Probiotics to Prevent or Treat Excessive Infant Crying

Abstract

IMPORTANCE Excessive infant crying is common, distressing, but without proven effective prevention or management options. Probiotics may be a promising solution. OBJECTIVE To examine whether probiotics are effective in the prevention/management of crying ("colic") in infants 3 months or younger. DATA SOURCES A systematic search of MEDLINE, EMBASE, and the Cochrane Library, supplemented by the metaRegister of Controlled Trials. STUDY SELECTION Studies that randomized infants 3 months or younger to oral probiotics vs placebo or no or standard treatment with the outcome of infant crying, measured as the duration or number of episodes of infant crying/distress or diagnosis of "infant colic." Twelve of the 1180 initially identified studies were selected. DATA EXTRACTION AND SYNTHESIS This review/meta-analysis was conducted according to guidelines from the Cochrane Handbook for Systematic Reviews of Interventions, with reporting following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Data were independently extracted by 3 of us. MAIN OUTCOME(S) AND MEASURE(S) Infant crying, measured as the duration or number of episodes of infant crying/distress, or diagnosis of "infant colic." RESULTS Of the 12 trials (1825 infants) reviewed, 6 suggested probiotics reduced crying, and 6 did not. Three of the 5 management trials concluded probiotics effectively treat colic in breastfed babies; 1 suggested possible effectiveness in formula-fed babies with colic, and 1 suggested ineffectiveness in breastfed babies with colic. Meta-analysis of 3 small trials of breastfed infants with colic found that Lactobacillus reuteri markedly reduced crying time at 21 days (median difference, -65 minutes/d; 95% CI, -86 to -44). However, all trials had potential biases. Meanwhile, of 7 prevention trials, 2 suggested possible benefits. Considerable variability in the study populations, study type, delivery mode/dose of probiotic supplementation, and outcomes precluded meta-analysis. CONCLUSIONS AND RELEVANCE Although L reuteri may be effective as treatment for crying in exclusively breastfed infants with colic, there is still insufficient evidence to support probiotic use to manage colic, especially in formula-fed infants, or to prevent infant crying. Results from larger rigorously designed studies applicable to all crying infants will help draw more definitive conclusions.

Effect of Probiotics on Central Nervous System Functions in Animals and Humans: A Systematic Review

“…To date, there are a few reviews on probiotic effects on infantile colic, which may reflect peripheral nervous system action, and one recent study reviewing only human studies. [64][65][66] Similarly, among the 56 RCTs so far which tested probiotics in adults with IBS that have or have not shown effects on peripheral (bowel) functions, 15 none have investigated whether any CNS effect was affected or improved. We identified studies applying probiotics as single-or multiple-strain preparations in animals and humans.…”

Treating infant colic with the probiotic Lactobacillus reuteri: double blind, placebo controlled randomised trial

“…[26][27][28][29][30] A recent meta-analysis of three small, randomised controlled trials of breastfed infants with colic reported that Lactobacillus reuteri noticeably reduced crying time at 21 days post supplementation. 31 However, one trial was unblinded, 32 two included only infants with mothers on dairy-free diets, 32 33 and none used validated measures of infant distress. No trials have included formula fed infants, which is relevant because colic is associated with early breastfeeding cessation.…”

Importancia de la microbiota gastrointestinal en pediatría

“…44 Estudios recientes han mostrado una diferencia en la microbiota de lactantes con y sin cólico [45][46][47] lo que podría explicar los cambios que causa esta patología: inflamación, producción de gas, distensión y alteración en la motilidad intestinal. 48 En una revisión sistemática realizada por Valerie Sung y sus colegas, en un meta-análisis de tres estudios, se encontró una marcada reducción en el llanto en un tiempo de 21 días en pacientes alimentados al seno materno con cólico infantil utilizando Lactobacillus reuteri; 49 sin embargo, se concluye que aún deben hacerse más estudios al respecto.…”