Probiotic drops may help ward off colic, GI disorders in infants

By Megan Brooks

NEW YORK (Reuters Health) - Giving an infant probiotic drops during the first three months of life might help guard against gastrointestinal disorders, hints a study from Italy.

Infant colic, acid reflux and constipation are the most common GI disorders that send new parents to their pediatrician during the first six months of life. The GI symptoms may lead not only to parental anxiety, but also hospitalization, feeding changes, and use of drugs.

Recent studies suggest a key role of the intestinal microbiota in the pathogenesis of gastrointestinal disorders, and many studies target probiotic therapy for specific conditions including colic, regurgitation, and constipation. The new study online today in JAMA Pediatrics adds to the evidence.

In a randomized controlled study, Dr. Flavia Indrio of the Aldo Moro University of Bari, Italy, and colleagues treated 554 newborns in nine pediatric units in Italy with the probiotic Lactobacillus reuteri DSM 17938 (L reuteri DSM 17938) or placebo for 90 days. Parents kept a diary of the number of vomiting episodes and bowel movements, the duration of inconsolable crying and the number of pediatrician visits.

After one month, infants receiving the probiotic had a significant decline in crying time and more bowel movements each day, compared with those receiving placebo, the investigators say. At the end of three months, infants in the probiotic group still had significantly less crying crying time (38 vs 71 minutes daily, p<0.01) and significantly more bowel movements (4.2 vs. 3.6 daily, p<0.01). They also had fewer episodes of regurgitations each day (mean 2.9 vs. 4.6, p<0.01). The probiotic was well tolerated and there were no adverse events reported.

The probiotic also saved money, by curbing health care resource and drug use and lost days from work by parents.

The researchers calculate that prophylactic use of L reuteri DSM 17938 led to an estimated average savings per infant of $119 for the family, even after taking into account the cost of the probiotic, and an additional savings of $140 for the community.

The researchers conclude, "Given the considerable burden of morbidity and the socioeconomic impact of early-life functional GI disorders, new research should urgently be initiated not only to validate our results but also to tailor optimal schemes of intervention."

"We need to identify the infant in which to use this preventive approach," Dr. Indrio told Reuters Health by email. "Including only siblings with colic is not enough. We are looking to find a more precise factor that could indicate the high risk infant. Meanwhile, I would suggest the use in all infant from the first day of life in order to prevent the onset of colic. This probiotic is widely available all over the world."

The co-authors of an editorial say the results of this study, which is much larger than prior similar studies, are "encouraging."

Dr. Bruno P. Chumpitazi and Dr. Robert J. Shulman from Baylor College of Medicine and Texas Children's Hospital in Houston note however that a systematic review and meta-analysis published last year in JAMA Pediatrics found that although probiotics show promise in the treatment and prevention of infantile colic, the evidence remains "insufficient" to support the general use of probiotics in all infants with colic or to recommend its use in preventing colic.

They point out that while studies on the use of probiotics for infantile colic have not identified adverse events to date, it's not clear how probiotic exposure in infancy may influence long-term health.

Given the potential role of the gut microbiome in a number of disorders including obesity and its ability to influence brain function, "their clinical use should be guided by well-done clinical studies. Ideally, participants should be reexamined several years after treatment to assess for potential long-term health consequences," they write.

Nonetheless, the study does "lend additional support to the potential use of L reuteri DSM 17938 for infantile colic. Perhaps there will come a time when medical providers will recommend 5 probiotic drops a day to keep infantile colic away," the authors conclude.

The study was supported by BioGaia AB, Sweden, which provided the probiotic and placebo. The company had no role in the design and conduct of the study, or collection, management, analysis, or interpretation of the data. The paper lists no disclosures for the study team.

SOURCE: http://bit.ly/1lWtmKt and http://bit.ly/1hjMMWO

JAMA Pediatrics 2014.

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