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      Efficacy of Lactobacillus reuteri DSM 17938 for infantile colic : Systematic review with network meta-analysis

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          Abstract

          Background:

          5% to 40% of infants cry excessively, usually accompanied by fussiness and excessive of gas. There are no uniform criteria for treatment of infantile colic. Lactobacillus reuteri DSM 17938 has been used with promising results. The objective of this network-meta-analysis (NMA) is to compare the efficacy of L reuteri DSM 17938 with other interventions for infantile colic.

          Methods:

          RCTs, published between 1960 and 2015 for the treatment of infantile colic were included. Primary outcome was duration of crying after 21 to 28 days of treatment. Different databases were searched. Information was analyzed using control group as central axis. A random effect model was used. Hedges standard mean difference (SMD) and odds ratio (OR) were calculated. A SUCRA analysis was performed to evaluate superiority for each intervention.

          Results:

          32 RCTs were analyzed, including 2242 patients. Studies with L reuteri DSM 17938 versus Ctrl., Diet versus Ctrl. and Acupuncture versus Ctrl. were the most influential studies in the NMA. L reuteri DSM 17938 [WMD −51.3 h (CI95% −72.2 to −30.5 h), P .0001] and dietetic approaches [WMD −37.4 h (CI95% −56.1 to −18.7 h), P .0001] were superior compared to the other treatments.

          Conclusions:

          L reuteri DSM 17938 and some dietetic approaches are better to other interventions for treatment of infantile colic.

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          Most cited references54

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          Paroxysmal fussing in infancy, sometimes called colic.

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            Intestinal microbiota of infants with colic: development and specific signatures.

            To provide a comprehensive analysis of the fecal microbiota in infants with colic, as compared with control infants, during their first 100 days of life. Microbial DNA of >200 samples from 12 infants with colic and 12 age-matched control infants was extracted and hybridized to a phylogenetic microarray. Microbiota diversity gradually increased after birth only in the control group; moreover, in the first weeks, the diversity of the colic group was significantly lower than that of the control group. The stability of the successive samples also appeared to be significantly lower in the infants with colic for the first weeks. Further analyses revealed which bacterial groups were responsible for colic-related differences in microbiota at age 1 or 2 weeks, the earliest ages with significant differences. Proteobacteria were significantly increased in infants with colic compared with control infants, with a relative abundance that was more than twofold. In contrast, bifidobacteria and lactobacilli were significantly reduced in infants with colic. Moreover, the colic phenotype correlated positively with specific groups of proteobacteria, including bacteria related to Escherichia, Klebsiella, Serratia, Vibrio, Yersinia, and Pseudomonas, but negatively with bacteria belonging to the Bacteroidetes and Firmicutes phyla, the latter of which includes some lactobacilli and canonical groups known to produce butyrate and lactate. The results indicate the presence of microbial signatures in the first weeks of life in infants who later develop colic. These microbial signatures may be used to understand the excessive crying. The results offer opportunities for early diagnostics as well as for developing specific therapies.
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              Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial.

              To test the efficacy of Lactobacillus reuteri on infantile colic and to evaluate its relationship to the gut microbiota. Fifty exclusively breastfed colicky infants, diagnosed according to modified Wessel's criteria, were randomly assigned to receive either L reuteri DSM 17 938 (10(8) colony-forming units) or placebo daily for 21 days. Parental questionnaires monitored daily crying time and adverse effects. Stool samples were collected for microbiologic analysis. Forty-six infants (L reuteri group: 25; placebo group: 21) completed the trial. Daily crying times in minutes/day (median [interquartile range]) were 370 (120) vs 300 (150) (P=.127) on day 0 and 35.0 (85) vs 90.0 (148) (P=.022) on day 21, in the L reuteri and placebo groups, respectively. Responders (50% reduction in crying time from baseline) were significantly higher in the L reuteri group versus placebo group on days 7 (20 vs 8; P=.006), 14 (24 vs 13; P=.007), and 21 (24 vs 15; P=.036). During the study, there was a significant increase in fecal lactobacilli (P=.002) and a reduction in fecal Escherichia coli and ammonia in the L reuteri group only (P=.001). There were no differences in weight gain, stooling frequency, or incidence of constipation or regurgitation between groups, and no adverse events related to the supplementation were observed. L. reuteri DSM 17 938 at a dose of 10(8) colony-forming units per day in early breastfed infants improved symptoms of infantile colic and was well tolerated and safe. Gut microbiota changes induced by the probiotic could be involved in the observed clinical improvement.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                December 2017
                22 December 2017
                : 96
                : 51
                : e9375
                Affiliations
                [a ]Center for Translational Research on Early Programming Nutrition and Mother-Child Nutrition, Hospital General Dr Manuel Gea González & Dirección de Investigación. Universidad Tecnológica de México-Unitec México
                [b ]University of Bari, Bari, Italy
                [c ]Universidad Tecnológica de México-Unitec, México
                [d ]Center for Analysis on Health Evidence, Hospital General Dr. Manuel Gea González
                [e ]Head of Medical Division, Hospital General Dr Manuel Gea González
                [f ]Genetic Biochemistry Department, Instituto Nacional de Pediatria.
                Author notes
                []Correspondence: Pedro Gutiérrez-Castrellón, Unidad de Investigación Translacional en Programación Metabólica, Temprana y Nutrición Materno-Infantil, Hospital General Dr Manuel Gea González. Tlalpan 4800, Sector XVI, 14080, Tlalpan. México, D.F. México (e-mail: pedrogtzca@ 123456prodigy.net.mx ).
                Article
                MD-D-16-07511 09375
                10.1097/MD.0000000000009375
                5758237
                29390535
                fc4d5d39-7d3d-4659-873a-78bf718d0f51
                Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 14 December 2016
                : 30 October 2017
                : 30 November 2017
                Categories
                6200
                Research Article
                Systematic Review and Meta-Analysis
                Custom metadata
                TRUE

                infantile colic,l reuteri dsm 17938,network meta-analysis

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