E Palumeri

Lactobacillus reuteri (American Type Culture Collection Strain 55730) Versus Simethicone in the Treatment of Infantile Colic: A Prospective Randomized Study

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 (108 live bacteria per day) or simethicone (60 mg/day) each day for 28 days. The mothers avoided cows 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.

Lactobacillus reuteri DSM 17938 in Infantile Colic: A Randomized, Double-Blind, Placebo-Controlled Trial

OBJECTIVE: To test the efficacy of Lactobacillus reuteri on infantile colic and to evaluate its relationship to the gut microbiota. STUDY DESIGN: Fifty exclusively breastfed colicky infants, diagnosed according to modified Wessels criteria, were randomly assigned to receive either L reuteri DSM 17 938 (108 colony-forming units) or placebo daily for 21 days. Parental questionnaires monitored daily crying time and adverse effects. Stool samples were collected for microbiologic analysis. RESULTS: Forty-six infants (L reuteri group: 25; placebo group: 21) completed the trial. Daily crying times in minutes/day (median [interquartile range]) were 370 (120) vs 300 (150) (P = .127) on day 0 and 35.0 (85) vs 90.0 (148) (P = .022) on day 21, in the L reuteri and placebo groups, respectively. Responders (50% reduction in crying time from baseline) were significantly higher in the L reuteri group versus placebo group on days 7 (20 vs 8; P = .006), 14 (24 vs 13; P = .007), and 21 (24 vs 15; P = .036). During the study, there was a significant increase in fecal lactobacilli (P = .002) and a reduction in fecal Escherichia coli and ammonia in the L reuteri group only (P = .001). There were no differences in weight gain, stooling frequency, or incidence of constipation or regurgitation between groups, and no adverse events related to the supplementation were observed. CONCLUSION: L. reuteri DSM 17 938 at a dose of 108 colony-forming units per day in early breastfed infants improved symptoms of infantile colic and was well tolerated and safe. Gut microbiota changes induced by the probiotic could be involved in the observed clinical improvement.

Intestinal microflora in breastfed colicky and non-colicky infants

Background: Infantile colics are a common problem in the first months of life. During this period, a process of intestinal colonization rapidly occurs. A difference in the gut microflora could play an important role in the pathogenesis of colics, changing the metabolism of carbohydrates and fatty acids. Actually, in the literature, only few data have been collected about this topic. In this study, we evaluated intestinal microflora in breastfed colicky and non‐colicky infants. Methods: Seventy‐one breastfed infants, aged 3.2 ± 0.6 wk, free from episodes of gastroenteritis and without previous assumption of antibiotic and probiotic drugs, were enrolled in the study. They were divided into two groups: colicky (42 cases) and non‐colicky (29 cases), according to Wessels criteria. Stool samples were collected, diluted and cultured on several selective media to detect lactobacilli, clostridia, Gram‐negative anaerobes and Enterobacteriaceae. Statistical analysis was performed using Students t‐test, χ2 test and a non‐parametric test (Mann‐Whitney U‐test). Results: Differences in gut microflora were found among colicky and non‐colicky infants: colicky infants were less frequently colonized by Lactobacillus spp., and more frequently by anaerobic Gram‐negative bacteria.

Reduction of crying episodes owing to infantile colic: a randomized controlled study on the efficacy of a new infant formula

Objectives:The aim of this study was to evaluate the efficacy on crying episodes owing to infantile colic of a new infant formula containing partially hydrolysed whey proteins, prebiotic oligosaccharides (OS), with a high β-palmitic acid content.Design:Prospective randomized controlled study.Setting:Italy.Subjects:Two hundred and sixty-seven formula-fed infants, aged less than 4 months, with infantile colic, were randomized to receive either the new infant formula (study treatment (ST)) or a standard formula and simethicone (6 mg/kg twice a day) (control treatment (CT)). A questionnaire was given to parents to evaluate for 14 days the daily number of colic episodes and crying time.Results:Out of the 199 infants who completed the study, 96 were treated with the new formula and 103 were not treated. Infants receiving the new formula had a significant decrease in colic episodes after 1 week (2.47±1.94 at day 7 vs 5.99±1.84 at the study entry) compared to infants receiving the CT (3.72±1.98 at day 7 vs 5.41±1.88 at the study entry) (P<0.0001). Also at day 14, the crying episodes were significantly different between the two groups of infants (1.76±1.60 in ST vs 3.32±2.06 in CT) (P<0.0001).Conclusions:The use of a partially hydrolysed formula supplemented with fructo- and galacto-OS induces a reduction of crying episodes in infants with colic after 7 and 14 days when compared with a standard formula and simethicone.Sponsorship:The study was supported by funds from Numico, Italy.

Molecular identification of coliform bacteria from colicky breastfed infants

Objective:  To determine the presence of intestinal coliform bacteria in colicky vs healthy infants.

Looking for a relation between serum leptin concentration and body composition parameters in healthy term infants in the first 6 months of life.

We carried out a cross-sectional study of 115 healthy infants, younger than 6 months old, exclusively breast-fed or formula-fed, to investigate correlations between circulating leptin concentrations and body composition measurements. Serum leptin was evaluated with radioimmunoassay, and body composition with bioelectrical impedance analysis. Multiple regression analysis showed a relationship between serum leptin and body mass index in the entire study population (P = 0.042). There was a significant negative relationship between serum leptin and phase angle (P = 0.006) in formula-fed infants. Serum leptin was positively related to subscapular skinfold thickness (P = 0.055) and negatively to reactance (P = 0.057) only in formula-fed infants, although the differences were just below significance. Serum leptin concentration was higher in breast-fed infants (P = 0.002), and was not correlated with body composition parameters. This study indicates that there is a relation between leptin and infant body composition in the first months of life, although the link needs to be explored further.

Must infants with colic really be hospitalized

Sir, We have read with great interest the recent article by Zwart et al. (1), however we have some comments on it. First, the study shows that infants with severe and persistent crying have a normal behaviour when admitted to hospital, also because apparently a lot of infants with normal crying are perceived by their parents to cry excessively. It is well known that infants with severe and persistent crying could take advantage from a continuously controlled early environment (2), but we are afraid that the take-home message of this study could be the admission to hospital as useful for such infants to interrupt parents–infants mutual distress. Moreover, laboratory examinations have been carried out in 80% of subjects in the colic group. We think this management could bring more detriment than benefit to the children, as usually infantile colic has a good prognosis and occurs in otherwise healthy infants. On the other hand, the young age of hospitalized patients can be considered a risk factor for nosocomial infections (3). Second, the infants’ persistent crying is defined as ‘crying behaviour that causes the parents to seek hospital-based pediatric advice’. Though the authors affirm that an exact evaluation of crying duration is difficultly reliable, such an assessment is necessary to define colicky infants. The parents’ perception of crying excessiveness could not be considered a valid criterion to identify properly these infants; further, a more accurate definition of inclusion criteria for the recruitment of the infants should be reported. Finally, healthcare’s support by pediatricians, appropriate reassurance and empathy to the harried caregivers is of extreme importance. Considering the favourable clinical course of infantile colic, a safe approach should be adopted (4). It is important that the pediatricians make an office visit in order to diagnose infantile colic and explain to the parents the self-limiting nature and suggest a more appropriate approach for each infant. Therefore, it is necessary to grade properly colicky symptoms as mild, moderate or severe in order to exclude underlying medical conditions. Only specific diseases should be further investigated and treated through feeding changes or any other medical remedies.

Gastric emptying in infants: Epigastric impedance versus scintigraphy

Aim: To compare epigastric impedance versus scintigraphy in monitoring the gastric emptying of the same adapted milk formula in infants. Methods: Seven infants with clinical symptoms of gastric motility disease underwent scintigraphy with 99mTc sulphur colloid for the 90 min following the ingestion of the same adapted milk formula, in order to evaluate gastric emptying. A bio‐impedance device, connected to a PC, was prepared for this purpose with four standard electrodes placed anteriorly on the upper part of the body. The obtained graphs were compared to those of the scintigraphic method. Statistical analysis was performed using Pearson correlation. The confidence limits were set at 95%. Parental consent was obtained before each analysis. Results: The gastric emptying patterns obtained with epigastric impedance were closely correlated to those shown by the scintigraphy (r= 0.86 ± 0.08; p < 0.05). A significant correlation between the gastric emptying velocity measured by the two techniques was found (r= 0.94; p= 0.002).

A prospective 10-year study on children who had severe infantile colic: Colicky infants 10 years later

Aim: To evaluate the association between infantile colic and gastrointestinal, allergic and psychological disorders in childhood. Methods: A prospective study was conducted on 103 infants aged 31–87 d. After 10 y, between 2001 and 2003, the children were recalled and a paediatrician evaluated the selected disorders by anamnesis, medical examination, laboratory tests and parent interviews. Results: Of the 103 infants enrolled, 96 completed the study. There was an association between infantile colic and recurrent abdominal pain (p=0.001) and allergic disorders: allergic rhinitis, conjunctivitis, asthmatic bronchitis, pollenosis, atopic eczema and food allergy (p<0.05). Sleep disorders, fussiness, aggressiveness and feelings of supremacy are more frequent in children who suffered from colic during early infancy (p<0.05). A family history of gastrointestinal diseases and atopic diseases was significantly higher in infants with colic than in controls (p<0.05).