Lactobacillus reuteri effective for breastfed infants with colic

Last Updated: 2017-12-26

By Will Boggs MD

NEW YORK (Reuters Health) - The probiotic Lactobacillus reuteri DSM17938 is effective for treating colic in breastfed infants, but there's not enough evidence to recommend it for formula-fed infants with colic, according to a meta-analysis.

Infant colic, excessive crying without a known cause, affects about one in five infants under 3 months of age. Probiotics, including L. reuteri, have shown promise for treating colic, but results have been conflicting.

Dr. Valerie Sung from The Royal Children's Hospital and the University of Melbourne, Victoria, Australia and colleagues undertook an individual participant data meta-analysis to determine if L. reuteri DSM17398 reduces crying and/or fussing in infants with colic, compared with placebo, at 21 days postrandomization.

They identified four double-blind randomized controlled trials involving 345 infants with colic. All four trials included breast-fed infants; only one included formula-fed infants.

Crying and/or fussing duration was reduced in both the probiotic and placebo groups but was significantly shorter in the probiotic group at all follow-up time points, according to the December 26th Pediatrics online report.

Treatment success, defined as at least 50% reduction in crying and/or fussing time from baseline, was about twice as likely in the probiotic group as in the placebo group at all time points (with adjusted probiotic:placebo success ratios of 2.08 at day 7, 1.98 at day 14, and 1.71 at day 21).

The differences in crying and/or fussing duration amounted to 21.0 fewer minutes per day at day 7 and 25.4 fewer minutes per day at day 21 for the probiotic group, compared with the placebo group.

In subgroup analyses, the reduction in crying and/or fussing duration was 46 minutes per day more in the probiotic group than in the placebo group's among breastfed infants, whereas there was no positive effect among formula-fed infants.

Similarly, breastfed infants in the probiotic group were 2 to 3 times more likely to experience treatment success than breastfed infants in the placebo group, whereas formula-fed infants had less treatment success with probiotics than with placebo.

"L. reuteri DSM17938 is effective and can be recommended for breastfed infants with colic," the researchers conclude. "Its role in formula-fed infants with colic needs further research."

Dr. Ian St. James-Roberts from University College London, UK, who wrote an editorial related to this report, remains unconvinced. He told Reuters Health by email, "The probiotic treatment is not effective in all infants. It reduced crying in breast-fed, but not formula-fed, infants. Around three-quarters of breast-fed infants in Italy, Poland, and Canada responded to it, but a quarter did not. It proved entirely ineffective in Australian infants."

"These differences are thought to reflect differences in gut microbiotic content in different locations, but this is poorly understood and we have no evidence about effectiveness in other countries, such as USA and the UK," he said. "Rather than prescribing probiotics as a universal treatment for breastfed infants with colic, clinicians may wish to take these limitations into account."

"We do not yet know why the probiotic helps some infants but not others, or how it works," Dr. St. James-Roberts said. "Although probiotic treatments have proved to be safe, our current understanding is inadequate and a great deal needs to be learned."

"The findings currently apply to one particular probiotic," he added. "The alternative is to allow colic to run its usual course and provide parents with information and support. Around 20% of 1- to 6-week-old infants cry excessively without an apparent reason, but this reduces to less than one percent of infants by three months of age without a probiotic treatment."

Dr. J. Marc Rhoads from the University of Texas Health Science Center at Houston McGovern Medical School, Houston recently reported daily administration of L. reuteri DSM17938 to be safe in newborn infants with colic in a study that also had a placebo response of 66%. He told Reuters Health by email, "I think the message is clear that all is not without hope for this condition. Colic indeed does cause parental frustration, depression, and thoughts of infanticide, and interviews of child abuse-perpetrating fathers have indicated that they shook the baby because they just wanted the crying to stop. Now, there are treatments that can help."

"There is no question that the probiotic helps," he said. "However, the spontaneous improvement over time is also dramatic."

"Even though these babies are likely to have resolution of their symptoms by 4 months of age, the parents want something to treat now," Dr. Rhoads said. "I see a lot of babies with this condition because of my research and because this is a common condition, affecting an estimated 5-10% of the infant population. For formula-fed babies, there is solid evidence that a hypoallergenic formula can improve crying."

Dr. Sung was unable to respond to a request for comments due to the holidays.

SOURCE: http://bit.ly/2zzahZP and http://bit.ly/2zy2cEN

Pediatrics 2017.