Lactobacillus reuteri to Treat Infant Colic: A Meta-analysis

Author:

Sung Valerie1,D’Amico Frank23,Cabana Michael D.4,Chau Kim5,Koren Gideon5,Savino Francesco6,Szajewska Hania7,Deshpande Girish8,Dupont Christophe9,Indrio Flavia10,Mentula Silja11,Partty Anna12,Tancredi Daniel13

Affiliation:

1. Murdoch Children's Research Institute, The Royal Children’s Hospital, and the University of Melbourne, Melbourne, Victoria, Australia;

2. Department of Mathematics, Duquesne University, Pittsburgh, Pennsylvania;

3. University of Pittsburgh Medical Center St. Margaret’s Hospital, Pittsburgh, Pennsylvania;

4. Department of Pediatrics, Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California;

5. University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada;

6. Ospendale Infantile Regina Margherita, Citta della Salute e della Scienza di Torino, Torino, Italy;

7. Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland;

8. Department of Neonatology, Nepean Hospital and Sydney Medical School Nepean, University of Sydney, Sydney, New South Wales, Australia;

9. Department of Pediatric Gastroenterology, Paris Descartes University and Necker-Enfants Malades Hospital, Paris, France;

10. Department of Pediatrics, University of Bari, Bari, Italy;

11. Bacteriology Unit, National Institute for Health and Welfare, Helsinki, Finland;

12. Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; and

13. Department of Pediatrics, University of California Davis Health System, Sacramento, California

Abstract

CONTEXT: Lactobacillus reuteri DSM17938 has shown promise in managing colic, but conflicting study results have prevented a consensus on whether it is truly effective. OBJECTIVE: Through an individual participant data meta-analysis, we sought to definitively determine if L reuteri DSM17938 effectively reduces crying and/or fussing time in infants with colic and whether effects vary by feeding type. DATA SOURCES: We searched online databases (PubMed, Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, the Database of Abstracts of Reviews of Effects, and Cochrane), e-abstracts, and clinical trial registries. STUDY SELECTION: These were double-blind randomized controlled trials (published by June 2017) of L reuteri DSM17398 versus a placebo, delivered orally to infants with colic, with outcomes of infant crying and/or fussing duration and treatment success at 21 days. DATA EXTRACTION: We collected individual participant raw data from included studies modeled simultaneously in multilevel generalized linear mixed-effects regression models. RESULTS: Four double-blind trials involving 345 infants with colic (174 probiotic and 171 placebo) were included. The probiotic group averaged less crying and/or fussing time than the placebo group at all time points (day 21 adjusted mean difference in change from baseline [minutes] −25.4 [95% confidence interval (CI): −47.3 to −3.5]). The probiotic group was almost twice as likely as the placebo group to experience treatment success at all time points (day 21 adjusted incidence ratio 1.7 [95% CI: 1.4 to 2.2]). Intervention effects were dramatic in breastfed infants (number needed to treat for day 21 success 2.6 [95% CI: 2.0 to 3.6]) but were insignificant in formula-fed infants. LIMITATIONS: There were insufficient data to make conclusions for formula-fed infants with colic. CONCLUSIONS: L reuteri DSM17938 is effective and can be recommended for breastfed infants with colic. Its role in formula-fed infants with colic needs further research.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

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