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Probiotics for infantile colic: a systematic review.

Anabrees J, Indrio F, Paes B, AlFaleh K - BMC Pediatr (2013)

Bottom Line: The objectives of this systematic review are to evaluate the efficacy of probiotic supplementation in the reduction of crying time and successful treatment of infantile colic.Similarly, probiotics compared to placebo significantly increased the treatment success of infantile colic with a relative risk (RR) of 0.06; 95% CI (0.01, 0.25) and a number needed to treat of 2.Results from larger rigorously designed studies will help draw more definitive conclusions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neonatal Care, Sulaiman Al Habib Medical Group, Arrayan Hospital, P,O, Box 272069, Riyadh, 11352, Saudi Arabia. jasim1800@yahoo.com.

ABSTRACT

Background: Infantile colic is a common paediatric condition which causes significant parental distress. Increased intestinal coliform colonization in addition to alteration in Lactobacillus abundance and distribution may play an important role in its pathogenesis. The objectives of this systematic review are to evaluate the efficacy of probiotic supplementation in the reduction of crying time and successful treatment of infantile colic.

Methods: Literature searches were conducted of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. Only randomized controlled trials enrolling term, healthy infants with colic were included. A meta-analysis of included trials was performed utilizing the Cochrane Collaboration methodology.

Results: Three trials that enrolled 220 breastfed infants met inclusion criteria, of which 209 infants were available for analysis. Two of the studies were assessed as good quality. Lactobacillus reuteri (strains-American Type Culture Collection Strain 55730 and DSM 17 938) was the only species utilized in the therapeutic intervention. Two of the trials were industry funded. Probiotic supplementation compared to simethicone or placebo significantly and progressively shortened crying times to 7 days reaching a plateau at three weeks post initiation of therapy [mean difference -56.03 minutes; 95% CI (-59.92, -52.15)]. Similarly, probiotics compared to placebo significantly increased the treatment success of infantile colic with a relative risk (RR) of 0.06; 95% CI (0.01, 0.25) and a number needed to treat of 2.

Conclusions: Although L. reuteri may be effective as a treatment strategy for crying in exclusively breastfed infants with colic, the evidence supporting probiotic use for the treatment of infant colic or crying in formula-fed infants remains unresolved. Results from larger rigorously designed studies will help draw more definitive conclusions.

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Forest plot of L. reuteri ATCC 55730 and L. reuteri DSM 17938 versus control effect in improving infantile colic treatment success rate over 28 days.
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Figure 3: Forest plot of L. reuteri ATCC 55730 and L. reuteri DSM 17938 versus control effect in improving infantile colic treatment success rate over 28 days.

Mentions: The overall response rate of L. reuteri was compared to simethicone or placebo. Responders (or treatment success) was defined as the percentage of infants achieving a reduction in the daily average crying time of more than fifty percent. The response rate was reported in two of the trials at each assessment interval. Savino et al. reported the response rate at 28 days only [24]. A progressive, statistically significant response was noted starting at 7 days [25] after initiation of therapy (Figure 3). The effect was maximal at 21 days following the commencement of treatment, with a relative risk (RR) of 0.06; 95% CI (0.01, 0.25) and a number needed to treat (NNT) of 2. Of note, a similar progressive improvement was also evident in the control subjects; however, the positive effect was more pronounced in the probiotic group.


Probiotics for infantile colic: a systematic review.

Anabrees J, Indrio F, Paes B, AlFaleh K - BMC Pediatr (2013)

Forest plot of L. reuteri ATCC 55730 and L. reuteri DSM 17938 versus control effect in improving infantile colic treatment success rate over 28 days.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4225660&req=5

Figure 3: Forest plot of L. reuteri ATCC 55730 and L. reuteri DSM 17938 versus control effect in improving infantile colic treatment success rate over 28 days.
Mentions: The overall response rate of L. reuteri was compared to simethicone or placebo. Responders (or treatment success) was defined as the percentage of infants achieving a reduction in the daily average crying time of more than fifty percent. The response rate was reported in two of the trials at each assessment interval. Savino et al. reported the response rate at 28 days only [24]. A progressive, statistically significant response was noted starting at 7 days [25] after initiation of therapy (Figure 3). The effect was maximal at 21 days following the commencement of treatment, with a relative risk (RR) of 0.06; 95% CI (0.01, 0.25) and a number needed to treat (NNT) of 2. Of note, a similar progressive improvement was also evident in the control subjects; however, the positive effect was more pronounced in the probiotic group.

Bottom Line: The objectives of this systematic review are to evaluate the efficacy of probiotic supplementation in the reduction of crying time and successful treatment of infantile colic.Similarly, probiotics compared to placebo significantly increased the treatment success of infantile colic with a relative risk (RR) of 0.06; 95% CI (0.01, 0.25) and a number needed to treat of 2.Results from larger rigorously designed studies will help draw more definitive conclusions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neonatal Care, Sulaiman Al Habib Medical Group, Arrayan Hospital, P,O, Box 272069, Riyadh, 11352, Saudi Arabia. jasim1800@yahoo.com.

ABSTRACT

Background: Infantile colic is a common paediatric condition which causes significant parental distress. Increased intestinal coliform colonization in addition to alteration in Lactobacillus abundance and distribution may play an important role in its pathogenesis. The objectives of this systematic review are to evaluate the efficacy of probiotic supplementation in the reduction of crying time and successful treatment of infantile colic.

Methods: Literature searches were conducted of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. Only randomized controlled trials enrolling term, healthy infants with colic were included. A meta-analysis of included trials was performed utilizing the Cochrane Collaboration methodology.

Results: Three trials that enrolled 220 breastfed infants met inclusion criteria, of which 209 infants were available for analysis. Two of the studies were assessed as good quality. Lactobacillus reuteri (strains-American Type Culture Collection Strain 55730 and DSM 17 938) was the only species utilized in the therapeutic intervention. Two of the trials were industry funded. Probiotic supplementation compared to simethicone or placebo significantly and progressively shortened crying times to 7 days reaching a plateau at three weeks post initiation of therapy [mean difference -56.03 minutes; 95% CI (-59.92, -52.15)]. Similarly, probiotics compared to placebo significantly increased the treatment success of infantile colic with a relative risk (RR) of 0.06; 95% CI (0.01, 0.25) and a number needed to treat of 2.

Conclusions: Although L. reuteri may be effective as a treatment strategy for crying in exclusively breastfed infants with colic, the evidence supporting probiotic use for the treatment of infant colic or crying in formula-fed infants remains unresolved. Results from larger rigorously designed studies will help draw more definitive conclusions.

Show MeSH
Related in: MedlinePlus