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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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Kozłowska-Jalowska A, Stróżyk A, Horvath A, Szajewska H. Effect of lactase supplementation on infant colic: Systematic review of randomized controlled trials. J Pediatr Gastroenterol Nutr 2024; 78:1009-1016. [PMID: 38426798 DOI: 10.1002/jpn3.12144] [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: 10/23/2023] [Revised: 01/09/2024] [Accepted: 01/20/2024] [Indexed: 03/02/2024]
Abstract
To systematically review evidence on the efficacy and safety of using a lactase supplementation for managing infant colic. The MEDLINE, EMBASE, and Cochrane Library databases were searched (up to September 2023) for randomized controlled trials (RCTs) comparing oral lactase supplementation with placebo or no intervention in infants younger than 6 months old with infant colic. The risk of bias was assessed using the revised version of the Cochrane risk-of-bias tool. Outcomes measured were selected according to a standardized core outcome set. Five RCTs involving a total of 391 infants were identified. Three RCTs reported reduced crying duration, but one showed effect only in a compliant group (40.4%, p = 0.0052). A meta-analysis of two RCTs found no difference in crying duration and fussing time during 1 week of lactase treatment compared with placebo (mean difference [MD] -17.66 min/day, 95% confidence interval [CI], -60.8 to 25.5; I2 = 68% and MD 2.75, 95% CI, -58.2 to 57.2; I2 = 80%, respectively). Other outcomes were assessed only in individual studies or not reported. The risk of bias was low in only one RCT, high in three, and raised some concerns in one. While individual trials have shown some promise, the overall evidence for the efficacy of lactase supplementation in treating infant colic remain inconclusive. Further well-designed RCTs are necessary to determine the effects of lactase on managing infant colic.
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Affiliation(s)
| | - Agata Stróżyk
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Andrea Horvath
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Hania Szajewska
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
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Mustafa M, Kariri TM, Majrabi RQ, Hufaysi AH, Abutalib Y, Khormi R, Alamri JM, Halawi M, Thurwi SA, Alhasani RA. Mothers' Perceptions and Attitudes About Infantile Colic in Jazan, Saudi Arabia. Cureus 2023; 15:e48210. [PMID: 38050512 PMCID: PMC10693718 DOI: 10.7759/cureus.48210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Background Infantile colic is excessive crying in infants who are otherwise healthy and whose origin is unknown. It is closely linked to maternal depression and is a risk factor for shaken baby syndrome and early cessation of breastfeeding. This study aims to assess mothers' knowledge and attitude about infantile colic in the Jazan region, as well as their knowledge of the causes, and the factors that affect their understanding. Methodology This descriptive cross-sectional study was conducted in the Jazan region, focusing on mothers who met the inclusion criteria. The data were collected using a self-administered Arabic electronic survey following participants' consent. The collected data were analyzed using SPSS Version 27 (IBM Corp., Armonk, NY) using the chi-square tests. Results This study examined mothers' perspectives on various aspects of infantile colic. A total of 215 (75.43%) out of the 285 participating mothers had experienced colic attacks in their infants, revealing statistically significant differences in urban/rural residence, education, birth order, and breastfeeding practices. Approximately half of the mothers agreed that bottle feeding could lead to colic (49.8%), while around half attributed colic to depression or anxiety (50.9%). Most mothers did not relate breastfeeding (69.8%) or smoking (60%) with colic. Around 55.5% believed that milk protein allergy could be a contributing factor. The majority acknowledged the value of massage (63.5%), placing a warm washcloth (59%), and showering the baby (58.6%). Mothers sought advice from diverse sources (56.5%), often family members (36.5%), with minimal doctor consultation (3.9%). Information about colic management was mixed (48.8%); 27.7% got information solely from healthcare staff, 13.7% exclusively depended on the internet, and 9.8% got information from TV and social media. Conclusion This study highlights maternal perspectives and practices regarding infantile colic, showing varying beliefs and approaches that help healthcare providers arrange educational and psychological support to improve infants' and mothers' well-being.
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Affiliation(s)
- Mai Mustafa
- Department of Pediatrics, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Talal M Kariri
- Department of Pediatrics, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Rania Q Majrabi
- Department of Pediatrics, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Anwar H Hufaysi
- Department of Pediatrics, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Yumna Abutalib
- Department of Pediatrics, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Raud Khormi
- Department of Pediatrics, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Joud M Alamri
- Department of Pediatrics, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Majidah Halawi
- Department of Pediatrics, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Shaden A Thurwi
- Department of Pediatrics, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Raffan A Alhasani
- Department of Pediatrics, Faculty of Medicine, Jazan University, Jazan, SAU
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Chouraqui JP, Brancato S, Delmas B, Hanh T. Effectiveness of a starch thickened infant formula with reduced lactose content, probiotics and prebiotics on quality of life and clinical outcome in infants with regurgitation and/or colic. Front Nutr 2023; 10:1164722. [PMID: 37305080 PMCID: PMC10249472 DOI: 10.3389/fnut.2023.1164722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Background Regurgitation and colic are quite common in young infants, leading to a reduced quality of life (QoL) and to parental distress. Their management is challenging and aims to effectively reassure and relieve symptoms. This study aimed to assess the effectiveness over 30 days of a starch thickened formula with a reduced lactose content, Limosilactobacillus reuteri (Lactobacillus reuteri) DSM 17938 and FOS/GOS. Methods A real-world prospective multicenter experimental study was conducted in a before-after design within subject. Full term infants 0-5 months with regurgitation or colic or both symptoms and without intercurrent illness were included after parental informed consent and received the studied formula. The primary endpoint was the improvement in QoL using the QUALIN infant's questionnaire. Secondary endpoints were the symptoms outcome and the formula tolerance. Results Of the 101 infants included (age: 6.2 ± 4.3 weeks), 33 had regurgitation, 34 colic and 34 had both. At D30, the QoL score was improved in 75% of infants in per protocol analysis (n = 68; +8.2 ± 13.7; p < 0.001), more in those with colic or both symptoms. Meanwhile, in intention to treat analysis (all p < 0.001), the daily number of regurgitations decreased by 61% and the weekly number of days with colic by 63% while the daily cumulative duration of crying decreased by 82 ± 106 mn. These improvements were observed within the first week by 89 and 76% of parents, respectively. Conclusion The study formula associated with reassurance is shown to be quickly effective in the management of infant's regurgitation or/and colic in routine clinical practice. Clinical trial registration https://clinicaltrials.gov/, identifier NCT04462640.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Pediatric Gastroenterology and Nutrition, University Hospital Grenoble-Alpes, La Tronche, France
| | - Sandra Brancato
- Association Française de Pédiatrie Ambulatoire (AFPA), Brignon, France
| | - Berenice Delmas
- Département Médical Nutrition Infantile, Nestlé France, Issy-les-Moulineaux, France
| | - Thierry Hanh
- Département Médical Nutrition Infantile, Nestlé France, Issy-les-Moulineaux, France
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