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HomePediatricsEfficacy of Probiotics in Preventing Infantile Colic
Efficacy of Probiotics in Preventing Infantile Colic
dr.Tubagus 4:40 PM
The benefits of probiotics in preventing infantile colic are still controversial because scientific evidence regarding their efficacy is inconsistent. Infantile colic is episodes of full-forces crying, at least jam 3 hours per day, and occurs ≥ three days per week for at least three weeks in healthy infants. Meanwhile, probiotics are living microorganisms that affect host microflora and have health benefits.
Currently, using probiotics is increasing because these are believed to improve health quality, especially in the digestive system. Several studies have shown that gut flora in colic infants is different from healthy infants. Therefore giving probiotics is thought to improve this balance and prevent colic. The most commonly used probiotics are Lactobacillus, Bifidobacterium, and Streptococcus.
The diagnosis of infantile colic can be made through the patient's clinical history after excluding other possible causes. Many theories have emerged to explain the causes of infantile colic, including the presence of gas, gastroesophageal reflux, food allergies, milk protein intolerance, intestinal dyspotility, and maternal tension. However, the cause of infantile colic is likely multifactorial.
Because the etiology is still unclear, various governance regimes emerge and study the benefits for infantile colic. First-line therapy includes calming and intervening in behavior. The intervention can be done in many ways, such as effective swaddling, gently rocking, and reducing the stimulation in infants. Remind parents not to shake their babies too hard, and to take care of themselves, so they are not too tired or stressed.
Elimination diets in nursing mothers and formula changes in infants who suckle from a bottle can also be tried in infantile colic management. Although several studies have shown the benefits of eliminating diets from breastfeeding mothers, this effect is not found in all patients. Monitor the mother's diet, and continue eliminating the diet only if there are clear benefits.
Theory of The Benefits of Probiotics for the Prevention of Infantile Colic
The action mechanisms of probiotics in preventing infantile colic are unknown. A study shows that the administration of probiotics early in life can prevent gastrointestinal functional problems. This process seems to be mediated by activity in the intrinsic sensory neurons of the colon with increased intestinal motility, as well as having a positive effect on visceral function and pain.
Probiotics such as Bifidobacteria show anti-inflammatory properties in vitro and the ability to inhibit the growth of coliform, which has a significant amount in colic infants. Some probiotics can also work directly on bacterial growth through bacteriocin production and final fermentation products.
Efficacy of Probiotics for the Prevention of Infantile Colic
In 2013, Partty et al. published a randomized and placebo-controlled randomized control trial (RCT) to evaluate the effects of early probiotic and prebiotic administration on the level of fussiness and crying in preterm infants. The study involved 94 premature infants (32-36 weeks gestational age, birth weight> 1500 g) randomized to receive a mixture of galactooligosaccharides and polydextrose, L. rhamnosus GG, or placebo, during the first two months of life. After that, monitoring was performed at ages 1, 2, 4, 6, and 12 months. Compared with the placebo group, the prebiotic and probiotic groups showed less frequent excessive crying. This study concluded that giving probiotics and prebiotics early can reduce the symptoms that cause crying and fussing in premature babies.
Another 2014 RCT conducted on 589 breastfed infants and formula milk, found that daily administration of L. reuteri DSM 17938 from the age of 3 days for 90 days resulted in a significant reduction in the average crying time. This reduction was obtained almost 51 minutes per day at one month of age and 33 minutes per day at three months of age.
In contrast to these two studies, several recent studies have found that probiotics are not effective in reducing symptoms of infantile colic. In a placebo-controlled double-blind RCT conducted in Australia, it was reported that the administration of L. reuteri DSM 17938 was ineffective in the management of infantile colic. This finding was later replicated in another experiment, which found that L. reuteri DSM 17938, although safe, did not significantly reduce crying time, plasma bicarbonate, or inflammatory markers.
Cochrane published a systematic review of this in March 2019. This review analyzed six studies, of which two studies used Lactobacillus reuteri, two studies using multistrain probiotics, one study using Lactobacillus rhamnosus, and another study using Lactobacillus paracasei and Bifidobacterium animalis. Two studies used probiotics from the time of pregnancy until after the baby was born.
This review found that, compared to placebo, probiotics had little or no effect on the appearance of infantile colic. However, probiotics seem to reduce crying time. Of all the studies analyzed, there were no significant differences in side effects. Four serious side effects were reported in one large study, but most likely were not related to the impact of the intervention.
1. Turner TL, Palamountain S. Infantile Colic: Management and Outcome. UpToDate, 2019. https://www.uptodate.com/contents/infantile-colic-management-and-outcome
2. Cohen GM, Albertini LW. Colic. Pediatrics in Review, 2012. 33(7), 332–333. doi:10.1542/pir.33-7-332
3. Ong TG, Gordon M, Banks SSC, Thomas MR, Akobeng AK. Probiotics to prevent infantile colic. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012473. DOI: 10.1002/14651858.CD012473.pub2.
4. Savino F, Quartieri A, De Marco A, et al. Comparison of formula-fed infants with and without colic revealed significant differences in total bacteria, Enterobacteriaceae and fecal ammonia. Acta Paediatr. 2016;106(4):573–578
5. Indrio F et al. Prophylactic use of a probiotic in the prevention of colic, regurgitation, and functional constipation: A randomized clinical trial. JAMA Pediatr. 2014;168(3): 228-33.
6. Guandalini S et al. VSL#3 improves symptoms in children with irritable bowel syndrome: A multicenter, randomized, placebo-controlled, double-blind, crossover study. J Pediatr Gastroenterol Nutr. 2010;51(1):24-30.
7. Sanders ME. Impact of probiotics on colonizing microbiota of the gut. J Clin Gastroenterol. 2011;45 Suppl:S115-9.
8. Pärtty A et al. Effects of early prebiotic and probiotic supplementation on development of gut microbiota and fussing and crying in preterm infants: A randomized, double-blind, placebo-controlled trial. J Pediatr. 2013;163(5):1272-7. e2.
10. Sung V, Hiscock H, Tang ML, Mensah FK, Nation ML, Satzke C, et al. Treating infant colic with the probiotic Lactobacillus reuteri: double-blind, placebo-controlled randomized trial. BMJ 2014;348:g2107. 10.1136/bmj.g2107
11. Fatheree NY, Liu Y, Taylor CM, Hoang TK, Cai C, Rahbar MH, et al. Lactobacillus reuteri for infants with colic: a double-blind, placebo-controlled, randomized clinical trial. J Pediatr 2017;191:170-178.e2. 10.1016/j.jpeds.2017.07.036
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