Infant colic: a new look at pathogenetic mechanisms and therapeutic measures (literature review)

Abstract

The article represents a review of the current literature on infant colic topic from the point of view of the recommendations of the IV Roman Criteria, reflecting the opinion of the World's leading experts - pediatricians, gastroenterologists, allergists. Infant colic refers to functional disorders of the gastrointestinal tract and is characteristic to infants up to 5 months of age. The key point in the diagnosis of infant colic is the exclusion of organic pathology ("red flags"), which is normally no more than 5%. The article discusses in details the current ideas concerning the pathogenetic mechanisms of infant colic and the modern principles of their correction based on these data from the point of view of evidence-based medicine. Correcting the symptoms of infant colic includes psychological support for the family, maintaining breastfeeding and the use of probiotics (Lactobacillus reuteri DSM17938), the efficiency of which has only been proven in breastfed babies. If breastfeeding is not possible, preference is given to partially hydrolyzed whey mixtures with reduced lactose content and enriched with prebiotics.

Keywords:infant, inconsolable cry, infant colic, breastfeeding, diet, prebiotics, probiotics, partially hydrolyzed low lactose formula

Funding. The study had no financial support.

Conflict of interests. Humana's company provided the Humana Anticolic milk formula. Contributions. All authors contributed equally to the writing of the article.

For citation: Puchkova A.A., Degtyareva A.V., Zhdanova S.I., Golubtsova Yu.M. Infant colic: a new look at pathogenetic mechanisms and therapeutic measures (literature review). Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2021; 9 (1): 50-9. DOI: https://doi.org/10.33029/2308-2402-2021-9-1-50-59 (in Russian)

References

1. Robin S.G., Keller C., Zwiener R., et al. Prevalence of pediatric functional gastrointestinal disorders utilizing the Rome IV criteria. J Pediatr. 2018; 195: 134–9.

2. Vandenplas Y., Abkari A., Bellaiche M., Benninga M., Chouraqui J.P., Çokura F., et al. Prevalence and healthoutcomes of functional gastrointestinal symptoms in infants from birth to 12 months of age. J Pediatr Gastroenterol Nutr. 2015; 61 (5): 531–7.

3. Iacovou M., Ralston R.A., Muir J., Walker K.Z., Truby H. Dietary management of infantile colic: a systematic review. Matern Child Health J. 2012; 16 (6): 1319–31.

4. McMahon C., Barnett B., Kowalenko N., Tennant C., Don N. Postnatal depression, anxiety and unsettled infant behavior. Aust N Z J Psychiatry. 2001; 35 (5): 581–8.

5. Howard C.R., Lanphear N., Lanphear B.P., Eberly S., Lawrence R.A. Parental responses to infant crying and colic: the effect on breastfeeding duration. Breastfeed Med. 2006; 1 (3): 146–55.

6. Barr R.G. Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers. Proc Natl Acad Sci USA. 2012; 16 (109 suppl 2): 17 294–301.

7. Zeevenhooven J., Browne P.D., L’Hoir M.P., de Weerth C., Benninga M.A. Infant colic: mechanisms and management. Nat Rev Gastroenterol Hepatol. 2018; 15 (8): 479–96.

8. Wolke D., Bilgin A., Samara M. Systematic review and meta-analysis: fussing and crying durations and prevalence of colic in infants. J Pediatr. 2017; 185: 55–61.e4.

9. Shergill-Bonner R. Infantile colic: practicalities of management, including dietary aspects. J Fam Health Care. 2010; 20 (6): 206–9.

10. Barr R. The normal crying curve: what do we really know? Dev Med Child Neurol. 1990; 32 (4): 356–62.

11. Trevarthen C., Aitken K.J. Regression Periods in Human Infancy. In: M. Heimann (ed.). Mahwah, NJ: Lawrence Erlbaum Associates, 2003: 107–84.

12. de Weerth C., Fuentes S., Puylaert P., de Vos W.M. Intestinal microbiota of infants with colic: development and specific signatures. Pediatrics. 2013; 131 (2): 550-8.

13. 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.

14. Rhoads J.M., Fatheree N.Y., Norori J., Liu Y., Lucke J.F., Tyson J.E., et al. Altered fecal microflora and increased fecal calprotectin in infants with colic. J Pediatr. 2009; 155 (6): 823-8.e1.

15. Savino F., Cordisco L., Tarasco V., et al. Molecular identification of coliform bacteria from colicky breastfed infants. Acta Paediatr. 2009; 98 (10): 1582-8.

16. Partty A., Kalliomaki M., Salminen S., Isolauri E. Infantile colic is associated with low-grade systemic inflammation. J Pediatr Gastroenterol Nutr. 2017; 64 (5): 691-5.

17. Partty A., 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): 32495.

18. Savino F., Cordisco L., Tarasco V., et al. Antagonistic effect of Lactobacillus strains against gas-producing coliforms isolated from colicky infants. BMC Microbiol. 2011; 30 (11): 157.

19. Lucassen P.L., Assendelft W.J., van Eijk J.T., et al. Systematic review of the occurrence of infantile colic in the community. Arch Dis Child. 2001; 84 (5): 398-403.

20. Aloisio I., Mazzola G., Corvaglia L.T., et al. Influence of intrapartum antibiotic prophylaxis against group B Streptococcus on the early newborn gut composition and evaluation of the anti-Streptococcus activity of Bifidobacterium strains. Appl Microbiol Biotechnol. 2014; 98 (13): 6051-60.

21. Clifford T.J., Campbell M.K., Speechley K.N., Gorodzinsky F. Sequelae of infant colic: evidence of transient infant distress and absence of lasting effects on maternal mental health. Arch Pediatr Adolesc Med. 2002; 156 (12): 1183-8.

22. Corvaglia L., Tonti G., Martini S., et al. Influence of intrapartum antibiotic prophylaxis for group B Streptococcus on gut microbiota in the first month of life. J Pediatr Gastroenterol Nutr. 2016; 62 (2): 304-8.

23. Mentula S., Tuure T., Koskenala R., et al. Microbial composition and fecal fermentation end products from colicky infants - a probiotic supplementation pilot. Microb Ecol Health Dis. 2008; 20 (1): 37-47.

24. Camilleri M., Park S.-Y., Scarpato E., Staiano A. Exploring hypotheses and rationale for causes of infantile colic. Neurogastroenterol Motil. 2017; 29 (2): 12943.

25. Hofmann A.F. Enterohepatic Circulation of Bile Acids. Comprehensive Physiology. USA: John Wiley and Sons, 2011: 567-96.

26. Zakharova I.N., Borovik T.E., Yatsyk G.V., Skvortsova V.A., Kholodova I.N., Sugyan N.G., et al. Pocket Recommendations for Pediatrics . Moscow: Remedium, 2019: 456 p. (in Russian)

27. Kanabar D., Randhawa M., Clayton P. Improvement of symptoms in infant colic following reduction of lactose load with lactase. J Hum Nutr Diet. 2001; 14 (5): 359-63.

28. Miller J.J., McVeagh P., Fleet G.H., Petocz P., Brand J.C. Effect of yeast lactase enzyme on «colic» in infants fed human milk. J Pediatr. 1990; 117 (2 pt 1): 261-3.

29. Heine R.G., Jordan B., Lubitz L., Meehan M., Catto-Smith A.G. Clinical predictors of pathological gastro-oesophageal reflux in infants with persistent distress. J Paediatr Child Health. 2006; 42 (3): 134-9.

30. Jordan B., Heine R.G., Meehan M., Catto-Smith A.G., Lubitz L. Effect of antireflux medication, placebo and infant mental health intervention on persistent crying: a randomized clinical trial. J Paediatr Child Health. 2006; 42 (1-2): 49-58.

31. Kurtoglu S., Uzdm K., Hallac I.K., Coskum A. 5-Hydroxy-3-indole acetic acid levels in infantile colic: is serotoninergic tonus responsible for this problem? Acta Paediatr. 1997; 86 (7): 764-5.

32. Savino F., Grassino E.C., Guidi C., Oggero R., Silvestro L., Miniero R. Ghrelin and motilin concentration in colicky infants. Acta Paediatr. 2006; 95 (6): 738-41.

33. Canivet C.A., Ostergren P.O., Rosen A.S., Jakobsson I.L., Ha-gander B.M. Infantile colic and the role of trait anxiety during pregnancy in relation to psychosocial and socioeconomic factors. Scand J Public Health. 2005; 33 (1): 26-34.

34. van den Berg M.P., van der Ende J., Crijnen A.A., et al. Paternal depressive symptoms during pregnancy are related to excessive infant crying. Pediatrics. 2009; 124 (1): 96-103.

35. Milidou I., Sondergaard C., Jensen M.S., Olsen J., Henriksen T.B. Gestational age, small for gestational age, and infantile colic. Paediatr Perinat Epidemiol. 2014; 28 (2): 138-45.

36. Salvatore S., Baldassarre M.E., Di Mauro A., et al. Neonatal antibiotics and prematurity are associated with an increased risk of functional gastrointestinal disorders in the first year of life. J Pediatr. 2019; 212: 44-51.

37. Canivet C.A., Ostergren P.O., Jakobsson I.L., Dejin-Karlsson E., Hagander B.M. Infantile colic, maternal smoking and infant feeding at 5 weeks of age. Scand J Public Health. 2008; 36 (3): 284-91.

38. Milidou I., Henriksen T.B., Jensen M.S., Olsen J., Sondergaard C. Nicotine replacement therapy during pregnancy and infantile colic in the offspring. Pediatrics. 2012; 129 (3): 652-8.

39. Johnson J.D., Cocker K., Chang E. Infantile colic: recognition and treatment. Am Fam Physician. 2015; 92 (7): 577-82.

40. van Sleuwen B.E., Lhoir M.P., Engelberts A.C., et al. Comparison of behavior modification with and without swaddling as interventions for excessive crying. J Pediatr. 2006; 149 (4): 512-7.

41. White-Traut R., Nelson M.N. Maternally administered tactile, auditory, visual, and vestibular stimulation: relationship to later interactions between mothers and premature infants. Res Nurs Health. 1988; 11 (1): 31-9.

42. van der Wal M.F., van den Boom D.C., Pauw-Plomp H., de Jonge G.A. Mothers’ reports of infant crying and soothing in a multicultural population. Arch Dis Child. 1998; 79 (4): 312-7.

43. Bennett C., Underdown A., Barlow J. Massage for promoting mental and physical health in typically developing infants under the age of six months. Cochrane Database Syst Rev. 2013; 4: CD005038.

44. Lucassen P. Colic in infants. BMJ Clin Evid. 2010; 2010: 0309.

45. Hayden C., Mullinger B. A preliminary assessment of the impact of cranial osteopathy for the relief of infantile colic. Complement Ther Clin Pract. 2006; 12 (2): 83-90.

46. Garvey W., Sung V. Non-pharmacological approaches to infantile colic: white noise versus swinging. Evid Based Nurs. 2018; 21 (4): 112.

47. Evans K., Evans R., Simmer K. Effect of the method of breast feeding on breast engorgement, mastitis and infantile colic. Acta Paediatr. 1995; 84 (8): 849-52.

48. Cohen Engler A., 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 (4): 729-32.

49. Anderson G., Vaillancourt C., Maes M., Reiter R.J. Breastfeeding and the gut-brain axis: is there a role for melatonin? Biomol Concepts. 2017; 8 (3-4): 185-95.

50. ince T., Akman H., Qimrin D., Aydin A. The role of melatonin and cortisol circadian rhythms in the pathogenesis of infantile colic. World J Pediatr. 2018; 14 (4): 392-8.

51. Katzer D., Pauli L., Mueller A., et al. Melatonin concentrations and antioxidative capacity of human breast milk according to gestational age and the time of day. J Hum Lact. 2016; 32 (4): 105-10.

52. Dumbell R., Matveeva O., Oster H. Circadian clocks, stress, and immunity. Front Endocrinol. (Lausanne). 2016; 2 (7): 37.

53. Vandenplas Y., Benninga M., Broekaert I., et al. Functional gastrointestinal disorder algorithms focus on early recognition, parental reassurance and nutritional strategies. Acta Paediatr. 2016; 105 (3): 244-52.

54. Hill D.J., Roy N., Heine R.G., et al. Effect of a low-allergen maternal diet on colic among breastfed infants: a randomized, controlled trial. Pediatrics. 2005; 116 (5): 709-15.

55. Gordon M., Biagioli E., Sorrenti M., et al. Dietary modifications for infantile colic. Cochrane Database Syst Rev. 2018; 10 (10): CD011029.

56. Vandenplas Y., Hauser B., Salvatore S. Functional gastrointestinal disorders in infancy: impact on the health of the infant and family. Pediatr Gastroenterol Hepatol Nutr. 2019; 22 (3): 207-16.

57. Vandenplas Y. Algorithms for common gastrointestinal disorders. J Pediatr Gastroenterol Nutr. 2016; 63 (suppl 1): 38-40.

58. Vandenplas Y., Gutierrez-Castrellon P., Velasco-Benitez C., et al. Practical algorithms for managing common gastrointestinal symptoms in infants. Nutrition. 2013; 29 (1): 184-94.

59. Ford E.L., Underwood M.A., German J.B. Helping mom help baby: nutrition-based support for the mother-infant dyad during lactation. Front Nutr. 2020; 21 (7): 54.

60. Costanzo M., Nocerino R.N., Cosenza L., Scala C.L.D.N., Ca-nani R.B. Efficacy of a partially hydrolyzed whey formula on infant colic: a randomized controlled trial International. J Nutr Sci Food Technol. 2018; 4 (6).

61. Gupta S.K. Update on infantile colic and management options. Curr Opin Invest Drugs. 2007; 8 (11): 921-6.

62. Harb T., Matsuyama M., David M., Hill R.J. Infant colic-what works: a systematic review of interventions for breast-fed infants. J Pediatr Gastroenterol Nutr. 2016; 62 (5): 668-86.

63. URL: https://www.fda.gov/food/generally-recognized-safe-gras/microorganisms-microbial-derived-ingredients-used-food-partial-list

64. Dryl R., Szajewska H. Probiotics for management of infantile colic: a systematic review of randomized controlled trials. Arch Med Sci. 2018; 14 (5): 1137-43.

65. Lyons K.E., Ryan C.A., Dempsey E.M., Ross R.P., Stanton C. Breast milk, a source of beneficial microbes and associated benefits for infant health. Nutrients. 2020; 12 (4): 1039.

66. Kianifar H., Ahanchian H., Grover Z., et al. Synbiotic in the management of infantile colic: a randomised controlled trial. J Paediatr Child Health. 2014; 50 (10): 801-5.

67. Privorotsky V.F., Luppova N.E. Infant intestinal colic: problem and solutions. Pediatriya [Pediatrics]. 2012; 91 (4): 98-105. (in Russian)

68. Anastasevich L. A. Intestinal colic in young children: causes, diagnosis, treatment. Russkiy meditsinskiy zhurnal [Russian Medical Journal]. 2008; (3): 154-7. (in Russian)

69. Zhdanova S.I., Gabitova N.Kh., Shagimardanova F.V., Ishkina F.V., Abdul’myanova G.F., Varlamova O.V., et al. Infant colic and breastfeeding - is there a connection? Meditsinskiy sovet [Medical Council]. 2019; (11): 23-7. (in Russian)

70. Biagioli E., Tarasco V., Lingua C., Moja L., Savino F. Pain-relieving agents for infantile colic. Cochrane Database Syst Rev. 2016; 9 (9): CD009999.

71. Ellwood J., Draper-Rodi J., Carnes D. Comparison of common interventions for the treatment of infantile colic: a systematic review of reviews and guidelines. BMJ Open. 2020; 10 (2): 035405.

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

CHIEF EDITOR
CHIEF EDITOR
Degtyarev Dmitriy Nikolaevich
Doctor of Medical Sciences, Professor, Deputy Director for Scientific Research of the V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Head of the Chair of Neonatology at the Clinical Institute of Children's Health named after N.F. Filatov, I.M. Sechenov First Moscow State Medical University, Chairman of the Ethics Committee of the Russian Society of Neonatologists, Moscow, Russian Federation

ORCID iD 0000-0001-8975-2425

Journals of «GEOTAR-Media»