02.04.2014 16:51

Article

 

Pedro Gutierrez-Castrellon, MD, MSc, DSca,b, Gabriel Lopez-Velazquez, MSc, PhDc, Luisa Diaz-Garcia, MNutr, DNutrc, Carlos Jimenez-Gutierrez, MPH, DPHa, Javier Mancilla-Ramirez, MD, MSc, DSca, Juliana Estevez-Jimenez, MD, MSca, and Minerva Parra, MDc

+ Author Affiliations

 

ABSTRACT

 

OBJECTIVES To evaluate whether daily administration of Lactobacillus reuteri DSM 17938 reduces the frequency and duration of diarrheal episodes and other health outcomes in day school children in Mexico.

 

METHODS: Healthy children (born at term, aged 6–36 months) attending day care centers were enrolled in this randomized, double-blind, placebo-controlled trial. They received L reuteri DSM 17938 (dose 108 colony-forming unit; n = 168) or identical placebo (n = 168) by mouth, daily for 3 months, after which they were followed-up after a further 3 months without supplementation.

 

RESULTS: Data from all children were included in the final analysis. L reuteri DSM 17938 significantly reduced the frequency and duration of episodes of diarrhea and respiratory tract infection at both 3 and 6 months (P < .05). Additionally, the number of doctor visits, antibiotic use, absenteeism from day school and parental absenteeism from work were significantly reduced in the L reuteri group (P < .05). A cost-benefit analysis revealed significant reductions in costs in the L reuteri-treated children. No adverse events related to the study product were reported.

 

CONCLUSIONS: In healthy children attending day care centers, daily administration of L reuteri DSM 17938 had a significant effect in reducing episodes and duration of diarrhea and respiratory tract infection, with consequent cost savings for the community.

 

Key Words:

Lactobacillus reuteri DSM 17938 diarrhea children

Accepted January 13, 2014.

Copyright © 2014 by the American Academy of Pediatrics

 

 

 

 

 

 

 

 

 

 

02.04.2014 13:58

 

Monday 24 March 2014 - 1am PST

 

Nutrition / DietPediatrics / Children's HealthGastroIntestinal / GastroenterologyImmune System / Vaccines  add your opinionemail  

 

Breastfeeding until at least nine months of age increases prevalence in the gastrointestinal tract of Lactobacilli andBifidobacteria, species which are known to contribute to development of a healthy immune system, according to a paper describing the establishment of the intestinal microbiota during the first three years of life. The research was published ahead of print in the journal Applied and Environmental Microbiology.

 

In the study, the investigators sampled the gut microbiota in the feces of 300 children at 9, 18, and 36 months of age. The nutritional factor with the greatest impact on the composition of the gut flora was the time of cessation of breast feeding.

 

"This is to our knowledge the first study to characterize the gut microbiota in such a large cohort of children for this duration," says corresponding author Tine Rask Licht, of the Technical University of Denmark.

 

The investigators also examined the microbiota, seeking enterotypes, or characteristic microbial communities. While enterotypes tend to be stable in adults (absent antibiotic use or major changes in diet) the investigators found that one particular enterotype-like grouping was prevalent at 18 months and another at 36 months, but that children frequently flipped a few times between the two.

 

"This indicates that the microbiota is still not completely stably established until after this time," says Licht.

 

"The research could ultimately lead to supplementation of infant formulas - or food for adults - with specific bacteria or carbohydrates expected to promote a healthy gut microbiota," says Licht. She and her collaborators are currently involved in studies testing effects of such pro- and prebiotics in animal models as well as in humans, she says, noting that in Denmark, several multinational companies are also involved in this research.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

02.04.2014 12:14

 

Giving probiotics to infants with colic does not appear to have any benefit, according to a large trial published today.

 

These findings differ from previous smaller trials and do not support a general recommendation for the use of probiotics to treat colic in infants.

 

Infant colic (excessive crying of unknown cause) affects up to 20% of infants and is a major burden to families and health services. Although it spontaneously resolves three to four months after birth, its cause remains elusive and no single effective treatment exists.

 

Previous small trials suggest that the probioticLactobacillus reuteri effectively treats colic inbreastfed infants. These studies, however, had limitations as they examined only a highly selective group of infants with colic. The effects of L reuteri on formula fed infants with colic are unknown.

 

So researchers based in Australia and Canada set out to determine whether the probiotic Lactobacillus reuteri reduces crying or fussing in 167 breastfed and formula fed infants with colic aged less than three months old.

 

A total of 85 infants were randomised to receive the probiotic and 82 to receive placebo for one month. Outcomes included daily duration of crying or fussing at one month, sleep duration, mother's mental health, family and infant quality of life.

 

Levels of gut microbial diversity, faecal calprotectin (a marker of gut inflammation) andE coli colonisation were also examined.

 

The results show that the probiotic group fussed significantly more than the placebo group at all time points from day seven to one month. At one month, the probiotic group cried or fussed 49 minutes more than the placebo group. This increased fussing occurred only in formula fed infants. L reuteri did not affect crying or fussing time in exclusively breastfed infants.

 

L reuteri treatment did not lead to changes in infant faecal microbial diversity, E colicolonisation, or calprotectin levels.

 

The researchers point out that this is the largest randomised controlled trial of probiotic intervention in infants with colic to date. They conclude that L reuteri treatment "did not reduce crying or fussing in infants with colic, nor was it effective in improving infant sleep, maternal mental health, family or infant functioning, or quality of life" and say "probiotics therefore cannot be routinely recommended for all infants with colic."

 

Further research is needed to identify which subgroups of infants with colic may benefit from probiotics, they add.

 

This represents the most definitive and well designed study to date on this controversial topic, writes William E Bennett Jr, Assistant Professor of Paediatrics at Indiana University School of Medicine, in an accompanying editorial.

 

With such a dearth of good evidence, should we be treating infant colic at all, he asks? He points out that children with colic "incur no serious long term effects" from the disorder and symptoms "abate with time," whereas the potential harm associated with diagnostic testing and treatment of infants "is likely to surpass the harm from colicitself."

 

As the old adage goes "babies cry," he concludes. Parents and their babies "may be better served if we devote more resources to studying the interventions recommended long before the discovery of probiotics: reassurance, family social support, and the tincture of time."

 

 Explore further: Study examines probiotics to prevent or treat excessive infant crying

 

More information: www.bmj.com/cgi/doi/10.1136/bmj.g2107 

www.bmj.com/cgi/doi/10.1136/bmj.g2286

 

 

 

 

 

 

 

 

 

 

 

 

 

 

28.02.2014 17:51

JAMA Pediatr. 2014 Jan 13. doi: 10.1001/jamapediatrics.2013.4367. [Epub ahead of print]

Prophylactic Use of a Probiotic in the Prevention of Colic, Regurgitation, and Functional Constipation: A Randomized Clinical Trial.

Indrio F1, Di Mauro A1, Riezzo G2, Civardi E3, Intini C4, Corvaglia L5, Ballardini E6, Bisceglia M7, Cinquetti M8, Brazzoduro E9, Del Vecchio A10, Tafuri S11,Francavilla R1.

 

 

https://www.ncbi.nlm.nih.gov/pubmed/24424513