Lactobacillus Reuteri DSM 17938 in Infantile Colic: A Systematic Review and Meta-Analysis

Background. Infantile colic, defined as paroxysmal, excessive, and consolable crying without an identifiable cause. It is common in the first 3 months of life. There have been many RCT studies conducted. A systematic synthesis is required to summarize the results of these RCTs. This study was aimed to systematically analyze the benefits of Lactobacillus reuteri DSM 17938 for infantile colic. Methods. This systematic review and meta-analysis used keywords: (“infantile colic” OR “abdominal cramps” OR “abdominal cramp” OR “infant colic”) AND “lactobacillus reuteri” AND (placebo OR placebos) AND (“randomized controlled trial” OR RCT). The databases used were: pubmed, science direct, and google scholar. Meta-analysis was conducted to combine the articles. The eligibility criteria were: patient with infantile colic, intervention with L. reuteri DSM 17938, control was placebo, RCT study design, outcome with dichotomous scale, all races, all ethnicities, all countries, all genders, in English, and not limited by year. Results. The search resulted in 800 articles. After reducing duplication, the number of articles was 747. Screening with titles and abstracts resulted in 13 full teks articles. Six articles fitted the eligibility criteria. The results of the meta-analysis were as follows. The forest plot showed that the combined effect of the six articles showed an RR of 0.47 and was statistically significant (p <0.001). Conclusion. Based on the results of this meta-analysis, L. reuteri DSM 17938 is recommended for infants with infantile colic. There were no significant side effects with the use of L. reuteri DSM 17938 on infantile colic.

Non-pharmacological therapy for infantile colic

Infant colic is an inconsolable cry of unknown cause in healthy babies. Observed in about 20% of infants, the most common reason for seeking medical attention at an early age. Colic is associated with maternal stress and the most significant risk factor for shaken baby syndrome, and can also cause premature breastfeeding termination. Informing and supporting parents with crying babies is increasingly important, and some guidelines recommend it as a cornerstone of intervention in families with a baby with colic. Because of the high quality randomized trials, none of the behavioral, dietary, pharmacological, or alternative interventions can be recommended as the only effective treatment. Unfortunately, many mothers around the world associate their child’s anxiety with “dietary mistakes” in their diets, leading to further dietary restrictions as a preventative measure. At the same time, according to the recommendations of the experts of the IV Rome Criteria, dietary restrictions for infant colic in breastfeeding mothers can be recommended only if there is a suspicion of suspicion of tolerance of cow’s milk protein. It is also possible for any type of feeding to prescribe fennel and chamomile preparations, in particular, in the form of aqueous infusions, and when breastfeeding it is desirable to use a bottle and excessively large volumes, which can reduce the amount of milk in a woman. It is desirable to exclude unreasonable dietary restrictions in breastfeeding mothers by excluding the so-called “gas-forming products” and ineffective therapy, in particular simethicone preparations.

Infant colic: where is the line between norm and pathology, the role of disruption of the intestinal microbiome

Infant colic is one of the most common functional disorders of the gastrointestinal tract in children of the first year of life, worsening the condition of both the child himself and the psychological climate in the family. Infant intestinal colic is a multifactorial symptom complex that requires differential diagnosis between norm and pathology. Until now, there is no clear understanding of the criteria for the need for dietary and drug correction of this condition. The article presents an analysis of the modern literature on the problem of intestinal colic in infants The pathogenesis of functional intestinal colic is determined by a combination of reasons, including the immaturity of the central nervous system, hypothalamic-pituitary system, regulation of the intestinal innervation and the enzymatic system, a certain dependence on psychosocial factors has also been identified, the intestinal microflora has a great influence. H. Kianifar et al. (2014) in the findings of a study noted that a multiprobiotic (seven strains of probiotics and fructooligosaccharides) significantly improved colic symptoms, in particular a reduction in crying time, (82.6%) compared with placebo (35.7%) on day 7 of intake (p < 0.005). On day 30, treatment success was 87% and 46% in the synbiotics and placebo groups, respectively (p < 0.01). The results of a domestic study by I.N. Zakharova et al. (2016) multiprobiotic, which showed that after the use of a multistrain probiotic, intestinal colic remained in 3 (10%) children of the main group and in all children in the placebo group. After taking the probiotic, 80% of children showed normalization of stool, and in the placebo group, stool disorders (loose, watery stools or no stool with the need to empty after an enema) were recorded in 87% of children. Cases from clinical practice with experience of using a multistrain probiotic for colic are shown.

Efficacy of Bifidobacterium animalis subsp. lactis, BB-12® on infant colic – a randomised, double-blinded, placebo-controlled study

To evaluate the administration of Bifidobacterium animalis subsp. lactis, BB-12® (BB-12) on infant colic in breastfed infants, a double-blind, placebo-controlled randomised study was conducted in Chengdu, China from April 2016 to October 2017 with 192 full-term infants less than 3 months of age and meeting the ROME III criteria for infant colic. After a 1-week run-in the infants were randomly assigned to receive daily BB-12 (1×109 cfu/day) or placebo for 3 weeks. Crying/fussing time were recorded using a 24 h structured diary. The primary endpoint was the proportion of infants achieving a reduction in crying and fussing time of ≥50% from baseline. Parent’s/caregiver’s health related quality of life was measured using a modified PedsQL™ 2.0 Family Impact Module and immunological biomarkers were evaluated from faecal samples at baseline and after the 21-day intervention. The percentage of infants achieving a reduction in the daily crying/fussing time ≥50% after the 21-day intervention was significantly higher in the infants supplemented with BB-12 (P<0.001). The mean number of crying episodes was significantly reduced in the BB-12 group compared to the placebo group (10.0±3.0 to 5.0±1.87 vs 10.5±2.6 to 7.5±2.8, respectively) (P<0.001) and the mean daily sleep duration was markedly increased from baseline to end of intervention in the BB-12 group compared to the infants in the placebo group (60.7±104.0 vs 31.9±102.7 min/day, respectively) (P<0.001). The faecal levels of human beta defensin 2, cathelicidin, slgA, calprotectin and butyrate were statistically higher in the BB-12 group compared to the placebo group after the 21-day intervention. At the end of the intervention the parent’s/caregiver’s physical, emotional and social functioning scores were significantly higher for the BB-12 group compared to the placebo group (all P<0.05). Supplementation of BB-12 is effective in reducing crying and fussing in infants diagnosed with infant colic.

Colic in infants: modern approaches to patient management

Функциональные расстройства желудочно-кишечного тракта у младенцев и детей раннего возраста являются крайне распространенной проблемой, диагностика которых опирается на Римские критерии IV (четвертого пересмотра). Колики у младенца определенно повышают уровень стресса в семье, ухудшая качество жизни как родителей, так и ребенка. Под младенческими коликами понимаются повторяющиеся длительные периоды плача, беспокойство или раздражительность у младенцев до 5 месяцев. Патофизиология младенческих колик не полностью ясна. Для многих педиатров наблюдение за младенцами с коликами представляет проблему. Среди немедикаментозных техник можно использовать пеленание, убаюкивание с помощью шипящих звуков («ч-ш-ш-ш-ш…»), выкладывание ребенка на живот, укачивание, использование соски, а также применение газоотводной трубочки. В настоящее время активно исследуются возможности применения пробиотиков, например, Lactobacillus reuteri. Functional disorders of the gastrointestinal tract in infants and young children are an extremely common problem, the diagnosis of which is based on the Rome IV criteria. Colic in an infant definitely increases family stress levels, impairing the quality of life for both the parent and the child. Infant colic refers to repeated, prolonged periods of crying, restlessness, or irritability in infants under 5 months of age. The pathophysiology of infant colic is not entirely clear. For many pediatricians, monitoring babies with colic is a challenge. Non-drug techniques include swaddling, prone positioning, rocking, as well as a gas tube. The possibilities of using probiotics, for example, Lactobacillus reuteri, are currently being actively explored.

Cultural Practices Regarding the Management of Infant Colic by Women in Limpopo Province, South Africa

Background: Infant colic is a self-limiting condition reported in the past decade. It is a syndrome distinguished by uncontrollable crying in a healthy baby and begins in the early weeks of life and settles around six months. This study aimed to explore the understanding of infant colic and the cultural practices regarding its management by women in a particular village of Limpopo province in South Africa. Methods: A qualitative phenomenological, exploratory and descriptive design was used to explore cultural practices regarding the management of infant colic by women at the particular village of Vhembe District, Limpopo province. Participants were selected based on their availability or accessibility for study purpose. Data was collected through unstructured interview, observational notes and field notes from 16 participants. The central question was: “What is your understanding of infant colic, and how do you manage it?” Tesch’s eight steps of open-coding was used to analyse data. Ethical clearance to conduct the study was obtained from the University of Venda Research Ethics Committee. The local authorities permitted interaction with the participants in the villages. The trustworthiness of the study was ensured through credibility, dependability, transferability and confirmability. Results: The misconceptions about infant colic, use of self-medication, cultural norms, taking the baby to the traditional and religious practitioners emerged during the analysis. Conclusion: The traditional approach to managing infant colic not be ignored because their forefathers discovered the formula, and it must be included and respected by citizens in the country.

Lactobacillus reuteri DSM 17938 and vitamin D3 in common clinical problems of infants

Purpose — to demonstrate the clinical significance of Lactobacillus reuteri DSM 17938 and vitamin D3 in common clinical problems in infants. Materials and methods. Clinical cases in pediatrics of infancy in children with infant colic (G4), infant regurgitation (G1), functional constipation (G7) are presented. Some international recommendations regarding a preventive dose of vitamin D in the first year of a child' life are considered. Results. The behavior of an infant is often a concern for parents and is a reason for seeking medical help. In particular, it has been shown when acute crying of a child is associated with threatening conditions. The prevalence of functional gastrointestinal disorders and the importance of using the Rome IV criteria in practice are emphasized. Clinical examples of infant colic (G4), infant regurgitation (G1), functional constipation (G7) demonstrated the management of patients with the importance of counseling, showing the evidence base for the use of Lactobacillus reuteri DSM 17938 and vitamin D3. Works on the importance of vitamin D for the prevention of respiratory infections and its dosage are presented. Conclusions. For children in the first year of life with infant colic (G4), infant regurgitation (G1), functional constipation (G7), counseling is important, as well as the use of, in particular, Lactobacillus reuteri DSM 17938. Additional benefits are provided by the combined use of Lactobacillus reuteri DSM 17938 with vitamin D3, which is also discussed for the prevention of respiratory infections. Provided international recommendations for a daily preventive dose of 400 IU of vitamin D for infants. No conflict of interest was declared by the author. Key words: vitamin D, infants, respiratory infections, functional gastrointestinal disorders, Lactobacillus reuteri DSM 17938.