Infant Colic Crying and Gastrointestinal Tract – Causes, Consequences and Cure

Despite over 50 years of investigation, the precise cause of infant colic crying remains unresolved and the long-term consequences unrevealed, and an effective treatment is lacking. Indeed, a more profound understanding of the complex nature of infants’ excessive crying is needed. The purpose of this series of studies was to investigate the association between gut microbiota composition and infant crying, to evaluate the impact of colic crying on children’s later health and to study the possibilities of treating and preventing excessive crying with pro- and prebiotics. The material comprised three on-going, prospective randomized controlled trials of the probiotic Lactobacillus rhamnosus GG (ATCC 53103, LGG) or a mixture of prebiotics administered in early infancy. The study populations consisted of term infants (n=89), preterm infants (n=94) and term colic infants (n=30). Early crying was found to be inversely associated with the number of Bifidobacterium and Lactobacillus. Furthermore, at the age of 13 years functional gastrointestinal disorders (FGID) were manifested more frequently among children with previous colic crying than in those without. In preterm infants pro- and prebiotic supplementation during the first months of life reduced the frequency of excessive crying when compared to placebo. In parallel, probiotic LGG in tandem with a cow’s milk elimination diet and behavioral counseling reduced the daily crying amount among term colic infants when compared to placebo. In conclusion, the composition of the gut microbiota is associated with infant crying and colic, and probiotic LGG might provide a safe and effective treatment or preventive option to alleviate excessive crying in early infancy in term and preterm infants. Furthermore, early colic crying might be associated with the later development of FGID.Imeväisen koliikki-itku ja gastrointestinaalikanava – syyt, seuraukset ja hoito Koliikki-itkulle ei ole pystytty yli 50 vuoden tutkimuksesta huolimatta löytämään yksiselitteistä syytä, eikä kontrolloiduissa tutkimuksissa ole pystytty osoittamaan tehokasta hoitomuotoa. Koliikin pitkäaikaisvaikutukset terveydelle ovat myös yhä osittain tuntemattomia. Näin ollen tarkempaa tutkimustietoa koliikin syystä, pitkäaikaisvaikutuksista sekä hoidosta tarvitaan vielä. Tämän tutkimuksen tarkoituksena oli selvittää suolistomikrobiston ja itkun yhteyttä, tutkia koliikkiitkun pitkäaikaisia vaikutuksia terveydelle sekä selvittää pro- ja prebioottien tarjoamaa mahdollisuutta vähentää ja ennaltaehkäistä koliikki-oireita. Väitöskirjan aineisto koostui kolmesta etenevästä, kaksoissokkoutetusta probiootti- tai prebiootti-interventiotutkimuksesta. Tutkimuspotilaat olivat täysiaikaisena syntyneitä lapsia (n=89), ennenaikaisina syntyneitä lapsia (n=94) sekä täysiaikaisina syntyneitä koliikki-lapsia (n=30). Tämän väitöskirjan tulokset osoittivat, että lapsen varhaisen itkun määrä on käänteisesti yhteydessä suoliston bifidobakteerien ja laktobasillien määrään. Varhainen koliikki-itku ennakoi teini-iässä esiintyviä toiminnallisia vatsavaivoja. Keskoslapsilla varhainen pro- ja prebioottilisä vähensi itkun esiintymistä ensimmäisen kahden elinkuukauden aikana. Myös täysiaikaisilla koliikkilapsilla probiootti Lactobacillus rhamnosus GG (ATCC 53103, LGG) vähensi päivittäistä koliikki-itkun määrää verrattuna lumevalmisteeseen. Tutkimuksen johtopäätöksenä voidaan todeta, että suolistomikrobiston koostumus on yhteydessä varhaiseen itkun määrään ja koliikkiin. Probiootti LGG tarjoaa mahdollisesti turvallisen ja tehokkaan tavan vähentää tai ennaltaehkäistä imeväisen itkuisuutta sekä täysiaikaisilla että ennenaikaisina syntyneillä lapsilla. Lisäksi varhainen koliikki-itku saattaa ennakoida myöhemmällä iällä ilmeneviä toiminnallisia vatsavaivoja.Siirretty Doriast

Compositional Development of Bifidobacterium and Lactobacillus Microbiota Is Linked with Crying and Fussing in Early Infancy

OBJECTIVES: Our aim was to establish whether there is an interconnection between the compositional development of the gut microbiota and the amount of fussing and crying in early infancy. METHODS: Behavioral patterns of 89 infants during the 7(th) and 12(th) week of life were recorded in parental diaries. Total distress was defined as the sum of daily amounts of crying and fussing. Infants' gut microbiota profiles were investigated by several molecular assays during the first six months of life. RESULTS: The median (range) duration of total distress among the infants was 106 (0-478) minutes a day during the 7(th) and 58 (0-448) minutes a day during the 12(th) week. The proportion of Bifidobacterium counts to total bacterial counts was inversely associated with the amount of crying and fussing during the first 3 months of life (p = 0.03), although the number of Bifidobacterium breve was positively associated with total distress (p = 0.02). The frequency of Lactobacillus spp. at the age of 3 weeks was inversely associated with total infant distress during the 7(th) week of life (p = 0.02). CONCLUSIONS: Bifidobacterium and Lactobacillus appear to protect against crying and fussing. Identification of specific strains with optimal protective properties would benefit at-risk infants

Probiotics on Pediatric Functional Gastrointestinal Disorders

The potential association between gut microbiota perturbations and childhood functional gastrointestinal disturbances opens interesting therapeutic and preventive possibilities with probiotics. The aim of this review was to evaluate current evidence on the efficacy of probiotics for the management of pediatric functional abdominal pain disorders, functional constipation and infantile colic. Thus far, no single strain, combination of strains or synbiotics can be recommended for the management of irritable bowel syndrome, functional abdominal pain or functional constipation in children. However, Lactobacillus reuteri DSM 17938 may be considered for the management of breastfed colic infants, while data on other probiotic strains, probiotic mixtures or synbiotics are limited in infantile colic

Probiotics on Pediatric Functional Gastrointestinal Disorders

The potential association between gut microbiota perturbations and childhood functional gastrointestinal disturbances opens interesting therapeutic and preventive possibilities with probiotics. The aim of this review was to evaluate current evidence on the efficacy of probiotics for the management of pediatric functional abdominal pain disorders, functional constipation and infantile colic. Thus far, no single strain, combination of strains or synbiotics can be recommended for the management of irritable bowel syndrome, functional abdominal pain or functional constipation in children. However, Lactobacillus reuteri DSM 17938 may be considered for the management of breastfed colic infants, while data on other probiotic strains, probiotic mixtures or synbiotics are limited in infantile colic

Reversible aberrancies in gut microbiome of moderate and late preterm infants: results from a randomized, controlled trial

ABSTRACTThe aim of this study was to obtain insight into the composition and function of the deviant gut microbiome throughout infancy in children born moderately and late preterm and their response to microbiome modulation. We characterized the longitudinal development of the gut microbiome from birth to the age of 12 months by metagenomic sequencing in 43 moderate and late preterm children participating in a randomized, controlled trial (ClinicalTrials.gov/no.NCT00167700) assessing the impact of a probiotic (Lactobacillus rhamnosus GG, ATCC 53,103, currently Lacticaseibacillus rhamnosus GG) and a prebiotic (galacto-oligosaccharide and polydextrose mixture, 1:1) intervention as compared to a placebo administered from 3 to 60 days of life. In addition, 9 full-term, vaginally delivered, breast-fed infants, who remained healthy long-term were included as references. Significant differences in taxonomy, but not in functional potential, were found when comparing the gut microbiome composition of preterm and full-term infants during the first month of life. However, the gut microbiome of preterm infants resembled that of full-term infants by 6 months age. Probiotic and prebiotic treatments were found to mitigate the shift in the microbiome of preterm infants by accelerating Bifidobacteria-dominated gut microbiome in beta diversity analysis. This study provides intriguing information regarding the establishment of the gut microbiome in children born moderately and late preterm, representing the majority of children born preterm. Specific pro- and prebiotics may reverse the proinflammatory gut microbiome composition during the vulnerable period, when the microbiome is low in resilience and susceptible to environmental exposure and simultaneously promotes immunological and metabolic maturation

Clinical characteristics of the study subjects.

<p>Results are given as mean (SD) or median (range) or as number (%) of subjects, if not otherwise stated.</p><p>*n = 85.</p

The amount (minutes/day; median with range) of fussing and crying, and total distress reported by parents during the 7^th and 12^th weeks of life.

<p>*Fussing was defined as a state of irritability, “not quite crying but not awake and content”.</p>†<p>Other cry was defined as crying responsive to intervention (feeding, change of diaper, carrying, sucking a pacifier); colic-type cry was defined as a cry not responsive to such intervention.</p>‡<p>The sum of colic type, other cry, and fussing reported by parents.</p

The frequency of <i>Bifidobacterium spp</i>. by PCR-DGGE during the first 6 months of life.

*<p><i>B. catenulatum</i> group includes <i>B. catenulatum</i> and <i>B. pseudocatenulatum</i>.</p><p>N.D. not detected.</p

Neonatal and early infancy antibiotic exposure is associated with childhood atopic dermatitis, wheeze and asthma

Antibiotics are frequently administered in the neonatal period and early infancy. Little is known about the long-term health consequences of early life antibiotic exposure. The objective is to investigate the association between neonatal and early life (0–6 months) antibiotic treatment and the development of atopic dermatitis, asthma and the use of inhaled corticosteroid medication later in childhood. We analyzed data obtained from hospital records and national registers in a cohort of 11,255 children. The association between early antibiotic exposure and the outcomes were analyzed using logistic regression. Confounding factors were included in the model. Neonatal antibiotic therapy for confirmed infection was associated with childhood atopic dermatitis (adjusted odds ratio 1.49; 95% confidence interval 1.15–1.94). Antibiotic therapy by six months of age was more common in children developing atopic dermatitis (adjusted odds ratio 1.38; 95% confidence interval 1.15–1.64), asthma (adjusted odds ratio 1.56; 95% confidence interval 1.32- 1.85) and inhaled corticosteroid medication use (adjusted odds ratio 1.88; 95% confidence interval 1.66–2.13). Conclusions: Neonatal antibiotic therapy for confirmed or clinically diagnosed infection is associated with increased risk of atopic dermatitis later in childhood. Antibiotic treatment before six months of age is associated with atopic dermatitis, asthma and inhaled corticosteroid use. (Table presented.)Peer reviewe