Infantile colic

Abstract

Najjednostavnija definicija dojenačkih kolika jest da je to ničim izazvano neutješno plakanje djeteta koje se ponavlja u prvim mjesecima života, a između tih epizoda dojenče je u potpunosti zdravo. Osim neutješnog plača često se istodobno javljaju crvenilo lica, distenzija trbuha i privlačenje nogu prema trbuhu. Tipične dojenačke kolike najjače su kasno popodne i navečer (18 – 23 sata). Dojenačke su kolike uglavnom benigno, samoograničavajuće stanje. Pojavljuju se u 5 – 19% dojenčadi, najčešće s 6 tjedana starosti i spontano prestaju u dobi od 3 do 6 mjeseci. Incidencija je jednaka u oba spola i nema povezanosti s načinom hranjenja, gestacijskom dobi ili socioekonomskim statusom. Uzrok dojenačkih kolika nije poznat, a najzastupljenije hipoteze o etiologiji dojenačkih kolika su gastrointestinalna, neurorazvojna i psihosocijalna hipoteza. Zbog oprečnih rezultata brojnih provedenih istraživanja, na ovom su području potrebna daljnja istraživanja kako bi se točno utvrdio razlog i etiopatogeneza njihove pojave. Prema trenutno važećim preporukama, tzv. IV. rimskim kriterijima, dijagnoza se postavlja temeljem pažljive anamneze i fizikalnog pregleda, u djeteta s karakterističnom kliničkom slikom, a bez dodatnih simptoma i tzv. znakova upozorenja koji bi upućivali na neki od organskih uzroka neutješnog plača dojenčeta. U liječenju kolika presudno je da liječnik razumije roditeljsku zabrinutost, umiri ih i pruži adekvatnu potporu. Iskušane su i brojne metode liječenja, no osim antikolinergičkih lijekova i probiotika Lactobacillus reuteri DSM 17938, drugi pripravci nisu djelotvorniji od placeba. Simetikon i inhibitori protonske pumpe nisu učinkoviti, a diciklomin je kontraindiciran. Nema znanstvenih dokaza o učinkovitosti akupunkture, kiropraktike i biljnih suplemenata.The simplest definition of infantile colic is a state of non-provoked inconsolable crying of an infant in the first few months of life, with the infant being completely healthy between those episodes. Besides inconsolable crying, other signs include facial redness, abdominal distension and traction of legs towards abdomen at the same time. Typical infantile colic mostly occur in the late afternoon and evening (between 6 pm and 11 pm). Infantile colic is usually a benign, self-limited condition. It affects approximately 5 – 19% of infants and peaks around six weeks of age, with symptoms resolving by three to six months of age. The incidence is equal between sexes, and there is no correlation with type of feeding, gestational age, or socioeconomic status. The cause of infantile colic is unknown and the most common hypotheses trying to explain ethiology of infantile colic are gastrointestinal, neurodevelopmental and psychosocial hypothesis. Due to presence of contrary results of numerous conducted studies, further research is needed to clarify the cause and etiopathogenesis of this phenomenon. According to the up to date recommendations, the so called The Rome IV Criteria, the diagnosis is based on precise medical history and physical examination of an infant presenting with typical clinical features, without warning signs and symptoms which would draw attention to some of the organic causes of inconsolable crying in infants. It is necessary for the doctor to understand the parental concern and show them support. Various methods have been tested, but only anticholinergic drugs and Lactobacillus reuteri DSM 17938 probiotic showed some efficacy; other medications do not differ from placebo. Simethicone and proton pump inhibitors are ineffective for the treatment of colic, and dicyclomine is contraindicated. Evidence does not support acupuncture, chiropractic manipulation or herbal supplements