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Haiden N, Savino F, Hill S, Kivelä L, De Koning B, Kӧglmeier J, Luque V, Moltu SJ, Norsa L, De Pipaon MS, Verduci E, Bronsky J. Infant formulas for the treatment of functional gastrointestinal disorders: A position paper of the ESPGHAN Nutrition Committee. J Pediatr Gastroenterol Nutr 2024; 79:168-180. [PMID: 38766683 DOI: 10.1002/jpn3.12240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/26/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024]
Abstract
Functional gastrointestinal disorders (FGID), such as infant regurgitation, infant colic, and functional constipation, are common and typically physiological phenomena during the early months of an infant's life and account for frequent consultations with pediatricians. Various infant formulas are marketed for their management and are frequently given by parents to infants before a medical consultation. However, the evidence supporting their effectiveness is limited and some have altered nutritional compositions when compared to standard formulas. Thus, these products should only be used under medical supervision and upon medical advice. Marketing and over-the-counter sales do not ensure proper medical guidance and supervision. The aim of this position paper is to review the current evidence regarding the safety and efficacy of formulas specifically formulated for addressing regurgitation, colic, and constipation, recognized as FGID. The objective is to provide guidance for clinical management based on the highest quality of available evidence. A wide search using Pubmed, MEDLINE, EMBASE and Cochrane Database of Systematic Reviews was performed including the MESH terms infant formula, colic, constipation, regurgitation, reflux, palmitate, lactase, lactose, magnesium, hydrolyzed protein, prebiotics or probiotics. 752 papers were identified and screened. Finally, 72 papers were included in the paper. In the absence of evidence, recommendations reflect the authors' combined expert opinion. Final consensus was obtained by multiple e-mail exchange and meetings of the Nutrition Committee. (1) For breastfed infants experiencing FGID such as regurgitation, colic, or constipation, transitioning from breastfeeding to commercial formulas is not recommended. (2) In general, whether an infant is breastfed or formula-fed, it's crucial to reassure parents that FGIDs are normal and typically do not necessitate treatment or change to a special formula. (3) Thickened formulas, often termed anti-reflux formulas, may be considered in specific cases of regurgitation. (4) The usage of specialized formulas for infants with colic is not advised due to a lack of clinical evidence. (5) In the case of constipation in infants, the use of formulas enriched with high β-palmitate and increased magnesium content may be considered to soften the stool. Generally, there is limited evidence supporting the use of specialized formulas for FGID. Breastfeeding should never be discontinued in favor of formula feeding.
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Affiliation(s)
- Nadja Haiden
- Department of Neonatology, Kepler University Hospital, Linz, Austria
| | - Francesco Savino
- Department of Patologia e cura del bambino "Regina Margherita" Regina Margherita Children Hospital, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Susan Hill
- Nutrition and Intestinal Failure Division, Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Laura Kivelä
- Celiac Disease Research Center, Tampere University, Tampere, Finland
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland; Research Institute, University of Oslo, Oslo, Norway
| | - Barbara De Koning
- Department of Pediatric Gastroenterology, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - Jutta Kӧglmeier
- Unit of Nutrition and Intestinal Failure Rehabilitation, Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Veronica Luque
- Serra Húnter Fellow, Paediatric Nutrition and Development Research Unit, Universitat Rovira i Virgili-IISPV, Tarragona, Spain
| | - Sissel J Moltu
- Department of Neonatal Intensive Care, Oslo University Hospital, Norway Pediatric, Oslo, Norway
| | - Lorenzo Norsa
- Pediatric Hepatology Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Miguel Saenz De Pipaon
- Neonatology Hospital La Paz Institute for Health Research - IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elvira Verduci
- Metabolic Diseases Unit, Department of Pediatrics, Vittore Buzzi Hospital, University of Milan, Milan, Italy
| | - Jiri Bronsky
- Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
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Zeevenhooven J, Zeevenhooven L, Biesbroek A, Schappin R, Vlieger AM, van Sleuwen BE, L'Hoir MP, Benninga MA. Functional gastrointestinal disorders, quality of life, and behaviour in adolescents with history of infant colic. Acta Paediatr 2024; 113:1435-1443. [PMID: 38535502 DOI: 10.1111/apa.17215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/19/2024] [Accepted: 03/13/2024] [Indexed: 06/09/2024]
Abstract
AIM To assess the prevalence of functional gastrointestinal disorders (FGIDs), health-related quality of life (HRQOL), and behavioural problems in a cohort of adolescents with a history of infant colic (IC), as defined by Wessel's criteria. METHODS 388 adolescents, aged 15-18 years, who participated in a randomised controlled trial for infants with colic, were invited for our observational follow-up study. Prevalence of FGIDs was assessed with the Rome IV Questionnaire on Paediatric Gastrointestinal Disorders (RIV-QPGD), HRQOL through self-report of the Paediatric Quality of Life Inventory (PedsQL), and behavioural problems through parent-report of the child behaviour checklist (CBCL). Multivariable models were used to compare prevalence rates of FGIDs and HRQOL scores. RESULTS 190 (49%) adolescents with a history of IC (cases) and 381 controls were included (median age 17.0 [IQR 16.0-17.0] and 16.0 [15.0-17.0] years, respectively). Cases had a significantly higher risk for postprandial distress syndrome compared to controls (aOR 2.49 (95%CI 1.18-5.25), p = 0.002). After multivariable regression, total, physical and school HRQOL scores were significantly lower in cases compared to controls (p = 0.003, 0.001, and 0.009). CONCLUSION Adolescents with a history of IC demonstrate higher prevalence rates of postprandial distress syndrome compared to controls. However, conclusions should be made with caution due to attrition and information bias.
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Affiliation(s)
- Judith Zeevenhooven
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, Hepatology and Nutrition, University of Amsterdam, Amsterdam, The Netherlands
| | - Lucas Zeevenhooven
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Angela Biesbroek
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Renske Schappin
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arine M Vlieger
- Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Monique P L'Hoir
- Nutrition and Health over the Lifecourse, Wageningen University & Research, Wageningen, The Netherlands
| | - Marc A Benninga
- Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, Hepatology and Nutrition, University of Amsterdam, Amsterdam, The Netherlands
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Karaahmet AY, Dolgun G, Özen M. Effects of probiotics on gastrointestinal symptoms, anthropometric measurements, and breastfeeding duration in infants with colic: a randomized control trial. SAO PAULO MED J 2024; 142:e2023069. [PMID: 38655990 DOI: 10.1590/1516-3180.2023.0069.r1.31052023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Infantile colic has a multifactorial etiology. Recent studies have suggested that probiotics may be effective in its management. OBJECTIVE This study was carried out to evaluate the effect of the Actiregularis strain (5×106 cfu\ml) included in maternal nutrition on gastrointestinal problems, growth development, and breastfeeding outcomes in infantile colic. DESIGN AND SETTING The study was a randomized controlled trial conducted in the neonatal outpatient clinic of a training and research hospital in Turkey. METHODS A probiotic drink containing the Actiregularis (5×106 cfu\ml) strain was added to the diet of mothers in the probiotics group once daily for 15 consecutive days. Data were collected for each infant's 0th (birth), 1st, 4th, and 6th months. RESULTS Infants whose mothers were administered Actiregularis for 15 days had decreased crying intensity (P = 0.000). When the difference in breastfeeding rates between the groups was significant at the 4th and 6th months (P = 0.044; P = 0.035). There was no difference in anthropometric values except the babies' weights at the 6th month. (P < 0.001). CONCLUSION Infants treated with Actiregularis, which was added to their mothers' diet for 15 days, showed a decrease in the frequency of crying, and the difference in breastfeeding rates between the groups was significant at the 4th and 6th months. There was no difference in anthropometric values except the babies' weights at the 6th month. CLINICAL TRIALS REGISTRATION NCT04374955 (https://clinicaltrials.gov/ct2/show/).
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Affiliation(s)
- Aysu Yıldız Karaahmet
- PhD. Assistant Professor, Department of Midwifery, Faculty of Health Science, Halic University, Istanbul, Turkiye
| | - Gülümser Dolgun
- PhD. Professor, Department of Midwifery, Faculty of Health Science, Istanbul University-Cerrahpasa, Istanbul, Turkiye
| | - Metehan Özen
- MD. Professor, Department of Child Health and Diseases, Faculty of Medicine, Acıbadem University, Istanbul, Turkiye
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Smolko NA, Valiev RI, Kabdesh IM, Fayzullina RA, Mukhamedshina YO. Eating disorder in children: Impact on quality of life, with a spotlight on autism spectrum disorder. Nutr Res 2024; 123:38-52. [PMID: 38241984 DOI: 10.1016/j.nutres.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024]
Abstract
Eating behavior, which includes eating habits and preferences, frequency of eating, and other features related to diet, is a major characteristic not only of a person's nutritional status, but also of health in general. In recent years, the prevalence of eating disorders in children has tended to increase; they also require cross-system approaches in diagnosis by a variety of specialists and correction requires appropriate selection of optimal methods. Maladaptive eating attitudes formed at an early age can contribute to the formation of eating disorders, which can lead to or worsen various neuropsychiatric diseases, digestive diseases, and other related conditions. In children with autism spectrum disorder (ASD), eating disorders often appear earlier than other major symptoms of the condition. However, the clinical manifestations of eating disorders in children with ASD are varied and differ in severity and duration, whereas these disorders in neurotypical children might present as short-lived and may not lead to serious consequences. Nevertheless, cases of progressive eating disorders accompanied by a child presenting as under- or overweight and/or with macronutrient and micronutrient deficiencies cannot be excluded. Given the high prevalence of eating disorders in children, many researchers have highlighted the lack of a valid and universally accepted instruments to assess atypical eating behaviors in this population. Therefore, in this review, we wanted to highlight the problems and causes of eating disorders in children, and also to analyze the existing approaches to the validation of these problems, taking into account the existing behavioral features in children with ASD.
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Affiliation(s)
- Natalia A Smolko
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia; Department of Propaedeutics of Pediatric Diseases and Faculty Pediatrics, Kazan State Medical University, Kazan, Russia
| | - Rushan I Valiev
- Department of General Hygiene, Kazan State Medical University, Kazan, Russia
| | - Ilyas M Kabdesh
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia.
| | - Rezeda A Fayzullina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia; Department of Propaedeutics of Pediatric Diseases and Faculty Pediatrics, Kazan State Medical University, Kazan, Russia
| | - Yana O Mukhamedshina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia; Department of Histology, Cytology and Embryology, Kazan State Medical University, Kazan, Russia
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Indrio F, Dargenio VN. Preventing and Treating Colic: An Update. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1449:59-78. [PMID: 39060731 DOI: 10.1007/978-3-031-58572-2_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Infantile colic (IC) is c is a self-limiting functional gastrointestinal disorder (FGID) with a favorable natural history. Worldwide, IC has a significant impact on many newborns and their families. Although not an indication of an illness, its symptoms are wide and generic and may indicate a potentially serious underlying issue in a tiny percentage of newborns who may require a medical evaluation. The pathogenesis appears to be multifactorial implying a complex relationship between the infant and the environment. One of the most studied theories attributes a key role to the gut microbiota in the pathogenesis of IC. A variety of approaches have been suggested for the clinical management of IC, and several randomized controlled trials have been reported in the literature. Probiotics can change the host's microbiota and positively impact health. They may be able to restore balance and create a better intestinal microbiota landscape since there is mounting evidence that the gut microbial environment of colicky newborns differs from that of healthy infants. In this review, we revise the most commonly studied probiotics and mixtures to treat and prevent IC and the most recent recommendations.
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Affiliation(s)
- Flavia Indrio
- Department of Experimental Medicine, Università del Salento, Lecce, Italy
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Bellaiche M, Tounian P, Oozeer R, Rocher E, Vandenplas Y. Digestive Tolerance and Safety of an Anti-Regurgitation Formula Containing Locust Bean Gum, Prebiotics and Postbiotics: A Real-World Study. Pediatr Gastroenterol Hepatol Nutr 2023; 26:249-265. [PMID: 37736220 PMCID: PMC10509020 DOI: 10.5223/pghn.2023.26.5.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/20/2023] [Accepted: 07/20/2023] [Indexed: 09/23/2023] Open
Abstract
Purpose Infant regurgitation is associated with other functional gastrointestinal disorders and signs and symptoms that have a major impact on the quality of life of infants and their families. This study evaluated the safety, tolerance, and real-world effectiveness of an anti-regurgitation formula containing locust bean gum (LBG), prebiotics, and postbiotics to alleviate digestive symptoms beyond regurgitation. Methods This 3-month study involved infants with regurgitation requiring the prescription of an anti-regurgitation formula according to usual clinical practice. Outcomes included evaluation of the evolution of stool consistency and frequency; occurrence of colic, constipation, and diarrhea; and assessment of regurgitation severity. Infant crying, parental assessment of infant well-being, and parental satisfaction with the stool consistency were also evaluated. Results In total, 190 infants (average age: 1.9±1.1 months) were included. After three months, stool frequency and consistency remained within the normal physiological range, with 82.7% of infants passing one or two stools per day and 90.4% passing loose or formed stools. There was no significant increase in the number of infants with diarrhea, whereas a decrease was observed in the number of infants with constipation after 1 month (p=0.001) and with colic after both 1 and 3 months (p<0.001). Regurgitation severity and crying decreased and parental satisfaction with stool consistency, formula acceptability, infant well-being, and sleep quality increased. Monitoring of adverse events did not reveal any safety concerns. Conclusion Formulas containing LBG, prebiotics, and postbiotics were well tolerated and provided an effective strategy for managing infant regurgitation and gastrointestinal discomfort.
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Affiliation(s)
- Marc Bellaiche
- Department of Gastroenterology and Pediatric Nutrition, Hospital Robert-Debré, AP-HP, Paris, France
| | - Patrick Tounian
- Department of Pediatric Nutrition and Gastroenterology, Trousseau Hospital, AP-HP, Sorbonne Université, Paris, France
| | | | | | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Infantile Colic and Long-Term Outcomes in Childhood: A Narrative Synthesis of the Evidence. Nutrients 2023; 15:nu15030615. [PMID: 36771322 PMCID: PMC9921915 DOI: 10.3390/nu15030615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
About 1 in 4 infants comes forward with prolonged crying, agitation, or infant colic (IC) during the first three months of life and is referred for medical evaluation. The pathogenesis remains poorly understood, as do its implications for future health. The aim of this narrative review was to critically examine and discuss the available literature on long-term consequences of excessive crying and/or colic. Most studies display an association between IC and the onset of functional gastrointestinal disorders (FGIDs) years later, probably related to the presence of common etiopathogenetic factors (environmental, dietary, intestinal dysmotility, visceral hypersensitivity). Although allergic disease in first-degree relatives may be a risk factor for IC, the latter does not appear to be a risk factor for subsequent atopic disease in the individual. Overall, there seems to be a relationship between IC and subsequent headaches, of the migraine type. Similarly, behavioral problems in children with a history of IC appear to be associated with higher parental stress scores. However, the current evidence is based on associations, and currently, a causal relationship between excessive crying and IC and long-term consequences remains not documented.
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Șchiopu CG, Ștefănescu C, Boloș A, Diaconescu S, Gilca-Blanariu GE, Ștefănescu G. Functional Gastrointestinal Disorders with Psychiatric Symptoms: Involvement of the Microbiome-Gut-Brain Axis in the Pathophysiology and Case Management. Microorganisms 2022; 10:2199. [PMID: 36363791 PMCID: PMC9694215 DOI: 10.3390/microorganisms10112199] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022] Open
Abstract
Functional Gastrointestinal Disorders have been an important cause of poor life quality in affected populations. The unclear etiology and pathophysiological mechanism alter the clinical evolution of the patient. Although a strong connection with psychological stress has been observed, it was not until recently that the gut-brain axis involvement has been revealed. Furthermore, the current literature not only promotes the gut-brain axis modulation as a therapeutical target for functional digestive disorders but also states that the gut microbiome has a main role in this bi-directional mechanism. Psychiatric symptoms are currently recognized as an equally important aspect of the clinical manifestation and modulation of both the digestive and central nervous systems and could be the best approach in restoring the balance. As such, this article proposes a detailed description of the physiology of the microbiome-gut-brain axis, the pathophysiology of the functional gastrointestinal disorders with psychiatric symptoms and current perspectives for therapeutical management, as revealed by the latest studies in the scientific literature.
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Affiliation(s)
- Cristina Gabriela Șchiopu
- Department of Psychiatry, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
| | - Cristinel Ștefănescu
- Department of Psychiatry, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
| | - Alexandra Boloș
- Department of Psychiatry, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
| | - Smaranda Diaconescu
- Medical-Surgical Department, Faculty of Medicine, University “Titu Maiorescu”, 040441 Bucuresti, Romania
| | | | - Gabriela Ștefănescu
- Department of Gastroentereology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
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Zeevenhooven J, de Bruin FE, Schappin R, Vlieger AM, van der Lee JH, Haverman L, van Sleuwen BE, L'Hoir MP, Benninga MA. Follow-up of infants with colic into childhood: Do they develop behavioural problems? J Paediatr Child Health 2022; 58:2076-2083. [PMID: 36054703 PMCID: PMC9804625 DOI: 10.1111/jpc.16174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/28/2022] [Accepted: 08/07/2022] [Indexed: 01/07/2023]
Abstract
AIM To assess whether infants with colic (IC) demonstrate persisting developmental dysregulation into childhood, manifested as behavioural problems, and to determine if these behavioural problems are associated with parenting factors. METHODS Preschool children with a history of IC at the age of 0-3 months, as defined by the Wessel criteria, were invited to participate in an observational follow-up study, in which their caregivers completed the Child Behaviour Checklist (CBCL). Raw scores and clinical-range scores on the internalising, externalising and total behavioural problems scales were compared with a Dutch normative sample using independent t-tests and Chi-square tests. For the clinical-range scores, multivariable logistic regressions (odds ratios [99% confidence interval, CI]) were used to adjust for confounders and to identify variables associated with behavioural problems. RESULTS Two hundred and fifty-eight children with a history of IC (median age 5.1 (interquartile range, IQR 4.6-5.5) years, 51.9% boys) were included. The cases had a significantly higher adjusted risk (adjusted odds ratios (aORs) [99% CI]) of scoring in the clinical range of the emotionally reactive, internalising and total problems scale (2.96 [1.24-7.06]; 2.50 [1.35-4.62]; 2.98 [1.46-6.07], respectively). Internalising (P < 0.001), externalising (P < 0.001) and total (P < 0.001) behavioural problems in children with a history of IC were associated with higher parenting stress scores. CONCLUSIONS Children with a history of IC demonstrated significantly more internalising behavioural problems at preschool age compared to the norm sample. Specific advice and support need to be available for parents to understand and regulate the behaviour of their child, from infancy to childhood.
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Affiliation(s)
- Judith Zeevenhooven
- Department of Medical Psychology and Social Work, Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtthe Netherlands,Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Françoise E de Bruin
- Faculty of Social and Behavioral SciencesUtrecht UniversityUtrechtthe Netherlands
| | - Renske Schappin
- Department of Medical Psychology and Social Work, Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Arine M Vlieger
- Department of PediatricsSt. Antonius HospitalNieuwegeinthe Netherlands
| | - Johanna H van der Lee
- Pediatric Clinical Research Office, Emma Children's Hospital, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Lotte Haverman
- Psychosocial Department, Emma Children's Hospital, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | | | - Monique P L'Hoir
- Nutrition and Health over the LifecourseWageningen University & ResearchWageningenthe Netherlands
| | - Marc A Benninga
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
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Kim JH, Lee SW, Kwon Y, Ha EK, An J, Cha HR, Jeong SJ, Han MY. Infantile Colic and the Subsequent Development of the Irritable Bowel Syndrome. J Neurogastroenterol Motil 2022; 28:618-629. [PMID: 36250369 DOI: 10.5056/jnm21181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/03/2022] [Accepted: 05/07/2022] [Indexed: 11/20/2022] Open
Abstract
Background/Aims Little is known about the association between infantile colic and the later onset of irritable bowel syndrome (IBS). Methods This study examined all 917 707 children who were born in Korea between 2007 and 2008. Infantile colic was defined with 1 or more diagnoses of ICD-10 code R10.4 or R68.1 at the age of 5 weeks to 4 months, and infants with a diagnosis of infantile colic and without were allocated into the infantile colic group and the control group. IBS was defined as 2 or more diagnoses of ICD-10 code K58.X after 4 years of age. Each child was traced until 2017. The risk of IBS with infantile colic was evaluated using a Cox proportional hazards model with propensity score inverse probability of treatment weighting (IPTW). Results After IPTW, 363 528 and 359 842 children were allocated to the control group and the infantile colic group, respectively. The infantile colic group had a higher risk of developing IBS in childhood (hazard ratio [95% CI], 1.12 [1.10 to 1.13]) than the control group. Moreover, the subgroup analyses according to the feeding status, birth weight, sex, or economic status, showed that the risk of IBS with former infantile colic remained statistically significant. Conclusions Children with a diagnosis of infantile colic during the infant period had a significant risk of developing IBS after 4 years of age. Understanding the pathogenesis of infantile colic in the neonatal period may reduce the prevalence and severity of functional gastrointestinal disorders from childhood to adolescence to adulthood.
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Affiliation(s)
- Ju Hee Kim
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Yoowon Kwon
- Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Jaewoo An
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Gyeonggi-do, Korea
| | - Hye Ryeong Cha
- Department of Comuputer Science and Engineering, Sungkyunkwan University, Suwon, Gyeonggi-do, Korea
| | - Su Jin Jeong
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Gyeonggi-do, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Gyeonggi-do, Korea
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Verwendung von diätetischen Lebensmitteln für besondere medizinische Zwecke („bilanzierte Diäten“) für Säuglinge, Aktualisierung 2022. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01528-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
OBJECTIVES Antibiotics may contribute to the development of functional gastrointestinal disorders (FGIDs). This study aimed to determine whether antibiotics during the first week of life, infantile colic in the first year of life, gut-associated immune markers at 1 year of age, and allergies at 4-6 years of age in term-born children were associated with a higher prevalence of FGIDs at 4-6 years of age. METHODS A prospective observational cohort of 436 term-born infants was followed up at the age of 4-6 years; 151 received broad-spectrum antibiotics (AB+), and 285 healthy controls (AB-). Validated Questionnaire On Pediatric Gastrointestinal Symptoms-Rome III and International Study of Asthma and Allergy in Childhood questionnaires were sent to parents of 418 available children. The independent t-test, chi-squared test or non-parametric test and logistic multivariate regression analyses were used. RESULTS In total, 340 of 418 (81%) questionnaires were completed. Only the presence of functional abdominal pain was significantly higher in AB+ than AB- (4% vs 0.4%, respectively, P = 0.045). Children with food allergy fulfilled significantly more often the criteria for irritable bowel syndrome (IBS) and abdominal migraine (26% vs 9%, P = 0.002 and 7% vs 1%, P = 0.043, respectively) compared to non-allergic children. No differences in FGIDs existed at the age of 4-6 years between children with and without a history of infantile colic. There were significant differences in gut-associated immune markers between children with and without FGIDs. CONCLUSION Antibiotics during the first week of life resulted in a higher risk for functional abdominal pain at 4-6 years. Furthermore, food allergy was associated with IBS and abdominal migraine at 4-6years.
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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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LenglarT L, Caula C, Moulding T, Lyles A, Wohrer D, Titomanlio L. Brain to Belly: Abdominal Variants of Migraine and Functional Abdominal Pain Disorders Associated With Migraine. J Neurogastroenterol Motil 2021; 27:482-494. [PMID: 34642268 PMCID: PMC8521460 DOI: 10.5056/jnm20290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
Migraine is one of the most frequent causes of primary headache and 9% of children suffer from migraines. Most children will continue to experience migraine attacks as adults, therefore it is imperative that we have a thorough understanding of this major health issue. This article considers the so-called abdominal variants of migraine, which are more commonly seen in children rather than adults: abdominal migraine, cyclic vomiting syndrome, and infantile colic. Other functional abdominal pain disorders such as irritable bowel syndrome and functional dyspepsia have also been linked to migraine in clinical studies. The common pathophysiological root of these diseases seems to be the gut-brain axis mechanism. Abdominal variants of migraine are considered pediatric precursors of migraine whereas the functional abdominal pain disorders related to migraine seem to share a pathophysiological root with no temporarily link as for today. In this review we aim to describe the epidemiological background, the current pathophysiological theories and the relationship of each disease to migraine. This review is the first to compile abdominal variants of migraine and functional abdominal pain disorders associated with migraine and we endeavor to elucidate the broad spectrum of migraine-related episodes in children.
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Affiliation(s)
- Léa LenglarT
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France
| | - Caroline Caula
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France
| | - Thomas Moulding
- Department of Specialty and Integrated Medicine, The Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - Annabel Lyles
- Department of Oncology, The Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - Delphine Wohrer
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France
| | - Luigi Titomanlio
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France.,Pediatric Migraine and Neurovascular Diseases Unit, APHP - Hopital Robert Debré, Paris, France.,Paris University, INSERM U1141, DHU Protect, Paris, France
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Indrio F, Enninger A, Aldekhail W, Al-Ghanem G, Al-Hussaini A, Al-Hussaini B, Al-Refaee F, Al-Said K, Eid B, Faysal W, Hijazeen R, Isa HM, Onkarappa D, Rawashdeh M, Rohani P, Sokhn M. Management of the Most Common Functional Gastrointestinal Disorders in Infancy: The Middle East Expert Consensus. Pediatr Gastroenterol Hepatol Nutr 2021; 24:325-336. [PMID: 34316467 PMCID: PMC8279821 DOI: 10.5223/pghn.2021.24.4.325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/24/2021] [Accepted: 05/15/2021] [Indexed: 11/18/2022] Open
Abstract
The occurrence of functional gastrointestinal disorders (FGIDs) is a formidable challenge for infants, parents, and healthcare professionals. Although data from the Middle East are scarce, experts consider FGIDs a prevalent condition in everyday clinical practice. The new Rome IV criteria revisited the definitions from a clinical perspective to provide a practical and consistent diagnostic protocol for FGIDs. However, the treatment practices for functional disorders vary considerably among Middle Eastern countries, often resulting in mismanagement with unnecessary investigations and treatments. In addition, the role of various treatment modalities, including probiotics such as Lactobacillus reuteri DSM 17938, in FGIDs requires further discussion and evaluation. During a consensus meeting, a locally relevant approach for treating common FGIDs such as infant regurgitation, infant colic, and functional constipation was discussed and approved by regional experts. The participants suggested a simplified treatment plan and protocol for general pediatricians and other primary care physicians managing FGIDs. This easy-to-follow standardized protocol will help streamline the initial management of this complex disorder in the Middle East region and even globally.
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Affiliation(s)
- Flavia Indrio
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Axel Enninger
- Department of General and Special Pediatrics, Olga Hospital (Klinikum Stuttgart), Stuttgart, Germany
| | - Wajeeh Aldekhail
- Department of Pediatric Gastroenterology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ghanem Al-Ghanem
- Department of Neonatal Perinatal Medicine, Adan Hospital, Ahmadi, Kuwait
| | - Abdulrahman Al-Hussaini
- Division of Pediatric Gastroenterology, Children's Specialized Hospital, King Fahad Medical City, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Bakr Al-Hussaini
- Department of Pediatric Gastroenterology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Fawaz Al-Refaee
- Pediatrics Department, Al-Adan Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Khoula Al-Said
- Department of Child Health, Pediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital, Muscat, Oman
| | - Bassam Eid
- Pediatrics/Pediatric Gastroenterology Unit, Hotel Dieu de France, Beirut, Lebanon
| | - Wafaa Faysal
- Pediatric Department, Dr Sulaiman Al Habib Hospital, Dubai, UAE
| | | | - Hasan M.A. Isa
- Pediatric Department, Salmaniya Medical Complex/Arabian Gulf University, Manama, Bahrain
| | | | | | - Pejman Rohani
- Department of Pediatrics, Mofid Children's Hospital, Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maroun Sokhn
- Pediatric Department, Saint George Hospital, Beirut, Lebanon
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16
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Long B, Koyfman A, Gottlieb M. Lactobacillus reuteri for Treatment of Infant Colic. Acad Emerg Med 2020; 27:1059-1060. [PMID: 32227404 DOI: 10.1111/acem.13977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Brit Long
- Department of Emergency Medicine Brooke Army Medical Center Fort Sam Houston TX
| | - Alex Koyfman
- Department of Emergency Medicine The University of Texas Southwestern Medical Center Dallas TX
| | - Michael Gottlieb
- Department of Emergency Medicine Rush University Medical Center Chicago IL
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17
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Lynøe N, Eriksson A. Is there an association between infantile colic and subdural hemorrhage? Med Hypotheses 2020; 144:110256. [PMID: 33254567 DOI: 10.1016/j.mehy.2020.110256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/01/2020] [Accepted: 09/05/2020] [Indexed: 11/15/2022]
Abstract
We present the hypothesis that subdural hemorrhages during childbirth might be associated with so-called three-month colic, whereby an infant cries intensively and repeatedly during its first three months. A traditional interpretation is that this infantile crying is associated with nutrition and is accordingly "a gut issue", but this is probably not the whole explanation. It has also been suggested that infantile crying can trigger a caregiver to shake the baby to make it stop crying, thereby inflicting a subdural hemorrhage. A mechanism-based argument supporting our hypothesis would be that the bilateral film-thin subdural hemorrhage associated with a high percentage of deliveries might cause meningeal irritation and in some cases also symptoms as inconsolable crying. An epidemiological argument is that infantile crying is more frequent among first-born, male and premature babies; these categories have also an increased incidence of subdural hemorrhage. Moreover, preventive programs for managing infantile crying have had no effect on the incidence of alleged shaken baby cases. As infantile crying is currently considered unexplained, it is reasonable to explore the proposed hypothesis and strategies which refute or corroborate it. We suggest that a cohort study of premature, first born and male babies with and without infantile crying are examined with brain MRI scan soon after delivery with clinically and MRI follow up during 3-6 months.
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Affiliation(s)
- Niels Lynøe
- Centre for Healthcare Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden.
| | - Anders Eriksson
- Dept of Community Medicine and Rehabilitation/Forensic Medicine, Umeå University, Umeå, Sweden
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18
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Baldassarre ME, Di Mauro A, Salvatore S, Tafuri S, Bianchi FP, Dattoli E, Morando L, Pensabene L, Meneghin F, Dilillo D, Mancini V, Talarico V, Tandoi F, Zuccotti G, Agosti M, Laforgia N. Birth Weight and the Development of Functional Gastrointestinal Disorders in Infants. Pediatr Gastroenterol Hepatol Nutr 2020; 23:366-376. [PMID: 32704497 PMCID: PMC7354866 DOI: 10.5223/pghn.2020.23.4.366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess the association between birth weight and the development of functional gastrointestinal disorders (FGIDs) in the first year of life. METHODS This is a secondary analysis of a prospective cohort multicenter study including neonates, consecutively enrolled at birth, and followed up for one year. At birth all infants were classified by birth weight as extremely low (ELBW), very low, or low when <1,000, <1,500, and <2,500 g, respectively, and by birth weight for gestational age as appropriate (AGA, weight in the 10-90th percentile), small (SGA, weight <10th percentile), and large (LGA, weight >90th percentile) for gestational age. FGIDs were classified according to the Rome III criteria and assessed at 1, 3, 6, and 12 months of life. RESULTS Among 1,152 newborns enrolled, 934 (81.1%) completed the study: 302 (32.3%) were preterm, 35 (3.7%) were ELBW, 104 (11.1%) were SGA, 782 (83.7%) were AGA, and 48 (5.1%) were LGA infants. Overall, throughout the first year of life, 718 (76.9%) reported at least one FGID. The proportion of infants presenting with at least one FGID was significantly higher in ELBW (97%) compared to LBW (74%) (p=0.01) and in LGA (85.4%) and SGA (85.6%) compared to AGA (75.2%) (p=0.0001). On multivariate analysis, SGA was significantly associated with infantile colic. CONCLUSION We observed an increased risk of FGIDs in ELBW, SGA, and LGA neonates. Our results suggest that prenatal factors determining birth weight may influence the development of FGIDs in infants. Understanding the role of all potential risk factors may provide new insights and targeted approaches for FGIDs.
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Affiliation(s)
| | - Antonio Di Mauro
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Silvia Salvatore
- Unit of Pediatrics and Neonatology, "F. Del Ponte" Hospital, Dipartimento di Medicina e Chirurgia University of Insubria, Varese, Italy
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Francesco Paolo Bianchi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Enzo Dattoli
- Unit of Pediatrics and Neonatology, "F. Del Ponte" Hospital, Dipartimento di Medicina e Chirurgia University of Insubria, Varese, Italy
| | - Lucia Morando
- Unit of Pediatrics and Neonatology, "F. Del Ponte" Hospital, Dipartimento di Medicina e Chirurgia University of Insubria, Varese, Italy
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Fabio Meneghin
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Dario Dilillo
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | | | - Valentina Talarico
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Francesco Tandoi
- Unit of Pediatrics and Neonatology, "F. Del Ponte" Hospital, Dipartimento di Medicina e Chirurgia University of Insubria, Varese, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Massimo Agosti
- Unit of Pediatrics and Neonatology, "F. Del Ponte" Hospital, Dipartimento di Medicina e Chirurgia University of Insubria, Varese, Italy
| | - Nicola Laforgia
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
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19
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Ahmadipour S, Fallahi A, Rahmani P. Probiotics for infantile colic. CLINICAL NUTRITION EXPERIMENTAL 2020. [DOI: 10.1016/j.yclnex.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Infant microbiota in colic: predictive associations with problem crying and subsequent child behavior. J Dev Orig Health Dis 2020; 12:260-270. [PMID: 32279681 DOI: 10.1017/s2040174420000227] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Infant colic is a condition of unknown cause which can result in carer distress and attachment difficulties. Recent studies have implicated the gut microbiota in infant colic, and certain probiotics have demonstrated possible efficacy. We aim to investigate whether the intestinal microbiota composition in infants with colic is associated with cry/fuss time at baseline, persistence of cry/fuss at 4-week follow-up, or child behavior at 2 years of age. Fecal samples from infants with colic (n = 118, 53% male) were analyzed using 16S rRNA sequencing. After examining the alpha and beta diversity of the clinical samples, we performed a differential abundance analysis of the 16S data to look for taxa that associate with baseline and future behavior, while adjusting for potential confounding variables. In addition, we used random forest classifiers to evaluate how well baseline gut microbiota can predict future crying time. Alpha diversity of the fecal microbiota was strongly influenced by birth mode, feed type, and child gender, but did not significantly associate with crying or behavioral outcomes. Several taxa within the microbiota (including Bifidobacterium, Clostridium, Lactobacillus, and Klebsiella) associate with colic severity, and the baseline microbiota composition can predict further crying at 4 weeks with up to 65% accuracy. The combination of machine learning findings with associative relationships demonstrates the potential prognostic utility of the infant fecal microbiota in predicting subsequent infant crying problems.
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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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22
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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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Shin A, Preidis GA, Shulman R, Kashyap PC. The Gut Microbiome in Adult and Pediatric Functional Gastrointestinal Disorders. Clin Gastroenterol Hepatol 2019; 17:256-274. [PMID: 30153517 PMCID: PMC6314902 DOI: 10.1016/j.cgh.2018.08.054] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/23/2018] [Accepted: 08/21/2018] [Indexed: 02/07/2023]
Abstract
The importance of gut microbiota in gastrointestinal (GI) physiology was well described, but our ability to study gut microbial ecosystems in their entirety was limited by culture-based methods prior to the sequencing revolution. The advent of high-throughput sequencing opened new avenues, allowing us to study gut microbial communities as an aggregate, independent of our ability to culture individual microbes. Early studies focused on association of changes in gut microbiota with different disease states, which was necessary to identify a potential role for microbes and generate novel hypotheses. Over the past few years the field has moved beyond associations to better understand the mechanistic implications of the microbiome in the pathophysiology of complex diseases. This movement also has resulted in a shift in our focus toward therapeutic strategies, which rely on better understanding the mediators of gut microbiota-host cross-talk. It is not surprising the gut microbiome has been implicated in the pathogenesis of functional gastrointestinal disorders given its role in modulating physiological processes such as immune development, GI motility and secretion, epithelial barrier integrity, and brain-gut communication. In this review, we focus on the current state of knowledge and future directions in microbiome research as it pertains to functional gastrointestinal disorders. We summarize the factors that help shape the gut microbiome in human beings. We discuss data from animal models and human studies to highlight existing paradigms regarding the mechanisms underlying microbiota-mediated alterations in physiological processes and their relevance in human interventions. While translation of microbiome science is still in its infancy, the outlook is optimistic and we are advancing in the right direction toward precise mechanism-based microbiota therapies.
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Affiliation(s)
- Andrea Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Geoffrey A Preidis
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Robert Shulman
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Purna C Kashyap
- Enteric Neuroscience Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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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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Mansouri S, Kazemi I, Baghestani AR, Zayeri F, Nahidi F, Gazerani N. A placebo-controlled clinical trial to evaluate the effectiveness of massaging on infantile colic using a random-effects joint model. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2018; 9:157-163. [PMID: 30532613 PMCID: PMC6247972 DOI: 10.2147/phmt.s185214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Infantile colic viewed as a non-dangerous prevalent issue could lead to stress in parents and long-term negative consequences in ex-colicky children. Researchers have not been successful in finding a certain treatment for colic symptoms. Studies suggest completely different approaches as its treatment. Massage therapy as an alternative method in reducing colic symptoms has been recommended in several studies. Methods A total of 100 colicky infants in a single blind study were randomly specified to two equal groups of intervention and control. Infants in the intervention group received massage for 15–20 minutes once during the day and once at night before sleep, while infants in the control group were rocked for 15–25 minutes when the symptoms of colic appeared. Parents recorded the details of the colic symptoms in a diary every day. All these outcomes were modeled simultaneously via a random-effects joint model. Results Among 100 infants included in the analysis, 48% were female; 91% of all infants were breastfed and 54% of them were born via normal vaginal delivery. In general, the effect of massage therapy on colic symptoms was assessed using the joint model. Our findings illustrated that massaging colicky infants would substantially reduce colic symptoms and increase the sleep duration in babies compared with the rocking group (P<0.001). Conclusion Massage therapy could be considered as an effective method in reducing colic symptoms. Mean of the symptoms dropped significantly in the intervention group compared with that in the rocking group. Our study also represents that a relevant and correct statistical model could result in more reliable findings.
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Affiliation(s)
- Samaneh Mansouri
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Iraj Kazemi
- Department of Statistics, Faculty of Sciences, University of Isfahan, Isfahan, Iran
| | - Ahmad Reza Baghestani
- Department of Biostatistics, Faculty of Paramedical Sciences, Physiotherapy Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
| | - Farid Zayeri
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nahidi
- Department of Midwifery and Reproductive Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nafiseh Gazerani
- Department of Midwifery and Reproductive Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Salvatore S, Pensabene L, Borrelli O, Saps M, Thapar N, Concolino D, Staiano A, Vandenplas Y. Mind the gut: probiotics in paediatric neurogastroenterology. Benef Microbes 2018; 9:883-898. [PMID: 30198327 DOI: 10.3920/bm2018.0013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The gut-brain axis has recently emerged as a key modulator of human health and the intestinal microbiome has a well-recognised pivotal role in this strong connection. The aim of this narrative review is to update and summarise the effect and clinical applicability of probiotics in paediatric neurogastroenterology. The Cochrane Database and PubMed were searched using keywords relating to different subtypes of functional gastrointestinal disorders (FGIDs) and their symptoms, those relating to the CNS and related neurological or behavioural dysfunction as well as 'probiotic' OR 'probiotics'. Included papers were limited to those including children (aged 0-18 years) and using English language. Although significant effects of specific strains have been reported in infants with FGIDs, heterogeneity amongst the studies (different products and concentrations used and FGID subtypes), has limited the ability to draw an overall conclusion on the clinical value of probiotics. According to different meta-analyses of randomised controlled trials, the use of Lactobacillus reuteri (DSM 17938) was associated with a significant decrease in average crying time in infantile colic. There is moderate evidence for this strain and LGG and limited evidence (based on one study each) for the beneficial effect of VSL#3 and a three-strain bifidobacteria mix in abdominal pain FGIDs, particularly in the irritable bowel disease subgroup of children, but not in functional dyspepsia. There is currently no clear evidence of positive effects of oral probiotics in autistic spectrum disorder. Efficacy and safety of other strains or beneficial effects in other conditions still need to be proven, as probiotic properties are strain-specific, and data cannot be extrapolated to other brain-gut or mood diseases or to other probiotics of the same or different species. To transform the use of probiotics from a tempting suggestion to a promising treatment modality in neurogastroenterological disorders more accurate differentiation of the efficacy-proven strains, clarification of dose, duration, and outcome and a careful selection of the target patients are still necessary.
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Affiliation(s)
- S Salvatore
- 1 Department of Pediatrics, University of Insubria, Via F. Del Ponte 19, 21100 Varese, Italy
| | - L Pensabene
- 2 Department of Medical and Surgical Sciences, Pediatric Unit, University Magna Graecia of Catanzaro, Viale Pio X, 88100 Catanzaro, Italy
| | - O Borrelli
- 3 Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, United Kingdom
| | - M Saps
- 4 Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Miami, 1601 NW 12. Ave, Miami FL 33136, USA
| | - N Thapar
- 3 Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, United Kingdom
| | - D Concolino
- 2 Department of Medical and Surgical Sciences, Pediatric Unit, University Magna Graecia of Catanzaro, Viale Pio X, 88100 Catanzaro, Italy
| | - A Staiano
- 5 Department of Translational Medical Science, Section of Pediatrics, University of Naples 'Federico II', Via S. Pansini 5, 80131 Naples, Italy
| | - Y Vandenplas
- 6 KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
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Daelemans S, Peeters L, Hauser B, Vandenplas Y. Recent advances in understanding and managing infantile colic. F1000Res 2018; 7:F1000 Faculty Rev-1426. [PMID: 30271572 PMCID: PMC6134333 DOI: 10.12688/f1000research.14940.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2018] [Indexed: 12/31/2022] Open
Abstract
A newborn brings joy to the family. Crying belongs to the spectrum of normal behaviour of young infants. However, although it occurs in about 20% of all infants, unsoothable and persistent crying in young infants distresses the family, although it is usually benign. The aetiology of infantile colic remains unknown, although an unbalanced gastro-intestinal microbiome, increased intestinal permeability, and chronic inflammation are involved, as well as behavioural factors, including over- and under-stimulation. It is a challenge for healthcare professionals to decide when organic disease needs to be excluded. Parental stress is a reason for babies to cry more, inducing a vicious cycle. Therefore, parental reassurance with explanatory guidance is the cornerstone of management. The placebo effect is estimated to be as high as 50%. If an intervention is felt to be necessary to offer further support to the baby and family, it is important to choose the options for which there is some efficacy without adverse effects. There is evidence that some specific probiotic strains such as Lactobacillus reuteri DSM 19378, especially in breastfed infants, are effective. However, there are also promising data for some synbiotics and/or killed or tyndallized bacteria, as well as substances decreasing intestinal permeability. Formula management with extensive and/or partial hydrolysates may also bring relief. But, above all, offering parental support remains imperative.
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Affiliation(s)
- Siel Daelemans
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Linde Peeters
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Bruno Hauser
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
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Salvatore S, Abkari A, Cai W, Catto‐Smith A, Cruchet S, Gottrand F, Hegar B, Lifschitz C, Ludwig T, Shah N, Staiano A, Szajewska H, Treepongkaruna S, Vandenplas Y. Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants. Acta Paediatr 2018; 107:1512-1520. [PMID: 29710375 PMCID: PMC6120453 DOI: 10.1111/apa.14378] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/21/2018] [Accepted: 04/23/2018] [Indexed: 12/31/2022]
Abstract
AIM Regurgitation, infantile colic and functional constipation are common functional gastrointestinal disorders (FGIDs) during infancy. Our aim was to carry out a concise review of the literature, evaluate the impact of these common FGIDs on infants and their families, and provide an overview of national and international guidelines and peer-reviewed expert recommendations on their management. METHODS National and international guidelines and peer-reviewed expert recommendations on the management of regurgitation, infantile colic and functional constipation were examined and summarised. RESULTS Regurgitation, infantile colic and functional constipation cause frequent parental concerns, lead to heavy personal and economic costs for families and impose a financial burden on public healthcare systems. Guidelines emphasise that the first-line management of these common FGIDs should focus on parental education, reassurance and nutritional advice. Nutritional advice should stress the benefits of continuing breastfeeding, while special infant formulas may be considered for non-breastfed infants with common FGIDs. Drug treatment is seldom required, with the exception of functional constipation. CONCLUSION By providing complete and updated parental education, reassurance and nutritional advice, healthcare professionals can optimise the management of FGIDs and related symptoms and reduce the inappropriate use of medication or dietary interventions.
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Affiliation(s)
| | - Abdelhak Abkari
- Faculty of MedicineUnit of Pediatric GastroenterologyUniversity Hospital Ibn RochdUniversity Hassan2CasablancaMorocco
| | - Wei Cai
- Xin Hua HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Anthony Catto‐Smith
- Lady Cilento Children's HospitalQueensland University of TechnologyBrisbaneAustralia
| | - Sylvia Cruchet
- Institute of Nutrition and Food TechnologyUniversity of Chile (INTA)SantiagoChile
| | - Frederic Gottrand
- Department of PediatricsJeanne de Flandre Children's HospitalCHU LilleUniversity of LilleLilleFrance
| | - Badriul Hegar
- Division of GastrohepatologyDepartment of Child HealthFaculty of MedicineUniversitas IndonesiaJakartaIndonesia
| | | | | | - Neil Shah
- Great Ormond Street HospitalLondonUK
| | - Annamaria Staiano
- Department of Translational Medical ScienceSection of PediatricsUniversity of Naples Federico IINaplesItaly
| | - Hania Szajewska
- Department of PaediatricsThe Medical University of WarsawWarsawPoland
| | - Suporn Treepongkaruna
- Department of PediatricsFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Yvan Vandenplas
- KidZ Health CastleUZ BrusselVrije Universiteit BrusselBrusselsBelgium
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30
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Sung V, D'Amico F, Cabana MD, Chau K, Koren G, Savino F, Szajewska H, Deshpande G, Dupont C, Indrio F, Mentula S, Partty A, Tancredi D. Lactobacillus reuteri to Treat Infant Colic: A Meta-analysis. Pediatrics 2018; 141:peds.2017-1811. [PMID: 29279326 DOI: 10.1542/peds.2017-1811] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 02/04/2023] Open
Abstract
CONTEXT Lactobacillus reuteri DSM17938 has shown promise in managing colic, but conflicting study results have prevented a consensus on whether it is truly effective. OBJECTIVE Through an individual participant data meta-analysis, we sought to definitively determine if L reuteri DSM17938 effectively reduces crying and/or fussing time in infants with colic and whether effects vary by feeding type. DATA SOURCES We searched online databases (PubMed, Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, the Database of Abstracts of Reviews of Effects, and Cochrane), e-abstracts, and clinical trial registries. STUDY SELECTION These were double-blind randomized controlled trials (published by June 2017) of L reuteri DSM17398 versus a placebo, delivered orally to infants with colic, with outcomes of infant crying and/or fussing duration and treatment success at 21 days. DATA EXTRACTION We collected individual participant raw data from included studies modeled simultaneously in multilevel generalized linear mixed-effects regression models. RESULTS Four double-blind trials involving 345 infants with colic (174 probiotic and 171 placebo) were included. The probiotic group averaged less crying and/or fussing time than the placebo group at all time points (day 21 adjusted mean difference in change from baseline [minutes] -25.4 [95% confidence interval (CI): -47.3 to -3.5]). The probiotic group was almost twice as likely as the placebo group to experience treatment success at all time points (day 21 adjusted incidence ratio 1.7 [95% CI: 1.4 to 2.2]). Intervention effects were dramatic in breastfed infants (number needed to treat for day 21 success 2.6 [95% CI: 2.0 to 3.6]) but were insignificant in formula-fed infants. LIMITATIONS There were insufficient data to make conclusions for formula-fed infants with colic. CONCLUSIONS L reuteri DSM17938 is effective and can be recommended for breastfed infants with colic. Its role in formula-fed infants with colic needs further research.
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Affiliation(s)
- Valerie Sung
- Murdoch Children's Research Institute, The Royal Children's Hospital, and the University of Melbourne, Melbourne, Victoria, Australia;
| | - Frank D'Amico
- Department of Mathematics, Duquesne University, Pittsburgh, Pennsylvania.,University of Pittsburgh Medical Center St. Margaret's Hospital, Pittsburgh, Pennsylvania
| | - Michael D Cabana
- Department of Pediatrics, Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Kim Chau
- University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gideon Koren
- University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Francesco Savino
- Ospendale Infantile Regina Margherita, Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Girish Deshpande
- Department of Neonatology, Nepean Hospital and Sydney Medical School Nepean, University of Sydney, Sydney, New South Wales, Australia
| | - Christophe Dupont
- Department of Pediatric Gastroenterology, Paris Descartes University and Necker-Enfants Malades Hospital, Paris, France
| | - Flavia Indrio
- Department of Pediatrics, University of Bari, Bari, Italy
| | - Silja Mentula
- Bacteriology Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Anna Partty
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; and
| | - Daniel Tancredi
- Department of Pediatrics, University of California Davis Health System, Sacramento, California
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Savino F, Garro M, Montanari P, Galliano I, Bergallo M. Crying Time and RORγ/FOXP3 Expression in Lactobacillus reuteri DSM17938-Treated Infants with Colic: A Randomized Trial. J Pediatr 2018; 192:171-177.e1. [PMID: 28969887 DOI: 10.1016/j.jpeds.2017.08.062] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/10/2017] [Accepted: 08/23/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate crying time, retinoid-related orphan receptor-γ (RORγ) and forkhead box P3 (FOXP3) messenger RNA levels (transcription factors that can modulate T cell responses to gut microbes), and to investigate gut microbiota and fecal calprotectin in infants treated with Lactobacillus reuteri for infantile colic. STUDY DESIGN A double-blind, placebo-controlled randomized trial was conducted in primary care in Torino from August 1, 2015 to September 30, 2016. Patients suffering from infantile colic were randomly assigned to receive daily oral L reuteri (1 × 108 colony forming unit) or placebo for 1 month. Daily crying times were recorded in a structured diary. FOXP3 and RORγ messenger RNA in the peripheral blood was assessed with real-time TaqMan reverse transcription polymerase chain reaction. Gut microbiota and fecal calprotectin were evaluated. RESULTS After infants with colic were supplemented with L reuteri DSM 17938 for 30 days, crying times were significantly shorter among infants with colic in the probiotic group compared with infants in the placebo group (74.67 ± 25.04 [IQR = 79] minutes /day vs 147.85 [IQR = 135] minutes /day [P = .001]). The FOXP3 concentration increased significantly (P = .009), resulting in decreased RORγ/FOXP3 ratios: 0.61 (IQR = 0.60) at day 0 and 0.48 (IQR = 0.28) at day 30 (P = .028). Furthermore, the probiotic increased the percentage of Lactobacillus (P = .049) and decreased fecal calprotectin (P = .0001). CONCLUSIONS Infants with colic treated with L reuteri for 30 days had a significantly decreased crying time and an increased FOXP3 concentration, resulting in a decreased RORγ/FOXP3 ratio. The treatment reduced fecal calprotectin. TRIAL REGISTRATION ClinicalTrials.gov: NCT00893711.
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Affiliation(s)
- Francesco Savino
- Department of Pediatrics, Universitary Hospital Città della Salute e della Scienza di Torino, Turin, Italy.
| | - Maria Garro
- Department of Pediatrics, Universitary Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paola Montanari
- Department of Public Health and Pediatric Sciences, University of Turin, School of Medicine, Turin, Italy
| | - Ilaria Galliano
- Department of Public Health and Pediatric Sciences, University of Turin, School of Medicine, Turin, Italy
| | - Massimiliano Bergallo
- Department of Public Health and Pediatric Sciences, University of Turin, School of Medicine, Turin, Italy
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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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Abstract
Excessive crying is a common complaint in young infants, especially in those less than 3 mo of age. Altered circadian rhythm, immaturity of central nervous system and alteration of intestinal microbiota are some of the proposed mechanisms for this problem. Although it is commonly benign, crying can be the only clinical manifestation of many serious underlying illnesses, thus warranting careful clinical examination for ruling out organic causes. Urgent care clinics are best suited for evaluation and treatment of benign etiologies and promptly referring children with red flags to an emergency department. Routine investigations are not indicated in an afebrile infant with no signs of illness on history and physical examination. Excessive crying due to colic often results in parental stress and exhaustion. Treatment in such cases revolves more on reassuring the parents and avoiding drugs with uncertain action and potential side-effects.
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Affiliation(s)
- Javed Ismail
- Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Karthi Nallasamy
- Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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34
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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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Steutel NF, Benninga MA, Langendam MW, Korterink JJ, Indrio F, Szajewska H, Tabbers MM. Developing a core outcome set for infant colic for primary, secondary and tertiary care settings: a prospective study. BMJ Open 2017; 7:e015418. [PMID: 28554931 PMCID: PMC5729993 DOI: 10.1136/bmjopen-2016-015418] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Infant colic (IC) is defined as recurrent and prolonged crying without an obvious cause or evidence of failure to thrive or illness. It is a common problem with a prevalence of 5%-25%. The unknown aetiology results in a wide variety in interventions and use of heterogeneous outcome measures across therapeutic trials. Our aim was to develop a core outcome set (COS) for IC to facilitate and improve evidence synthesis. DESIGN AND SETTING Prospective study design; primary, secondary and tertiary care. METHODS The COS was developed using a modified Delphi technique. First, healthcare professionals (HCPs) and parents of infants with IC were asked to list up to five outcomes they considered relevant in the treatment of IC. Outcomes mentioned by >10% of participants were forwarded to a shortlist. In the second round, outcomes on this shortlist were rated and prioritised. The final COS was defined in a face-to-face expert meeting of paediatricians. RESULTS F of invited stakeholders (133 HCPs and 55 parents of infants with IC) completed both Delphi rounds. Duration of crying, family stress, sleeping time of infant, quality of life (of family), discomfort of infant and hospital admission/duration were rated as most important outcomes in IC, framing the final COS. CONCLUSIONS The use of this COS should serve as a minimum of outcomes to be measured and reported. This will benefit evidence synthesis, by enhancing homogeneity of outcomes, and enable evaluation of success in therapeutic trials on IC. Researchers are strongly encouraged to use this COS when setting up a clinical trial in primary, secondary and/or tertiary care or performing a systematic review on IC.
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Affiliation(s)
- Nina F Steutel
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Miranda W Langendam
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Judith J Korterink
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Flavia Indrio
- Department of Paediatrics, Giovanni XXIII Hospital, University of Bari, Bari, Italy
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Merit M Tabbers
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
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Chumpitazi BP, Shulman RJ. Underlying molecular and cellular mechanisms in childhood irritable bowel syndrome. Mol Cell Pediatr 2016; 3:11. [PMID: 26883355 PMCID: PMC4755958 DOI: 10.1186/s40348-016-0036-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/04/2016] [Indexed: 12/17/2022] Open
Abstract
Irritable bowel syndrome (IBS) affects a large number of children throughout the world. The symptom expression of IBS is heterogeneous, and several factors which may be interrelated within the IBS biopsychosocial model play a role. These factors include visceral hyperalgesia, intestinal permeability, gut microbiota, psychosocial distress, gut inflammation, bile acids, food intolerance, colonic bacterial fermentation, and genetics. The molecular and cellular mechanisms of these factors are being actively investigated. In this mini-review, we present updates of these mechanisms and, where possible, relate the findings to childhood IBS. Mechanistic elucidation may lead to the identification of biomarkers as well as personalized childhood IBS therapies.
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Affiliation(s)
- Bruno P Chumpitazi
- Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, 77030, TX, USA.
- Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, 6621 Fannin Street, 77030, Houston, TX, USA.
| | - Robert J Shulman
- Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, 77030, TX, USA.
- Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, 6621 Fannin Street, 77030, Houston, TX, USA.
- Children's Nutrition Research Center, 1100 Bates Avenue, Houston, 77030, TX, USA.
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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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Indrio F, Di Mauro A, Di Mauro A, Riezzo G, Panza R, Cavallo L, Francavilla R. Prevention of functional gastrointestinal disorders in neonates: clinical and socioeconomic impact. Benef Microbes 2016; 6:195-8. [PMID: 25609653 DOI: 10.3920/bm2014.0078] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Infantile colic, gastro-oesophageal reflux and constipation are the most common functional gastrointestinal disorders (FGIDs) affecting infants during the first months of life. Despite infantile colic, functional constipation and regurgitation had a self-limited pattern, they are considered a risk factor for developing different disorders later in life. The pathophysiology of these functional diseases is still controversial but there is growing evidence that an abnormal gut microbiota colonisation may play a crucial role. An early probiotic supplementation could determine a change in colonisation and may represent a new strategy for preventing FGIDs.
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Affiliation(s)
- F Indrio
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari 'Aldo Moro', Giovanni XXIII Hospital, Via Amendola 270, 70126 Bari, Italy
| | - A Di Mauro
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari 'Aldo Moro', Giovanni XXIII Hospital, Via Amendola 270, 70126 Bari, Italy
| | - A Di Mauro
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari 'Aldo Moro', Giovanni XXIII Hospital, Via Amendola 270, 70126 Bari, Italy
| | - G Riezzo
- Laboratory of Experimental Physiopathology, IRCCS, Via F. Valente 4, 70013 Castellana Grotte, Italy
| | - R Panza
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari 'Aldo Moro', Giovanni XXIII Hospital, Via Amendola 270, 70126 Bari, Italy
| | - L Cavallo
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari 'Aldo Moro', Giovanni XXIII Hospital, Via Amendola 270, 70126 Bari, Italy
| | - R Francavilla
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari 'Aldo Moro', Giovanni XXIII Hospital, Via Amendola 270, 70126 Bari, Italy
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Abstract
OBJECTIVES The aim of the study was to review published evidence and the opinion of practising clinicians on the prevalence and long-term health consequences of functional gastrointestinal symptoms in infants younger than 12 months. METHODS PubMed was searched from inception to November 2014 to find articles reporting the prevalence and long-term health outcomes of infantile colic, regurgitation, functional constipation, functional diarrhoea, and dyschezia in infants younger than <12 months. A questionnaire was sent to practising clinicians worldwide, and a group of 15 international experts met to discuss the likely frequency and longer-term consequences of these symptoms. RESULTS The literature search identified 30 studies reporting the prevalence of infantile colic (2%-73%), 13 that of regurgitation (3%-87%), 8 that of functional constipation (0.05%-39.3%), 2 that of functional diarrhoea (2%-4.1%), and 3 that of dyschezia (0.9%-5.6%). The studies varied in design, populations investigated, and definition of the symptoms. Questionnaires were received from 369 respondents. The experts agreed that the likely prevalences for colic, regurgitation, and functional constipation were 20%, 30%, and 15%, respectively. The limited data in the literature for functional diarrhoea and dyschezia suggest prevalences <10%. Infantile colic may be associated with future health problems in a subset of infants. CONCLUSIONS Functional gastrointestinal symptoms appear to occur in a significant proportion of infants younger than 12 months and may have an impact on future health outcomes. Prospective collection of data according to agreed criteria is needed to obtain more accurate estimates of the prevalence and consequences of these symptoms.
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Probiotic Lactobacillus rhamnosus GG therapy and microbiological programming in infantile colic: a randomized, controlled trial. Pediatr Res 2015; 78:470-5. [PMID: 26151493 DOI: 10.1038/pr.2015.127] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 04/07/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Probiotic Lactobacillus reuteri and reduced allergen load may lessen the daily crying of colic infants, but the role of Lactobacillus rhamnosus GG (LGG) has remained obscure. METHODS Infants with colic (n = 30) were enrolled during the first 6 wk of life. All families received behavioral support and allergen avoidance diet: breastfeeding mothers followed cow's milk elimination diet and formula-fed infants received extensively hydrolyzed casein formula. The randomized, double-blind intervention employed of LGG 4.5 × 10(9) cfu/d or placebo for a 4-wk study period. Daily crying was recorded by diaries and parental interviews. Fecal calprotectin and gut microbiota composition by quantitative PCR were evaluated before and after the intervention. RESULTS Daily crying time was comparable between the probiotic (173 min) and the placebo group (174 min; P = 0.99) at the end of the intervention according to the parental diary. However, parents reported a decrease of 68% (95% confidence interval (CI): 58-78) in daily crying in the probiotic and 49% (95% CI: 32-66) in the placebo group (P = 0.05). CONCLUSION LGG in infants treated in tandem with behavioral support and a cow's milk elimination diet did not provide additional treatment effect for diary-verified colic crying although parental report of crying suggested the probiotic intervention effective.
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Infantile colic, regurgitation, and constipation: an early traumatic insult in the development of functional gastrointestinal disorders in children? Eur J Pediatr 2015; 174:841-2. [PMID: 25504357 DOI: 10.1007/s00431-014-2467-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 11/26/2014] [Accepted: 12/01/2014] [Indexed: 12/30/2022]
Abstract
UNLABELLED Functional gastrointestinal disorders (FGIDs) are defined as a variable combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities. Infantile colic, gastroesophageal reflux, and constipation are the most common FGIDs that lead to referral to a pediatrician during the first 6 months of life and are often responsible for hospitalization, feeding changes, use of drugs, parental anxiety, and loss of parental working days with relevant social consequences. We performed a retrospective study on patients referred for recurrent abdominal pain from January 2002 trough December 2009 to our Pediatric Gastroenterology Outpatient Unit. The population studied was matched with healthy control without history of recurrent abdominal pain, enrolled among pediatricians practicing primary health care. History of infantile colic, regurgitation, and functional constipation was detected respectively in 26.41, 25.31, and 30.16% of children diagnosed with FGIDs compared to 11.34, 12.85, and 11.76% of healthy children. CONCLUSION According to our data, children with a history of gastrointestinal infantile distress have a higher prevalence of FGIDs years later.
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Sung V, Cabana MD, D'Amico F, Deshpande G, Dupont C, Indrio F, Mentula S, Partty A, Savino F, Szajewska H, Tancredi D. Lactobacillus reuteri DSM 17938 for managing infant colic: protocol for an individual participant data meta-analysis. BMJ Open 2014; 4:e006475. [PMID: 25475244 PMCID: PMC4256605 DOI: 10.1136/bmjopen-2014-006475] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Infant colic, or excessive crying of unknown cause in infants less than 3 months old, is common and burdensome. Its aetiology is undetermined, and consensus on its management is still lacking. Recent studies suggest a possible link between infant colic and gut microbiota, indicating probiotics to be a promising treatment. However, only a few strains have been tested, and results from randomised controlled trials are conflicting. It is important to clarify whether probiotics are effective for treating infant colic in general, and to identify whether certain subgroups of infants with colic would benefit from particular strains of probiotics. METHODS AND ANALYSIS Through an individual participant data meta-analysis (IPDMA), we aim to identify whether the probiotic Lactobacillus reuteri DSM 17938 is effective in the management of infant colic, and to clarify whether its effects differ according to feeding method (breast vs formula vs combined), proton pump inhibitor exposure, and antibiotic exposure. The primary outcomes are infant crying duration and treatment success (at least 50% reduction in crying time from baseline) at 21 days postintervention. Individual participant data from all studies will be modelled simultaneously in multilevel generalised linear mixed-effects regression models to account for the nesting of participants within studies. Subgroup analyses of participant-level and intervention-level characteristics will be undertaken on the primary outcomes to assess if the intervention effect differs between certain groups of infants. ETHICS AND DISSEMINATION Approved by the Royal Children's Hospital Human Research Ethics Committee (HREC 34081). Results will be reported in a peer-reviewed journal in 2015. TRIAL REGISTRATION NUMBER PROSPERO CRD42014013210.
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Affiliation(s)
- Valerie Sung
- Murdoch Childrens Research Institute, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael D Cabana
- Department of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco (UCSF) School of Medicine, San Francisco, California, USA
| | - Frank D'Amico
- Duquesne University/UPMC St. Margaret Hospital, Pittsburgh, Pennsylvania, USA
| | - Girish Deshpande
- Department of Children's health division and NICU, Nepean Hospital Sydney, Sydney, New South Wales, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, New South Wales, Australia
| | - Christophe Dupont
- Department of Pediatric Gastroenterology, Paris Descartes University, Necker Hospital, Paris, France
| | - Flavia Indrio
- Department of Pediatrics, University of Bari, Bari, Italy
| | - Silja Mentula
- Bacteriology Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Anna Partty
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Francesco Savino
- Ospedale Infantile Regina Margherita, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Daniel Tancredi
- Department of Pediatrics, UC Davis Health System, Sacramento, California, USA
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Abstract
OBJECTIVES Infant colic (IC), with an estimated prevalence of 5% to 25%, has a high impact on health care costs. Furthermore, reported negative sequelae are disturbed parent-infant interaction, increased susceptibility to abdominal pain, and even child abuse. Its etiology remains unknown, leading to a wide variety in interventions. We hypothesize that definitions and outcome measures in studies on IC will be heterogeneous as well. Our objective is to systematically assess how definitions and outcome measures are reported in randomized controlled trials (RCTs) of IC. METHODS CENTRAL, Embase, and MEDLINE/PubMed were searched from inception to December 2012. English-language systematic reviews (SRs) and RCTs concerning IC in children ages 0 to 9 months were included. Bibliographies of included SRs were searched for additional articles. Quality was assessed using the Delphi list. RESULTS A total of 1702 studies were found; 55 articles were included (16 SRs, 39 RCTs). In 39 trials, we found 20 different definitions for IC, 11 different definitions for improvement, 28 different interventions, and 19 different outcomes. Fifty-one percent of the trials were of good methodological quality. All of the trials used parental diaries; only 31% stated that their instrument was validated. CONCLUSIONS Too many different definitions and outcome measures for IC are used in RCTs. Only a minority of the trials reported parental perception as primary outcome. Uniform definitions, outcomes, and validated instruments are needed to make a comparison between intervention studies possible.
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Affiliation(s)
- Bruno P. Chumpitazi
- Baylor College of Medicine, Department of Pediatrics, Texas Children’s Hospital, Houston
| | - Robert J. Shulman
- Baylor College of Medicine, Department of Pediatrics, Texas Children’s Hospital, Houston2US Department of Agriculture/Agricultural Research Service Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas
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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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Sung V, Hiscock H, Tang M, Mensah FK, Heine RG, Stock A, York E, Barr RG, Wake M. Probiotics to improve outcomes of colic in the community: protocol for the Baby Biotics randomised controlled trial. BMC Pediatr 2012; 12:135. [PMID: 22928654 PMCID: PMC3508922 DOI: 10.1186/1471-2431-12-135] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 08/24/2012] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Infant colic, characterised by excessive crying/fussing for no apparent cause, affects up to 20% of infants under three months of age and is a great burden to families, health professionals and the health system. One promising approach to improving its management is the use of oral probiotics. The Baby Biotics trial aims to determine whether the probiotic Lactobacillus reuteri DSM 17938 is effective in reducing crying in infants less than three months old (<13.0 weeks) with infant colic when compared to placebo. METHODS/DESIGN DESIGN Double-blind, placebo-controlled randomised trial in Melbourne, Australia. PARTICIPANTS 160 breast and formula fed infants less than three months old who present either to clinical or community services and meet Wessel's criteria of crying and/or fussing. INTERVENTION Oral once-daily Lactobacillus reuteri (1x108 cfu) versus placebo for one month. PRIMARY OUTCOME Infant crying/fussing time per 24 hours at one month. SECONDARY OUTCOMES i) number of episodes of infant crying/fussing per 24 hours and ii) infant sleep duration per 24 hours (at 7, 14, 21, 28 days and 6 months); iii) maternal mental health scores, iv) family functioning scores, v) parent quality adjusted life years scores, and vi) intervention cost-effectiveness (at one and six months); and vii) infant faecal microbiota diversity, viii) infant faecal calprotectin levels and ix) Eschericia coli load (at one month only). ANALYSIS Primary and secondary outcomes for the intervention versus control groups will be compared with t tests and non-parametric tests for continuous data and chi squared tests for dichotomous data. Regression models will be used to adjust for potential confounding factors. Intention-to-treat analysis will be applied. DISCUSSION An effective, practical and acceptable intervention for infant colic would represent a major clinical advance. Because our trial includes breast and formula-fed babies, our results should generalise to most babies with colic. If cost-effective, the intervention's simplicity is such that it could be widely taken up as a new standard of care in the primary and secondary care sectors. TRIAL REGISTRATION Current Controlled Trials ISRCTN95287767.
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Affiliation(s)
- Valerie Sung
- Royal Children's Hospital, Parkville, Australia.
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Dysautonomia in autism spectrum disorder: case reports of a family with review of the literature. AUTISM RESEARCH AND TREATMENT 2011; 2011:129795. [PMID: 22937241 PMCID: PMC3420600 DOI: 10.1155/2011/129795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 04/10/2011] [Indexed: 11/18/2022]
Abstract
Case histories of a mother and her two children are reported. The mother was a recovered alcoholic. She and her two children, both of whom had symptoms that are typical of autistic spectrum disorder, had dysautonomia. All had intermittently abnormal erythrocyte transketolase studies indicating abnormal thiamine pyrophosphate homeostasis. Both children had unusual concentrations of urinary arsenic. All had symptomatic improvement with diet restriction and supplementary vitamin therapy but quickly relapsed after ingestion of sugar, milk, or wheat. The stress of a heavy metal burden, superimposed on existing genetic or epigenetic risk factors, may be important in the etiology of autism spectrum disorder when in combination. Dysautonomia has been associated with several diseases, including autism, without a common etiology. It is hypothesized that oxidative stress results in loss of cellular energy and causes retardation of hard wiring of the brain in infancy, affecting limbic system control of the autonomic nervous system.
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Abstract
UNLABELLED Infantile colic is a widespread clinical condition in the first 3 months of life, which is easily recognized, but incompletely understood and difficult to solve. The available evidence suggests that infantile colic might have several independent causes. The medical hypotheses include food hypersensitivity or allergy, immaturity of gut function and dysmotility, and the behavioural hypotheses include inadequate maternal-infant interaction, anxiety in the mother and difficult infant temperament. Other recent hypotheses, such as hormone alterations and maternal smoking, still need confirmation, whereas the new concept of alterations in the gut microflora, have been reported. A number of interventions, including pharmacological agents, are discussed, but it is probable that infants with colic require a graded strategy. CONCLUSION Considering the favourable clinical course and the wide range of manifestations, a safe approach should be adopted, which is proportional to the intensity of the infantile colic. However, further research and guidelines are still needed.
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Affiliation(s)
- Francesco Savino
- Department of Pediatrics, Regina Margherita Children's Hospital, University of Turin, Piazza Polonia 94, 10126 Turin, Italy.
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Savino F, Pelle E, Palumeri E, Oggero R, Miniero R. Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study. Pediatrics 2007; 119:e124-30. [PMID: 17200238 DOI: 10.1542/peds.2006-1222] [Citation(s) in RCA: 199] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to test the hypothesis that oral administration of Lactobacillus reuteri in a prospective randomized study would improve symptoms of infantile colic. METHODS Ninety breastfed colicky infants were assigned randomly to receive either the probiotic L. reuteri (10(8) live bacteria per day) or simethicone (60 mg/day) each day for 28 days. The mothers avoided cow's milk in their diet. Parents monitored daily crying times and adverse effects by using a questionnaire. RESULTS Eighty-three infants completed the trial: 41 in the probiotic group and 42 in the simethicone group. The infants were similar regarding gestational age, birth weight, gender, and crying time at baseline. Daily median crying times in the probiotic and simethicone groups were 159 minutes/day and 177 minutes/day, respectively, on the seventh day and 51 minutes/day and 145 minutes/day on the 28th day. On day 28, 39 patients (95%) were responders in the probiotic group and 3 patients (7%) were responders in the simethicone group. No adverse effects were reported. CONCLUSIONS In our cohort, L. reuteri improved colicky symptoms in breastfed infants within 1 week of treatment, compared with simethicone, which suggests that probiotics may have a role in the treatment of infantile colic.
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Affiliation(s)
- Francesco Savino
- Department of Pediatrics, Regina Margherita Children's Hospital, University of Turin, Piazza Polonia, 94 10126 Turin, Italy.
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