days. The primary outcome measures were the treatment success, defined as the percentage of children achieving a reduction in the daily average crying time ≥ 50%, and the duration of crying (minutes per day) at 7, 14, 21, and 28 days after randomization. RESULTS The rate of responders to treatment was significantly higher in the probiotic group compared with the placebo group at day 7 (P = .026), at day 14 (relative risk (RR) 4.3, 95% CI 2.3-8.7), at day 21 (RR 2.7, 95% CI 1.85-4.1), and at day 28 (RR 2.5, 95% CI 1.8-3.75). In addition, throughout the study period, the median crying time was significantly reduced in the probiotic group compared with the control group. CONCLUSION Exclusively or predominantly breastfed infants with infantile colic benefit from the administration of L reuteri DSM 17938 compared with placebo.
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Affiliation(s)
- Hania Szajewska
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
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Schmerzbehandlung. PÄDIATRISCHE GASTROENTEROLOGIE, HEPATOLOGIE UND ERNÄHRUNG 2013. [PMCID: PMC7498799 DOI: 10.1007/978-3-642-24710-1_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Zwar lassen sich die meisten abdominalen Schmerzen lokalisieren, allerdings ist der Ort des stärksten Schmerzes nicht unbedingt identisch mit dem Ort der Schmerzentstehung. Dennoch empfiehlt sich zur Schmerzlokalisation ein systematisches Vorgehen, das – je nach klinischer Erfahrung des Untersuchers und der Akutheit des Geschehens – selbstverständlich auch abgekürzt werden kann: Zunächst wird davon ausgegangen, dass Schmerzlokalisation und Ort der Schmerzentstehung identisch sind. Es sind entsprechende gezielte Untersuchungsmaßnahmen einzuleiten (klinische Untersuchung, klinisch-chemische Diagnostik, Bildgebung). Ab dem Schulalter kann die angegebene Schmerzqualität wertvolle Hinweise auf die Schmerzursache geben. Ergeben sich keine Hinweise auf die zugrunde liegende (lokale) Schmerzursache, wird der Blick mehr auf diejenigen inneren Organe gerichtet, die über die Head- Zonen mit dem Ort der Schmerzlokalisation korrespondieren. Wird man auch hier nicht fündig, muss an eine Läsion im Verlauf der Afferenz gedacht werden. Übrig bleiben schließlich idiopathische Schmerzen, bei denen der Schmerz selbst die Krankheit darstellt und keine zu behandelnden Ursachen aufzufinden sind (Migräne, funktionelle Bauchschmerzen etc.). Davon abzugrenzen sind noch definierte kinderpsychiatrische Krankheiten, die mit Schmerzen einhergehen können.
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Effectiveness of Mentha piperita in the Treatment of Infantile Colic: A Crossover Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:981352. [PMID: 22844342 PMCID: PMC3403674 DOI: 10.1155/2012/981352] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 05/25/2012] [Indexed: 01/09/2023]
Abstract
Background. Infantile colic is a distressing and common condition for which there is no proven standard treatment. Objective. To compare the efficacy of Mentha piperita with simethicone in treatment for infantile colic. Methods. A double-blind crossover study was performed with 30 infants attending IMIP, Recife, Brazil. They were randomized to use Mentha piperita or simethicone in the treatment of infantile colic during 7 days with each drug. Primary outcomes were mother_s opinion about responses to the treatment, number of daily episodes of colic, and time spent crying, measured by a chronometer. Mann-Whitney and chi-square tests were used to compare the results. This study was previously approved by the Ethical Committee in Research at IMIP. Results. At baseline daily episodes of infantile colic was 3.9 (±1.1) and the mean crying time per day was 192 minutes (±51.6). At the end of the study daily episodes of colic fell to 1.6 (±0.6) and the crying duration decreased to 111 (±28) minutes. All mothers reported decrease of frequency and duration of the episodes of infantile colic and there were no differences between responses to Mentha piperita and simethicone. Conclusions. These findings suggest that Mentha piperita may be used to help control infantile colic. However, these results must be repeated by others studies.
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Savino F, Tarasco V, Lingua C, Moja L, Ricceri F. Pain-relieving agents for infant colic. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009999] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Collado MC, Cernada M, Baüerl C, Vento M, Pérez-Martínez G. Microbial ecology and host-microbiota interactions during early life stages. Gut Microbes 2012; 3:352-65. [PMID: 22743759 PMCID: PMC3463493 DOI: 10.4161/gmic.21215] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The role of human microbiota has been redefined during recent years and its physiological role is now much more important than earlier understood. Intestinal microbial colonization is essential for the maturation of immune system and for the developmental regulation of the intestinal physiology. Alterations in this process of colonization have been shown to predispose and increase the risk to disease later in life. The first contact of neonates with microbes is provided by the maternal microbiota. Moreover, mode of delivery, type of infant feeding and other perinatal factors can influence the establishment of the infant microbiota. Taken into consideration all the available information it could be concluded that the exposure to the adequate microbes early in gestation and neonatal period seems to have a relevant role in health. Maternal microbial environment affects maternal and fetal immune physiology and, of relevance, this interaction with microbes at the fetal-maternal interface could be modulated by specific microbes administered to the pregnant mother. Indeed, probiotic interventions aiming to reduce the risk of immune-mediated diseases may appear effective during early life.
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Affiliation(s)
- Maria Carmen Collado
- Institute of Agrochemistry and Food Technology, Spanish National Research Council (IATA-CSIC), Department of Biotechnology, Unit of Lactic Acid Bacteria and Probiotics, Valencia, Spain.
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Liu Y, Fatheree NY, Mangalat N, Rhoads JM. Lactobacillus reuteri strains reduce incidence and severity of experimental necrotizing enterocolitis via modulation of TLR4 and NF-κB signaling in the intestine. Am J Physiol Gastrointest Liver Physiol 2012; 302:G608-17. [PMID: 22207578 PMCID: PMC3311308 DOI: 10.1152/ajpgi.00266.2011] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Necrotizing enterocolitis (NEC) is the leading gastrointestinal cause of mortality and morbidity in the premature infant. Premature infants have a delay in intestinal colonization by commensal bacteria and colonization with potentially pathogenic organisms. Lactobacillus reuteri is a probiotic that inhibits enteric infections, modulates the immune system, and may be beneficial to prevent NEC. In previous studies, L. reuteri strains DSM 17938 and ATCC PTA 4659 differentially modulated inflammation in vitro; however, the strains had equivalent anti-inflammatory responses in LPS feeding-induced ileitis in neonatal rats in vivo. The impact of these two strains in the prevention of NEC has not been previously investigated. NEC was induced in newborn rats by orogastric formula feeding and exposure to hypoxia. L. reuteri was added to the formula to prevent NEC. NEC score, Toll-like receptor (TLR)-signaling genes, phospho-IκB activity, and cytokine levels in the intestine were examined. Both strains significantly increased survival rate and decreased the incidence and severity of NEC, with optimal effects from DSM 17938. In response to probiotic, mRNA expression of IL-6, TNF-α, TLR4, and NF-κB was significantly downregulated, while mRNA levels of anti-inflammatory cytokine IL-10 were significantly upregulated. In parallel, L. reuteri treatment led to decrease intestinal protein levels of TLR4 and cytokine levels of TNF-α and IL-1β in newborn rats with NEC. Both strains significantly inhibited not only intestinal LPS-induced phospho-IκB activity in an ex vivo study but also decreased the levels of phospho-IκB in the intestines of NEC rat model. Cow milk formula feeding produced a similar but milder proinflammatory profile in the intestine that was also ameliorated by 17938. Our studies demonstrate that each of the two L. reuteri strains has potential therapeutic value in our NEC model and in enteritis associated with cow milk feeding. These results support the concept that L. reuteri may represent a valuable treatment to prevent NEC.
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Affiliation(s)
- Yuying Liu
- Department of Pediatrics, Division of Gastroenterology, University of Texas Health Science Center at Houston Medical School, Houston, Texas
| | - Nicole Y. Fatheree
- Department of Pediatrics, Division of Gastroenterology, University of Texas Health Science Center at Houston Medical School, Houston, Texas
| | - Nisha Mangalat
- Department of Pediatrics, Division of Gastroenterology, University of Texas Health Science Center at Houston Medical School, Houston, Texas
| | - Jon Marc Rhoads
- Department of Pediatrics, Division of Gastroenterology, University of Texas Health Science Center at Houston Medical School, Houston, Texas
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Savino F, Cordisco L, Tarasco V, Locatelli E, Di Gioia D, Oggero R, Matteuzzi D. Antagonistic effect of Lactobacillus strains against gas-producing coliforms isolated from colicky infants. BMC Microbiol 2011; 11:157. [PMID: 21718486 PMCID: PMC3224137 DOI: 10.1186/1471-2180-11-157] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 06/30/2011] [Indexed: 05/06/2023] Open
Abstract
Background Infantile colic is a common disturb within the first 3 months of life, nevertheless the pathogenesis is incompletely understood and treatment remains an open issue. Intestinal gas production is thought to be one of the causes of abdominal discomfort in infants suffering from colic. However, data about the role of the amount of gas produced by infants' colonic microbiota and the correlation with the onset of colic symptoms are scanty. The benefit of supplementation with lactobacilli been recently reported but the mechanisms by which they exert their effects have not yet been fully defined. This study was performed to evaluate the interaction between Lactobacillus spp. strains and gas-forming coliforms isolated from stools of colicky infants. Results Strains of coliforms were isolated from stools of 45 colicky and 42 control breastfed infants in McConkey Agar and identified using PCR with species-specific primers, and the BBL™ Enterotube™ II system for Enterobacteriaceae. Gas-forming capability of coliforms was assessed in liquid cultures containing lactose as sole carbon source. The average count of total coliforms in colicky infants was significantly higher than controls: 5.98 (2.00-8.76) log10 vs 3.90 (2.50-7.10) CFU/g of faeces (p = 0.015). The following strains were identified: Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter aerogenes, Enterobacter cloacae and Enterococcus faecalis. Then, 27 Lactobacillus strains were tested for their antagonistic effect against coliforms both by halo-forming method and in liquid co-cultures. Lactobacillus delbrueckii subsp.delbrueckii DSM 20074 and L. plantarum MB 456 were able to inhibit all coliforms strains (halo-forming method), also in liquid co-cultures, thus demonstrating an antagonistic activity. Conclusions This study shows that two out of 27 strains of Lactobacillus examined possess an antimicrobial effect against six species of gas-forming coliforms isolated from colicky infants. Our findings may stimulate new researches to identify which Lactobacillus strains can improve colicky symptoms by acting on coliforms gut colonization.
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Affiliation(s)
- Francesco Savino
- Department of Pediatrics, Regina Margherita Children Hospital, Torino, Italy.
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Cabana MD. Lactobacillus reuteri DSM 17938 appears to be effective in reducing crying time for colic. J Pediatr 2011; 158:516-7. [PMID: 21316530 DOI: 10.1016/j.jpeds.2011.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Michael D Cabana
- University of California San Francisco, San Francisco, California, USA
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