Nine-Strain Bacterial Synbiotic Improves Crying and Lowers Fecal Calprotectin in Colicky Babies-An Open-Label Randomized Study

Malgorzata Bernatek, Jacek Piątek, Marcin Pszczola, Hanna Krauss, Janina Antczak, Paweł Maciukajć, Henning Sommermeyer, Malgorzata Bernatek, Jacek Piątek, Marcin Pszczola, Hanna Krauss, Janina Antczak, Paweł Maciukajć, Henning Sommermeyer

Abstract

The aim of this study (ClinicalTrials.gov registration NCT04666324) was to determine the effects of a nine-strain synbiotic and simethicone on the duration of crying and the gut inflammation marker calprotectin in colicky babies aged 3-6 weeks, diagnosed using the Wessel criteria. The open-label study comprised a control group of non-colicky babies (n = 20) and two parallel treatment groups (each n = 50) to which colicky babies were randomly and equally assigned to receive the multi-strain synbiotic or simethicone orally for 28 days. Primary outcome measures were the change in daily crying duration and the level of fecal calprotectin on days 1 and 28 of the study. Administration of the synbiotic resulted in a rechange of crying duration of -7.18 min/day of treatment, while simethicone had a significantly smaller effect (-5.74 min/day). Fecal calprotectin levels in colicky babies were significantly elevated compared to those in non-colicky babies. Treatment with the nine-strain synbiotic resulted in a significant lowering of fecal calprotectin at the end of the study, while no such effect was found for simethicone. No adverse effects were reported. Study results confirm earlier findings of crying duration reductions in colicky babies by the synbiotic, an effect that might be linked to its anti-inflammatory properties.

Keywords: colic; colicky babies; crying; dysbiosis; fecal calprotectin; gut inflammation; gut microbiota; infantile colic; simethicone; synbiotic.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient enrollment and study progress.
Figure 2
Figure 2
Effects of simethicone or multi-strain synbiotic treatment in colicky babies on daily crying duration over the course of the treatment.
Figure 3
Figure 3
Fecal calprotectin levels in the control, simethicone, and multi-strain synbiotic groups on day 1 (before treatment) and on day 28 (at end of the treatment period) of the study. Different lowercase letters indicate significant differences between groups (p < 0.05).

References

    1. Benninga M.A., Faure C., Hyman P.E., St James Roberts I., Schechter N.L., Nurko S. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology. 2016;150:1443–1455.e2. doi: 10.1053/j.gastro.2016.02.016.
    1. Wessel M.A., Jackson E.B., Harris G.S., Detwiler A.C. Paroxysmal fussing in infancy, sometimes called colic. Pediatrics. 1954;14:421–435. doi: 10.1542/peds.14.5.421.
    1. Sung V. Infantile colic. Aust. Prescr. 2018;41:105–110. doi: 10.18773/austprescr.2018.033.
    1. Lucassen P., Assendelft W., van Eijk J.T.M., Gubbels J., Douwes A., van Geldrop W.J. Systematic review of the occurrence of infantile colic in the community. Arch. Dis. Child. 2001;84:398–403. doi: 10.1136/adc.84.5.398.
    1. Lucassen P. Colic in infants. BMJ Clin. Evid. 2010;2010:0309.
    1. Vik T., Grote V., Escribano J., Socha J., Verduci E., Fritsch M., Carlier C., von Kries R., Koletzko B., for the European Childhood Obesity Trial Study Group Infantile colic, prolonged crying and maternal postnatal depression. Acta Paediatr. 2009;98:1344–1348. doi: 10.1111/j.1651-2227.2009.01317.x.
    1. 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;1:146–155. doi: 10.1089/bfm.2006.1.146.
    1. 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;109:17294–17301. doi: 10.1073/pnas.1121267109.
    1. Anabrees J., Indrio F., Paes B., AlFaleh K. Probiotics for infantile colic: A systematic review. BMC Pediatr. 2013;13:186. doi: 10.1186/1471-2431-13-186.
    1. Sarasu J.M., Narang M., Shah D. Infantile Colic: An Update. Indian Pediatr. 2018;55:979–987. doi: 10.1007/s13312-018-1423-0.
    1. De Weerth C., Fuentes S., de Voss W.M. Crying in infants. On the possible role of intestinal microbiota in the development of colic. Gut Microbes. 2013;4:416–421. doi: 10.4161/gmic.26041.
    1. 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:e035405. doi: 10.1136/bmjopen-2019-035405.
    1. Dryl R., Szajewska H. Probiotics for management of infantile colic: A systematic review of randomized controlled trials. Arch. Med. Sci. 2018;14:1137–1143. doi: 10.5114/aoms.2017.66055.
    1. Schreck Bird A., Gregory P.J., Jalloh M.A., Risoldi Cochrane Z., Hein D.J. Probiotics for the Treatment of Infantile Colic: A Systematic Review. J. Pharm. Pract. 2017;30:366–374. doi: 10.1177/0897190016634516.
    1. Tintore M., Colome G., Santas J., Espadaler J. Gut Microbiota Dysbiosis and Role of Probiotics in Infant Colic. Arch. Clin. Microbiol. 2017;8:56.
    1. Pärtty A., Lehtonen L., Kalliomäki M., Salminen S., Isolauri E. Probiotic Lactobacillus rhamnosus GG therapy and microbiological programming in infantile colic: A randomized, controlled trial. Pediatr. Res. 2015;78:470–475. doi: 10.1038/pr.2015.127.
    1. Fatheree N.Y., Liu Y., Ferris M., Van Arsdall M., McMurtry V., Zozaya M., Cai C., Rahbar M.H., Hessabi M., Vu T., et al. Hypoallergenic formula with Lactobacillus rhamnosus GG for babies with colic: A pilot study of recruitment, retention, and fecal biomarkers. World J. Gastrointest. Pathophysiol. 2016;7:160–170. doi: 10.4291/wjgp.v7.i1.160.
    1. Kianifar H., Ahanchian H., Grover Z., Jafari S., Noorbakhsh Z., Khakshour A., Sedaghat M., Kiani M. Synbiotic in the management of infantile colic: A randomised controlled trial. J. Paediatr. Child. Health. 2014;50:801–805. doi: 10.1111/jpc.12640.
    1. Piątek J., Bernatek M., Krauss H., Wojciechowska M., Chęcińska-Maciejewska Z., Kaczmarek P., Sommermeyer H. Effects of a nine-strain bacterial synbiotic compared to simethicone in colicky babies—An open-label randomised study. Benef Microbes. 2021;12:249–257. doi: 10.3920/BM2020.0160.
    1. Savino F., Garro M., Montanari P., Galliano I., Bergallo M. Crying Time and RORγ/FOXP3 Expression in Lactobacillus reuteri DSM17938-Treated Infants with Colic: A Randomized Trial. J. Pediatr. 2018;192:171–177. doi: 10.1016/j.jpeds.2017.08.062.
    1. Pathirana W.G.W., Chubb S.P., Gillett M.J., Vasikaran S.D. Faecal Calprotectin. Clin. Biochem. Rev. 2018;39:77–90.
    1. Li F., Ma J., Geng S., Wang J., Liu J., Zhang J., Sheng X. Fecal calprotectin concentrations in healthy children aged 1–18 months. PLoS ONE. 2015;10:e0119574. doi: 10.1371/journal.pone.0119574.
    1. Sommermeyer H., Krauss H., Chęcińska-Maciejewska Z., Pszczola M., Piątek J. Infantile Colic-The Perspective of German and Polish Pediatricians in 2020. Int. J. Environ. Res. Public Health. 2020;17:7011. doi: 10.3390/ijerph17197011.
    1. Piatek J., Krauss H., Ciechelska-Rybarczyk A., Bernatek M., Wojtyla-Buciora P., Sommermeyer H. In-Vitro Growth Inhibition of Bacterial Pathogens by Probiotics and a Synbiotic: Product Composition Matters. Int. J. Environ. Res. Public Health. 2020;17:3332. doi: 10.3390/ijerph17093332.
    1. Team R.C. R Foundation for Statistical Computing. R Software; Vienna, Austria: 2021. [(accessed on 3 January 2022)]. R: A Language and Environment for Statistical Computing. Available online:
    1. Kassambra A. R Foundation for Statistical Computing. R Software; Vienna, Austria: 2021. [(accessed on 3 January 2022)]. Rstatix: Pipe-Friendly Framework for Basic Statistical Tests. Available online:
    1. Lenth R.V. R Foundation for Statistical Computing. R Software; Vienna, Austria: 2022. [(accessed on 3 January 2022)]. Emmeans: Estimated Marginal Means, aka Least-Squares Means. Available online:
    1. Bates D., Maechler M., Bolker B., Walker S. Fitting Linear Mixed-Effects Models Using lme4. J. Stat. Softw. 2015;67:1–48. doi: 10.18637/jss.v067.i01.
    1. Meier R., Steuerwald M. Review of the therapeutic use of simethicone in gastroenterology. Schweiz. Z. Für Ganzheitsmed. 2007;19:380–387. doi: 10.1159/000286002.
    1. Hizli S., Can D., Kiliç I., Örün E., Tunç T., Özkan H. Diagnosis and Treatment Approaches in Infantile Colic (IC): Results of a Survey Among Paediatricians in Turkey. Front. Pediatr. 2021;9:1543. doi: 10.3389/fped.2021.779997.
    1. Barr R.G., Kramer M.S., Boisjoly C., McVey-White L., Plesset I.B. Parental diary of infant cry and fuss behaviour. Arch. Dis. Child. 1988;63:380–387. doi: 10.1136/adc.63.4.380.
    1. Stone A.A., Shiffman S., Schwartz J.E., Broderick J.E., Hufford M.R. Patient compliance with paper and electronic diaries. Control. Clin. Trials. 2003;24:182–199. doi: 10.1016/S0197-2456(02)00320-3.
    1. Lam J., Barr R.G., Catherine N., Tsui H., Hahnhaussen C.L., Pauwels J., Brant R. Electronic and paper diary recording of infant and caregiver behaviors. J. Dev. Behav. Pediatr. 2010;31:685–693. doi: 10.1097/DBP.0b013e3181e416ae.

Source: PubMed

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