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Infant Colic-What works: A Systematic Review of Interventions for Breast-fed Infants
Tracy Harb1, Misa Matsuyama, Michael David
1*Child Health Research Centre, Children's Nutrition Research Centre †School of Public Health, The University of Queensland, Brisbane, Australia.
Insights
Probiotics, specifically Lactobacillus reuteri, and fennel preparations show effectiveness in reducing infant colic crying time. Evidence for other interventions like maternal diet changes remains weak, requiring more research.
Area of Science:
- Pediatrics
- Gastroenterology
- Evidence-Based Medicine
Background:
- Infant colic is a common condition affecting breast-fed and mixed-fed infants under six months.
- Identifying effective interventions for infant colic is crucial for parental well-being and infant health.
Purpose of the Study:
- To evaluate the strength of evidence for common infant colic interventions.
- To assess the efficacy of phytotherapies, medications, and maternal dietary changes.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) published between July 2014 and July 2015.
- Searched major databases including PubMed, CINAHL, Embase, AMED, and Web of Science.
- Included studies used Wessel or modified Wessel criteria for colic diagnosis and excluded trials with fewer than 16 participants.
Main Results:
- Meta-analysis of six studies indicated probiotics, particularly Lactobacillus reuteri, significantly reduced crying time by -55.8 min/day (P=0.001).
- Meta-analysis of three studies suggested fennel preparations were effective, with a mean difference in crying time of -72.1 min/day (P<0.001).
Conclusions:
- Probiotics (Lactobacillus reuteri) and fennel oil preparations demonstrate efficacy in reducing infant colic.
- Evidence supporting maternal dietary manipulation, lactase, sucrose, glucose, and simethicone for colic is currently weak.
- Further high-quality clinical trials are necessary to solidify evidence for all evaluated infant colic interventions.
Objectives:
To determine the strength of evidence for commonly used interventions for colic in breast-fed and mixed-fed infants younger than 6 months.
Methods:
Searches of PubMed, CINAHL, Embase, AMED, and Web of Science databases were conducted from July 2014 to July 2015. Included studies were randomised controlled trials involving mothers and their colicky infants younger than 6 months; assessed colic against the Wessel or modified Wessel criteria; and included phytotherapies, prescription medicines, and maternal dietary interventions. Studies with <16 participants were excluded. Meta-analyses were conducted where data were sufficient to enable pooling. Quality was assessed against the Cochrane Risk Bias Assessment Tool.
Results:
A total of 17 articles met the inclusion criteria for this review. The 6 studies included for subgroup meta-analysis on probiotic treatment, notably Lactobacillus reuteri, demonstrated that probiotics appear an effective treatment, with an overall mean difference in crying time at day 21 of -55.8 min/day (95% CI -64.4 to -47.3, P = 0.001). The 3 studies included for subgroup meta-analysis on preparations containing fennel suggest it to be effective, with an overall mean difference of -72.1 min/day (95% CI -126.4 to -17.7, P < 0.001).
Conclusions:
Probiotics, in particular L reuteri, and preparations containing fennel oil appear effective for reducing colic, although there are limitations to these findings. The evidence for maternal dietary manipulation, lactase, sucrose, glucose, and simethicone is weak. Further well-designed clinical trials are required to strengthen the evidence for all of these interventions.
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