Infant colic: where is the line between norm and pathology, the role of disruption of the intestinal microbiome
https://doi.org/10.21518/2079-701X-2021-17-246-254
Abstract
Infant colic is one of the most common functional disorders of the gastrointestinal tract in children of the first year of life, worsening the condition of both the child himself and the psychological climate in the family. Infant intestinal colic is a multifactorial symptom complex that requires differential diagnosis between norm and pathology. Until now, there is no clear understanding of the criteria for the need for dietary and drug correction of this condition. The article presents an analysis of the modern literature on the problem of intestinal colic in infants The pathogenesis of functional intestinal colic is determined by a combination of reasons, including the immaturity of the central nervous system, hypothalamic-pituitary system, regulation of the intestinal innervation and the enzymatic system, a certain dependence on psychosocial factors has also been identified, the intestinal microflora has a great influence. H. Kianifar et al. (2014) in the findings of a study noted that a multiprobiotic (seven strains of probiotics and fructooligosaccharides) significantly improved colic symptoms, in particular a reduction in crying time, (82.6%) compared with placebo (35.7%) on day 7 of intake (p < 0.005). On day 30, treatment success was 87% and 46% in the synbiotics and placebo groups, respectively (p < 0.01). The results of a domestic study by I.N. Zakharova et al. (2016) multiprobiotic, which showed that after the use of a multistrain probiotic, intestinal colic remained in 3 (10%) children of the main group and in all children in the placebo group. After taking the probiotic, 80% of children showed normalization of stool, and in the placebo group, stool disorders (loose, watery stools or no stool with the need to empty after an enema) were recorded in 87% of children. Cases from clinical practice with experience of using a multistrain probiotic for colic are shown.
About the Author
L. D. PanovaRussian Federation
Luydmila D. Panova, Dr. Sci. (Med.), Assistant Professor, Professor of the Department of Hospital Pediatrics.
3, Lenin St., Ufa, 450008
References
1. BeLyaeva I.A., Namazova-Baranova L.S., Potekhina T.V. InfantiLe coLic: a new Look at an oLd probLem. Pediatria. 2015;94(1):137-144. (In Russ.) AvaiLabLe at: https://pediatriajournaL.ru/fiLes/upLoad/mags/344/2015_1_4212.pdf.
2. WesseL М.А., Cobb J.C., Jackson E.B., Harris G.S. Jr., DetwiLer A.C. ParoxysmaL fussing in infancy, sometimes caLLed сoLic. Pediatrics. 1954;14(5):421-435. AvaiLabLe at: https://pubmed.ncbi.nLm.nih.gov/13214956.
3. VandenpLas Y., Gutierrez-CastreLLon P., VeLasco-Benitez C., PaLacios J., Jaen D., Ribeiro H. et aL. PracticaL aLgorithms for managing common gastrointestinaL symptoms in infants. Nutrition. 2013;29(1):184-194. https://doi.org/10.1016/j.nut.2012.08.008.
4. Benninga S., Nurko M.A., Faure C., Hyman P.E., James Roberts I. St., Schechter N.L. ChiLdhood FunctionaL GastrointestinaL Disodrders: NeonateAoddLer. Gastroenterology. 2016;150(6):1443-1455. https://doi.org/10.1053/j.gastro.2005.11.065.
5. Cohen-SiLver J., RatnapaLan S. Management of infantiLe coLic: a review. Clin Pediatr. 2009;48(1):14-17. https://doi.org/10.1177/0009922808323116.
6. KoLetzko S., Niggemann B., Arato A., Dias J.A., HeuschkeL R., Husby S. et aL. European Society of Pediatric GastroenteroLogy, HepatoLogy and Nutrition. Diagnostic approach and management of cow-s-miLk protein aLLergy in infants and chiLdren: ESPGHAN GL Committee practicaL guideLines. J Pediatr Gastroenterol Nutr. 2012;55(2):221-229. https://doi.org/10.1097/MPG.0b013e31825c9482.
7. Miranda А. EarLy Life stress and pain: an important Link to functionaL boweL disorders. Pediatr Ann. 2009;38(5):279-282. AvaiLabLe at: https://pubmed.ncbi.nLm.nih.gov/19476301.
8. ShergiLL-Bonner R. InfantiLe coLic: practicaLities of management, incLuding dietary aspects. J Fam Health Care. 2010;20(6):206-209. AvaiLabLe at: https://pubmed.ncbi.nLm.nih.gov/21319674.
9. Critch J. InfantiLe coLic: is there a roLe for dietary interventions? Pediatr Child Health. 2011;16(1):47-49. AvaiLabLe at: https://pubmed.ncbi.nLm.nih.gov/22211076.
10. St James-Roberts I., ALvarez M., Hovish K. Emergence of a deveLopmentaL expLanation for proLonged crying in 1-to 4-month-oLd infants: review of the evidence. J Pediatr Gastroenterol Nutr. 2013;57(1):30-36. https://doi.org/10.1097/01.mpg.0000441932.07469.1b.
11. Brand S., FurLano R., SidLer M., SchuLz J.C., HoLsboer-TrachsLer E.A. “Oh, baby, pLease don't cry!”: in infants suffering from infantiLe coLic hypothaLamic-pituitary-adrenocorticaL axis activity is reLated to poor sLeep and increased crying intensity. Neuropsychobiology. 2011;64:15-23. https://doi.org/10.1159/000322456.
12. Burns AJ., Thapar N. DeveLopmentaL and postnataL changes in the enteric nervous system. J Pediatr Gastroenterol Nutr. 2013;57(1):4-8. https://doi.org/10.1097/01.mpg.0000441925.75189.01.
13. van der WaL M.F., van E.M., BonseL GJ. Stress and emotionaLprobLems during pregnancy and excessive infant crying. J DevBehavPediatr. 2007;28(6):431-437. https://doi.org/10.1097/DBP.0b013e31811ff8f4.
14. Vik T., Grote V., Escribano J., Socha J., Verduci E., Fritsch M. et aL. InfantiLe coLic, proLonged crying and maternaL postnataL depression. Acta Paediatr. 2009;98(8):1344-1348. https://doi.org/10.1111/j.1651-2227.2009.01317.x.
15. Ha-Vinh Leuchter R., Darque A., Huppi P.S. Brain maturation, earLy sensory processing and infant coLic. J Pediatr Gastroenterol Nutr. 2013;57(1):18-25. AvaiLabLe at: https://journaLs.Lww.com/jpgn/FuLLtext/2013/12001/Brain_Maturation,_EarLy_Sensory_Processing,_and.8.aspx.
16. Cohen EA., Hadash A., Shehadeh N., PiLLar G. Breastfeeding may improve nocturnaL sLeep and reduce infantiLe coLic: potentiaL roLe of breast miLk meLatonin. Eur J Pediatr. 2012;171:729-732. https://doi.org/10.1007/s00431-011-1659-3.
17. Grenham S., CLarke G., Cryan J.F., Dinan T.G. Brain-gut-microbe communication in heaLth and disease. Front Physiol. 2011;2:94. https://doi.org/10.3389/fphys.2011.00094.
18. Partty А., KaLLiomaki M., Endo A., SaLminen S., IsoLauri E. CompositionaL DeveLopment of Bifidobacterium and Lactobacillus Microbiota Is Linked with Crying and Fussing in EarLy Infancy. PLoS ONE. 2012;7(3):e32495. https://doi.org/10.1371/journaL.pone.0032495.
19. Indrio F., Dargenio V.N., Giordano P, FrancaviLLa R. Preventing and Treating CoLic. Adv Exp Med Biol. 2019;1125:49-56. https://doi.org/10.1007/5584_2018_315.
20. de Weerth C., Fuentes S., PuyLaert P., de Vos W. IntestinaL Microbiota of Infants With CoLic: DeveLopment and Specific Signatures. Pediatrics. 2013;131(2):550-558. https://doi.org/10.1542/peds.2012-1449.
21. Partty A., Kalliomaki M., SaLminen S., IsoLauri E. infantile Colic Is Associated With Low-grade Systemic Inflammation. J Pediatr Gastroenterol Nutr. 2017;64(5):691-695. https://doi.org/10.1097/MPG.0000000000001340.
22. Rhoads J.M., Fatheree NJ., Norori J., Liu Y., Lucke J., Tyson J., Ferris M. Altered fecal microflora and increased fecal calprotectin in infant colic. J Pediatr. 2009;155(6):823-828. Available at: https://pubmed.ncbi.nlm.nih.gov/19628216.
23. Loughman A., Quinn T., Nation M.L., Reichelt A., Moore RJ.,Van T.T.H., Sung V., Tang M.L.K. Infant microbiota in colic: predictive associations with problem crying and subsequent child behavior. J Dev Orig Health Dis. 2021;12(2): 260-270. https://doi.org/10.1017/S2040174420000227.
24. Altman R.L., Canter J., Patrick P.A., Daley N., Butt N., Brand D. Parent educa-tionby maternity nurses and prevention of abusive head trauma. Pediatrics. 2011;128(5):1164-1172. https://doi.org/10.1542/peds.2010-3260.
25. Bechtel K., Le K., Martin K.D., Shah N., Leventhal J., Colson E. Impact of an educational intervention on caregivers' beliefs about infant cryingand knowledge of shaken baby syndrome. Acad Pediatr. 2011;11(6):481-486. https://doi.org/10.1016/j.acap.2011.08.001.
26. Makarova E.G., Ukraintsev S.E. Functional Gastrointestinal Disorders in Infants: Long-Tern Consequences and Modern Approaches for Prevention and Treatment. Pediatricheskaya farmakologiya = Pediatric Pharmacology. 2017;14(5):392-399. (In Russ.) https://doi.org/10.15690/pf.v14i5.1788.
27. Wolke D., Schmid G., Schreier A., Meyer R. Crying and feeding problems in infancy and cognitive outcome in preschool children born at risk: a prospective population study. J Dev Behav Pediatr. 2009;30(3):226-238. https://doi.org/10.1097/DBP.0b013e3181a85973.
28. Romanello S., Spiri D., Marcuzzi E., Zanin A., Boizeau P., Rivier S. et al. Association between childhood migraine and history of infantile colic. JAMA. 2013;309(15):1607-1612. https://doi.org/10.1001/jama.2013.747.
29. Savino F., Castano E., Bretto R., Brondello C., Palumeri E., Oggero R. A prospective 10-year study on children who had severe infantile colic. Acta Paediatr Suppl. 2005;94(449):129-132. https://doi.org/10.1111/j.1651-2227.2005.tb02169.x.
30. Botha E., Joronen K., Kaunonen. The consequences of having an excessively crying infant in the family: an integrative literature review. Scand J Caring Sci. 2019;33(4):779-790. https://doi.org/10.1111/scs.12702.
31. Benninga M.A., Nurko S., Faure C., Hyman P, Roberts I., Schechter N. Childhood Functional Gastrointestinal Disorders: Neonate/^oddler. Gastroenterology. 2016;150(6):1443-1455. https://doi.org/10.1053/j.gas-tro.2016.02.016.
32. Heine R.G. Cow's-milk allergy and lactose malabsorption in infants with colic. J Pediatr Gastroenterol Nutr. 2013;57(1):25-27. https://doi.org/10.1097/01.mpg.0000441930.13307.9b.
33. Vandenplas Y., Rudolph C.D., Di Lorenzo C., Hassall E., Liptac G., Mazur L. et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009;49(4):498-547. https://doi.org/10.1097/MPG.0b013e3181b7f563.
34. Freedman S.B., Al-Harthy N., Thull-Freedman J. The crying infant: diagnostic testing and frequency of serious underlying disease. Pediatrics. 2009;123(3):841-848. https://doi.org/10.1542/peds.2008-0113.
35. Zakharova I.N., Yatsyk G.V., Borovik T.E., Skvortsova V.A., Zvonkova N.G., Dmitrieva Yu.A. et al. Infantile intestinal colic: modern view on the problem. Consilium Medicum. Pediatrics (Suppl.). 2014;(4):34-41. (In Russ.) Available at: https://www.pfizerprofi.ru/sites/default/files/cm_pediatriya_2014.pdf.
36. Savino F., Zakharova I.N. Diagnosis and treatment of infantile colic: the experts ESPGHAN opinion. Consilium Medicum. Pediatrics (Suppl.). 2016;(2):10-17. (In Russ.) Available at: https://omnidoctor.ru/upload/iblock /95a/95a55b61b413b8984888ebe5d5cde1cc.pdf.
37. Daelemans S., Peeters L., Hauser B., Vandenplas Y. Recent advances in understanding and managing infantile colic. F1000Res. 2018;7:F1000. https://doi.org/10.12688/f1000research.14940.1.
38. Ruzhentsova T.A. Baby colics: from pathogenesis to treatment. RMZh = RMJ. 2018;(5):82-85. (In Russ.) Available at: https://www.rmj.ru/articles/pediatriya/Mladencheskie_koliki_ot_patogeneza_klecheniyu.
39. Waikar Y. Infantile Colic: An Overview. J Neonatal Pediatr. 2018;4(1):1-3. https://doi.org/10.4172/2572-4983.1000153.
40. Karkhaneh M., Fraser L., Jou H., Vohra S. Effectiveness of probiotics in infantile colic: A rapid review. Paediatr Child Health. 2020;25(3):149-159. https://doi.org/10.1093/pch/pxz007.
41. Skonieczna-Zydecka K., Janda K., Kaczmarczyk M., Marlicz W., Loniewski I., Loniewska B. The Effect of Probiotics on Symptoms, Gut Microbiota and Inflammatory Markers in Infantile Colic: A Systematic Review, MetaAnalysis and Meta-Regression of Randomized Controlled Trials. J Clin Med. 2020;9(4):999. https://doi.org/10.3390/jcm9040999.
42. Hjern A., Lindblom K., Reuter A., Silfverdal S.A. A systematic review of prevention and treatment of infantile colic. Acta Paediatr. 2020;109(9):1733-1744. https://doi.org/10.1111/apa.15247.
43. Pourmirzaiee M.A., Famouri F., Moazeni W., Hassanzadeh A., Hajihashemi M. The efficacy of the prenatal administration of Lactobacillus reuteri LR92 DSM 26866 on the prevention of infantile colic: a randomized control trial. Eur J Pediatr. 2020;179(10):1619-1626. https://doi.org/10.1007/s00431-020-03641-4.
44. Ringgel-Kulra T., Goldsmith J.R., Carroli I.M., Barros S. P, Palsson O., Jobin C., Ringel Y. Lactobacillus acidophilus NCFM affects colonic mucosal opioid receptor expression in patient with functional abdominal pain - a randomized clinical study. Aliment Pharmacol Ther. 2014;40(2):200-207. https://doi.org/10.1111/apt.12800.
45. Szajewska H., Konarska Z., Kolodziej M. Probiotic Bacterial and Fungal Strains: Claims with Evidence. Dig Dis. 2016;34(3):251-259. https://doi.org/10.1159/000443359.
46. Savino F., Montanari P, Galliano I., Dapra V., Bergallo M. Lactobacillus rhamnosus GG (ATCC 53103) for the Management of Infantile Colic: A Randomized Controlled Trial. Nutrients. 2020;12(6):1693. https://doi.org/10.3390/nu12061693.
47. Brenner D.M., Chey W.D. Bifidobacterium infantis: a novel probiotic for the treatment ofirritable bowel syndrome. Rev Gastroenterol Disord. 2009;9(1):7-15. Available at: https://pubmed.ncbi.nlm.nih.gov/19367213.
48. Nocerino R., De Filippis F., Cecere G., Marino A., Micillo M., Di Scala C. et al. The therapeutic efficacy of Bifidobacterium animalis subsp. lactis BB-12® in infant colic: A randomised, double blind, placebo-controlled trial. Aliment Pharmacol Ther. 2020;51(1):110-120. https://doi.org/10.1111/apt.15561.
49. Maldonado-Lobon JA., Blanco-Rojo R., Maldonado J., Ali MA., Almazan M.V., Suanes-Cabello A. et al. Efficacy of Bifidobacterium breve CECT7263 for infantile colic treatment: an open-label, parallel, randomised, controlled trial. Benef Microbes. 2021;12(1):55-67. https://doi.org/10.3920/BM2020.0105.
50. Chen K., Liu C., Li H., Lei Y., Zeng C., Xu S. et al. Infantile Colic Treated With Bifidobacterium longum CECT7894 and Pediococcus pentosaceus CECT8330: A Randomized, Double-Blind, Placebo-Controlled Trial. Front Pediatr. 2021;9:635176. Available at: https://www.frontiersin.org/articles/10.3389/fped.2021.635176/full.
51. Yala E.T. The Clinical Efficacy of Multi-strain Probiotics (Bac-Set) in the Management of Acute Gastroenteritis in Children Two Months to Two Years Old. PIDSPJournal. 2010;11(2):86-91. Available at: http://pidsphil.org/pdf/Journal_12312011/jo39_ja05.pdf.
52. Kianifar H., Ahanchian H., Grover Z., Jafari S., Noorbakhsh Z., Khakshour A. et al. Synbiotic in the management of infantile colic: A randomized controlled trial. J Paed Chil Heal. 2014;50(10):801-805. https://doi.org/10.1111/jpc.12640.
53. Kharitonova L.A., Kucherya T.V. Using Probiotics in Pediatric Practice: Clinical Study Results. Doktor.Ru. 2016;(6):38-41. (In Russ.) Available at: https://journaldoctor.ru/catalog/pediatriya/primenenie-probiotika-v-pediatricheskoy-praktike-rezultaty-klinicheskogo-issledovaniya/?lang=ru&clear_cache=Y.
54. Hojsak I. Probiotics in Functional Gastrointestinal Disorders Adv Exp Med Biol. 2019;1125:121-137. https://doi.org/10.1007/5584_2018_321.
55. Ishaque M., Khosruzzaman S., Ahmed D., Sah M. A randomized placebo-controlled clinical trial of a multi-strain probiotic formulation (Bio-Kult®) in the management of diarrheapredominant irritable bowel syndrome. Meditsinskiy sovet = Medical Council. 2018;(14):98-108. (In Russ.) https://doi.org/10.21518/2079-701X-2018-14-98-108.
56. Zakharova I.N., Ardatskaya M.D., Sugyan N.G. The Effect of MultiStrain Probiotic on the Metabolic Activity of the Intestinal Microflora in Infants with Functional Disorders of the Gastrointestinal Tract: the Results of a Placebo-Controlled Study. Voprosy sovremennoj pedi-atrii = Current Pediatrics. 2016;15(1):68-73. (In Russ.) https://doi.org/10.15690/vsp.v15i1.1501.
57. Zakharova I.N., Sugyan N.G. Bac-set multiprobiotic: results of russian and foreign clinical research. Meditsinskiy sovet = Medical Council. 2017;(19):104-110. (In Russ.) https://doi.org/10.21518/2079-701X-2017-19-104-110.
58. Simonson J., Haglund K., Weber E., Fial A., Hanson L. Probiotics for the Management of Infantile Colic: A Systematic Review. MCN Am J Matern Child Nurs. 2021;46(2):88-96. https://doi.org/10.1097/NMC.0000000000000691.
Review
For citations:
Panova LD. Infant colic: where is the line between norm and pathology, the role of disruption of the intestinal microbiome. Meditsinskiy sovet = Medical Council. 2021;(17):246-254. (In Russ.) https://doi.org/10.21518/2079-701X-2021-17-246-254