Abstract
A newborn brings joy to the family. Crying belongs to the spectrum of normal behaviour of young infants. However, although it occurs in about 20% of all infants, unsoothable and persistent crying in young infants distresses the family, although it is usually benign. The aetiology of infantile colic remains unknown, although an unbalanced gastro-intestinal microbiome, increased intestinal permeability, and chronic inflammation are involved, as well as behavioural factors, including over- and under-stimulation. It is a challenge for healthcare professionals to decide when organic disease needs to be excluded. Parental stress is a reason for babies to cry more, inducing a vicious cycle. Therefore, parental reassurance with explanatory guidance is the cornerstone of management. The placebo effect is estimated to be as high as 50%. If an intervention is felt to be necessary to offer further support to the baby and family, it is important to choose the options for which there is some efficacy without adverse effects. There is evidence that some specific probiotic strains such as Lactobacillus reuteri DSM 19378, especially in breastfed infants, are effective. However, there are also promising data for some synbiotics and/or killed or tyndallized bacteria, as well as substances decreasing intestinal permeability. Formula management with extensive and/or partial hydrolysates may also bring relief. But, above all, offering parental support remains imperative.
Highlights
Infantile colic represents a major cause of discomfort and distress for the infant, caregivers, and even healthcare providers
Analysis of response rates showed that infants receiving L. reuteri DSM 17938 had a 2.3-fold greater chance of having a 50% or greater decrease in crying/fussing time compared to controls[40]
The combination of formula fermented with B. breve and S. thermophilus (Lactofidus) in combination with prebiotic short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides resulted in a lower overall crying time and a lower incidence of infantile colic in healthy term infants[60]
Summary
Infantile colic represents a major cause of discomfort and distress for the infant, caregivers, and even healthcare providers. Tyndallized probiotics L. reuteri SGL01 100 × 109 colonyforming units (CFU)/g and B. breve SGB01 100 × 109 CFU/g were recently compared to lactase in a clinical trial[53] Both interventions reduced crying time, which may be related to the placebo effect or to the fact that both interventions are effective, but APT198K decreased the mean duration per crying episode significantly more than a lactase dietary supplement in infants with colic[53]. The combination of formula fermented with B. breve and S. thermophilus (Lactofidus) in combination with prebiotic short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides resulted in a lower overall crying time and a lower incidence of infantile colic in healthy term infants[60] These data suggest that killed bacteria might be effective as well. The symptoms of regurgitation, constipation, and infant crying and colic were decreased with a formula containing intact protein and synbiotics (fructo-oligosaccharides and B. lactis)[61]
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