Roberto Oggero

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.

Breast milk hormones and their protective effect on obesity.

Data accumulated over recent years have significantly advanced our understanding of growth factors, cytokines, and hormones in breast milk. Here we deal with leptin, adiponectin, IGF-I, ghrelin, and the more recently discovered hormones, obestatin, and resistin, which are present in breast milk and involved in food intake regulation and energy balance. Little is known about these compounds in infant milk formulas. Nutrition in infancy has been implicated in the long-term tendency to obesity, and a longer duration of breastfeeding appears to protect against its development. Diet-related differences in serum leptin and ghrelin values in infancy might explain anthropometric differences and differences in dietary habits between breast-fed and formula-fed infants also later in life. However, there are still gaps in our understanding of how hormones present in breast milk affect children. Here we examine the data related to hormones contained in mothers milk and their potential protective effect on subsequent obesity.

High incidence of adverse reactions to egg challenge on first known exposure in young atopic dermatitis children: predictive value of skin prick test and radioallergosorbent test to egg proteins.

Background Egg skin prick test (SPT) and/or radioallergosorbent test (RAST) positivity has been described in infants and children with a food allergy, or in infants at high risk of atopy who have never eaten eggs. Clinical reactions are also observed when some of these children or infants eat eggs for the first time.

Ghrelin, leptin and IGF-I levels in breast-fed and formula-fed infants in the first years of life.

Aim: To establish ghrelin, leptin and IGF‐I serum levels in breastfed (BF) and formula‐fed (FF) infants during the first period of life. Methods: A cross‐sectional study was conducted on fasting blood venous samples obtained from exclusively BF (n=106) and FF (n=100) infants to measure total ghrelin (RIA test), leptin (RIA test) and IGF‐I (chemiluminescence). Anthropometrical measurements of weight, length and cranial circumference were performed. Results: During the first 4 mo of life, FF infants compared to BF ones showed higher ghrelin levels (2654.86 vs 2132.96 pg/ml; p<0.032), higher IGF‐I levels (3.73 vs 3.15 ng/ml; p=0.00) and lower leptin levels (0.68 vs 1.16 ng/ml; p<0.04). Leptin values were higher in females than in males (0.80 vs 0.47 ng/ml; p<0.03), while no gender‐related difference was found for ghrelin and IGF‐I. No differences were found in anthropometrical measurements comparing the two groups of infants. A multiple regression analysis showed an inverse correlation between ghrelin and leptin values (p<0.04) and between IGF‐I and leptin levels (p=0.00).

Can hormones contained in mothers' milk account for the beneficial effect of breast-feeding on obesity in children?

Nutrition and growth during infancy are an emerging issue because of their potential link to metabolic health disorders in later life. Moreover, prolonged breast‐feeding appears to be associated with a lower risk of obesity than formula feeding. Human milk is a source of various hormones and growth factors, namely adipokines (leptin and adiponectin), ghrelin, resistin and obestatin, which are involved in food intake regulation and energy balance. These compounds are either not found in commercial milk formulas or their presence is still controversial. Diet‐related differences during infancy in serum levels of factors involved in energy metabolism might explain anthropometric differences and also differences in dietary habits between breast‐fed (BF) and formula‐fed (FF) infants later in life, and may thus have long‐term health consequences. In this context, the recent finding of higher leptin levels and lower ghrelin levels in BF than in FF infants suggests that differences in hormonal values together with different protein intake could account for the differences in growth between BF and FF infants both during infancy and later in life. In this review, we examine the data related to hormones contained in mothers’ milk and their potential protective effect on subsequent obesity and metabolic‐related disorders.

Leptin levels in breast‐fed and formula‐fed infants

Aim: Leptin, a hormone that regulates food intake and energy metabolism, is present in breast milk and thus may be involved in body composition differences between breastfed and formula‐fed infants. The aim of this study was to evaluate whether diet and gender affect plasma leptin concentration in breastfed and formula‐fed infants during the first months of life. Methods: Anthropometric and bioelectrical impedance measurements [total body water (TBW) calculated with the Fjeld equation] were made and venous blood plasma samples were analysed for leptin concentration in healthy, exclusively breastfed or formula‐fed Italian infants in the first year of life. Infants were subdivided in two ways: three groups (periods) in relation to age, and five groups in relation to weight. Results: The average serum concentration of leptin was 7.35 ng ml‐1. Serum leptin values were higher in breastfed than in formula‐fed infants. Breastfed infants in group 1 had a statistically higher serum leptin concentration (2500–3749 g). There were no significant differences in anthropometric measurements, body mass index or skinfold thickness between breastfed and formula‐fed infants. In the periods I and II, breastfed infants had a significantly higher TBW than formula‐fed infants. Males had a significantly higher TBW than females in periods I and II. Breastfed infants in group 2 (3750–4999 g) had a significantly higher TBW than formula‐fed infants.

Minor feeding problems during the first months of life: effect of a partially hydrolysed milk formula containing fructo- and galacto-oligosaccharides.

Background: Colic, regurgitation and constipation are common feeding problems in formula‐fed infants that might benefit from dietary treatment. A formula containing fructo‐ and galacto‐oligosaccharides, partially hydrolysed proteins, low levels of lactose and palmitic acid in the β position and higher density has been tested to reduce the occurrence of these symptoms. The aim of this prospective study was to describe the effects of such a formula in infants with minor gastrointestinal disorders. Methods: An observational prospective trial involving practising Italian paediatricians was performed. Formula fed‐infants up to 90 d of age with minor gastrointestinal problems such as infantile colics and/or regurgitation and/or constipation were enrolled in the study from January 2001 to May 2001. The study was completed within 14 d of treatment. On days 1, 7 and 14 the infants were visited by the paediatricians. Parents were given a structured diary to record daily episodes of colic, regurgitation and type and number of stools. Results: Of the 932 infants enrolled, 604 completed the study. Of the 214 infants with colic, 169 (79%) demonstrated a reduction in frequency of colic from 4.1 ± 2.0 per day at the beginning of the study to 2.0 ± 1.8 at the end of the study (I.C. 95%: 1.72–2.39; p < 0.005). A reduction in the number of episodes of colic of 1.8 per day at the beginning of the study (I.C. 95%: 1.49–2.11; p < 0.05) was recorded between day 1 and day 7, and of 0.26 (I.C. 95%: 0.15–0.37; p < 0.05) between day 7 and day 14. Of the 201 infants with regurgitation problems, 141 (70%) demonstrated a reduction of frequency of the symptoms from 4.2 ± 2.0 per day at the beginningof the study to 2.1 ± 2.2 at the end of the study (I.C. 95%: 1.75–2.35; p < 0.005). A reduction of 1.87 in the number of regurgitation episodes was reported between day 1 and day 7 (I.C. 95%: 1.57–2.16; p < 0.05) and of 0.18 (I.C. 95%: 0.06–0.31; p < 0.05) between day 7 and day 14. Of the 232 infants with constipation, 147 (63%) demonstrated an increase in the daily number of stools of 0.42 (I.C. 95%: 0.5–0.3; p < 0.005). An increase in stool frequency of 0.41 (I.C. 95%: 0.51–0.23; p < 0.05) was reported between day 1 and day 7, and of 0.04 (I.C. 95%: 0.22–0.14; p= ns) between day 7 and day 14. Parents’evaluation of the formula was 7.9 ± 1.8 (score 0–10); 550 parents (91%) gave a positive judgement (score >6). The evaluation by the paediatricians of the improvement in symptoms after the treatment was 8.2 ± 1.5; 574 (95%) a positive effect (score >6).