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Three Part Question

In [babies presenting with infantile colic] is [probiotic] effective at [improving symptoms]

Clinical Scenario

A 4 week old baby is brought by parents with inconsolable crying for more than 3 hours a day for the past 3-4 days.Child is passing a lot of flatus and from the history the child is having a typical colic behaviour.
Parents are advised by someone to use Gripe Water which din't help the baby and they want to know if there is anything we can do in ED.You hear from your colleague that that Probiotiocs help the baby.Is there any evidence for probiotic use in Infantile colic?

Search Strategy

MEDLINE 1950 to November Week 1 2007 using the OVID interface.
MEDLINE Strategy [Exp Probiotics or probiotics.mp OR exp Lactobacillus or Lactobacillus.mp OR probiotic bacteria.mp OR probiotic.mp] AND [Exp colic or Baby colic.mp OR Infant colic.mp OR infantile colic.mp OR three month colic.mp OR colicky infants.mp] Limit to Humans and English

Search Outcome

5 papers found of which one is relevant to the three part question

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Savino, Francesco. Pelle, Emanuela. Palumeri, Elisabetta. Oggero, Roberto. Miniero, Roberto. Jan 2007 Italy	90 Breastfed infants suffering with infantile colic randomly revieved either Probiotic Lactobacillus Reuteri or Simethicone everyday for 28 days	Daily median crying times in the probiotic and Simethicone group we measured for 28days	Response measured as decreased median crying time	Responders 95% in Probiotic group and 7% in Simethicone group	Non blinded study and bias could not be avoided from parents or clinicians Only one strain of the probiotic bacteria used. Studied only breastfed infants.

Comment(s)

Infantile colic is one of the most commom presenting problem is ED and primary care as it affects nearly 1 in 5 infants in UK. As the cause of the colic is not still established there are prevous observational studies which found that colicly infants are less fequently colonised by Lactobacillus species. Different treatment modailites were advocated ranging from soothing the bay to using simethocaine(infacol).None of the treatments are supported by good evidence. This paper has got it own weakness but supports the theory of Lactobacillus improving the symptoms. Level of Evidence is 2b

Clinical Bottom Line

Further large scale mutli center RCT are required before advocating the treatment of probiotic in all infants with colic.

References

1. Savino, Francesco. Pelle, Emanuela. Palumeri, Elisabetta. Oggero, Roberto. Miniero, Roberto. Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study Pediatrics 2007 Jan ;119(1):e124-30