Top 10 best colic remedies for newborns - Pediatrics and neonatology

Colic - translated from Greek as intestinal - is an acute pain that is sudden, paroxysmal and recurring. This condition occurs in 70% of newborns. As a rule, they begin to torment a newborn from the age of three weeks, and gradually fade away by three months. It is important to remember that this is not a disease. Infant colic is temporary, and parents should be patient and work through this phenomenon. Medicine for colic in a newborn will help with this.

Dill water

This is an excellent remedy for preventing and reducing the symptoms of colic. “Dill water” should be given to the child before each meal. In addition to relieving intestinal spasms, this concentrate improves digestion and has an antimicrobial effect.

Dill water

KorolevPharm LLC, Russia

Dill water relieves spasm of the intestinal muscles, thereby allowing accumulated gases to escape.
Dill water is especially effective for newborns, who have pronounced flatulence during the first 4-6 months of life. This water also has antimicrobial properties and helps improve the digestion process. from 216

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Dysbacteriosis in infants

Until the moment of birth, the baby is in a completely sterile environment; its gastrointestinal tract does not contain any bacteria or microorganisms. At the moment of birth, moving along the birth canal, the child first “gets acquainted” with the mother’s natural microflora, which normally contains lacto- and bifidobacteria and E. coli. Signs and main symptoms indicating that an infant may have an imbalance of intestinal flora:

bloating;
flatulence;
frequent abdominal pain;
bad breath;
increased salivation;
dry skin;
manifestations of allergic dermatitis;
thrush, stomatitis on mucous membranes;
constipation;
diarrhea for more than 2-3 days

If the doctor has diagnosed “intestinal dysbiosis”, then a comprehensive, fairly long-term treatment will be required. At the first stage, bacteriophages are prescribed - the so-called “tamed” viruses. Their action is aimed at destroying pathogenic and opportunistic flora (while they do not affect beneficial bacteria). In parallel with intestinal antiseptics, sorbents (to quickly remove toxins from the body) and enzymes (to help the digestive system) are prescribed.

"Bifidumbacterin"

The dietary supplement is suitable for newborns in any form except tablets. Lactose, sugar and gelatin are included in the drug, which is due to the mechanism of its effect on the intestinal environment. You need to remember about the components of the probiotic and not prescribe it to babies who are not capable of adequately absorbing them. Mostly “Bifidumbacterin” is given in the form of a powder solution. It is convenient to do this using a pipette, dissolving it in breast milk or an adapted formula.

There are a number of requirements that you need to remember when taking the course:

The probiotic is consumed only fresh.
By introducing the powder into water warmer than 40 degrees, you deprive it of all its beneficial properties.
The product should be stored in the refrigerator, but not frozen.
Give the medicine before feeding or half an hour before meals.
The dosage recommendation is to use the solution 2-3 times (take 1 sachet per dose). If we are talking not about treatment, but about the prevention of colic, the dose is halved.
Typically, the probiotic should be taken for 3 weeks.

The main component of this drug is bifidobacteria. They inhibit the growth of pathogenic bacteria and help eliminate bloating. The components of the probiotic do not have a harmful effect on the newborn’s body.

"Linex"

This drug is known for a large number of positive reviews and is designed to quickly improve the baby’s condition, starting from the first days of life. It must be remembered that the composition is not indicated for infants with lactase deficiency, as well as hypersensitivity to the components of the drug. The contents of the capsule or sachet are diluted in water or breast milk. The dosage regimen is 3 times a day after a certain period of time before feeding. The powder does not have a distinct taste or smell, however, there are certain difficulties in using the prepared solution, so it is preferable to give the drug to the child at the moment when he experiences the greatest feeling of hunger.

The composition will not only improve the condition of the microflora, but can also provide additional nutrition and prevent spasms in artificially-trained children. For newborns with colic and milk intolerance, Narine lactobacteria successfully cope with the breakdown of lactose and protein.

It has been proven that about 5% of children are born with a lack of necessary enzymes.

In addition to traditional probiotic treatment, foods fermented with this culture are used in the diet of a colicky child. They can be given from 3 days of age if breastfeeding is not available. ½ packet dissolves in 30-40 ml. water (the course requires 14 daily doses in the amount of 1 sachet, which is divided into two doses). You can use juice or fruit drink for these purposes.

The general opinion of pediatricians is not to prescribe or select probiotics on your own, without tests, examination, etc. Self-medication is a risk to the baby’s health.

All probiotics are dietary supplements, and therefore do not have as developed an evidence base as patented medications for colic. They can overstimulate the immune system, not always leading to positive results. The probiotic dose should be taken for 1-3 weeks, 20-60 minutes before feeding or an hour after. If the condition improves, it can be halved. Some drugs have a long course of up to several months - this should also be selected by a specialist based on test results.

In particular, Hilak Forte, prescribed incorrectly, has a negative effect on the esophagus. Exceeding the dosage is fraught with manifestations on the skin, including urticaria, which causes obvious discomfort. In general, a sign that the probiotic has been selected incorrectly may be a high temperature or increased abdominal pain.

Espumisan L

The active ingredient of the drug is simethicone. Eliminating gas formation and bloating, Espumisan L is not absorbed, but is excreted from the body unchanged. The drug is suitable for the relief of acute attacks of colic and for prevention.

Espumisan L

Berlin-Chemie/Menarini, Germany

Espumisan L, based on the active substance - simethicone, reduces the amount of gases in the gastrointestinal tract (GIT): has surface-active properties and the ability to reduce surface tension at the liquid/gas interface, which makes it difficult to form gas bubbles and also promotes their fusion and the destruction of foam in the intestines, as a result of which the released gas is absorbed and excreted naturally under the influence of intestinal peristalsis.
The use of simenticon in preparation for diagnostic studies prevents the occurrence of image defects caused by gas bubbles. from 300

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Prevention of intestinal colic:

Follow feeding technique: monitor the baby’s position when feeding so that the baby does not swallow air along with food. If the baby is bottle-fed, you can change the formula only after consulting with your pediatrician. After feeding, it is recommended to raise the baby to an upright position and wait for burping.
Do not overfeed your child. Mom must adhere to a feeding schedule. If your baby is bottle-fed, it is important to follow the rules of preparation and dosage of food recommended by your doctor.
Place on the tummy before feeding - this will strengthen the abdominal muscles and improve digestion. You can start with a couple of minutes and gradually increase the time.
A nursing mother must follow a diet. It is important to exclude potential allergens (chocolate, citrus fruits, eggs, seafood, milk, etc.), spicy and fatty foods, as well as laxatives and gas-inducing foods.
Create a calm atmosphere. For the best results, it is important that the baby is calm. The mother can talk to the child, sing a lullaby, play a recording with monotonous quiet sounds (the sound of the surf, the rustling of a fan, the beating of the heart) or calm classical music.

To relieve gas, 30-60 minutes after eating, you can lightly stroke your tummy clockwise. After the massage, bend and straighten the baby’s legs several times. In some cases, warmth helps relieve an attack of colic: consult your pediatrician; perhaps a bath with soothing herbs or a warm diaper placed on the tummy will help your baby.

Plantex

This is a herbal remedy for colic, based on fennel seeds. "Plantex" relieves the baby from pain and is not addictive. One sachet per day is enough for a newborn, which is three doses of Plantex.

Plantex

Lek d.d., Slovenia

As a preventive and therapeutic agent in children from 2 weeks of age and older: - to eliminate spastic pain in the intestines with mild digestive disorders;
- when switching from breastfeeding to other types of nutrition. from 285

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How can you tell if your baby has colic?

The main question is usually whether you are missing symptoms of something more serious.

If you notice that the child begins to cry

unusual timbre (louder, shriller, similar to a cry of pain),
much more often and for longer than before,
without calming down from what had helped before.

carefully examine his skin, do not forget to take off his socks, diaper (it happens that an adult’s hair accidentally pinches a finger or penis, wrapped around the base) remember what happened before the crying began, measure the temperature.

Urgently inform the doctor (“red flags” in the child’s condition)

Cries for more than two hours straight without calming down.
The temperature is above 38 degrees in an undressed baby.
It has been dropped or shaken violently.
He began to react worse to you, looks inhibited, “limp.”
Stopped eating and urinating as usual.
There is blood in the stool.
Age 1 month (+/− a few days).

If there is none of this, and the baby looks as usual between bouts of crying, there is definitely no need to urgently run somewhere. This means the reason is not dangerous, and it can be discussed with your treating pediatrician during his working hours.

Now notice how you feel when your baby cries.

Urgently see loved ones/psychologist/social worker (“red flags” in the mother’s condition)

You feel that if the child continues to scream, you may lose your temper and treat him roughly.
It seems to you that he is manipulating and mocking.
You can't do this anymore, life doesn't bring you joy.

These are signs that the mother’s rest should come first in the family. If rest does not help, these are signs of postpartum depression, you should definitely consult a doctor (psychiatrist or psychotherapist). If there are no loved ones, you can be supported in the social protection department, antenatal clinic, center for psychological assistance to the population, and charitable organizations that help mothers.

Bobotik

The active ingredient of the medicine is simethicone, which relieves attacks of pain and reduces gas formation in the intestines. “Bobotik” is not absorbed into the blood and is not addictive.

Bobotik

Medana Pharma SA (Medana Pharma), Poland

- increased gas formation and accumulation of gases in the gastrointestinal tract (colic, feeling of fullness in the abdominal cavity, flatulence (including in the postoperative period), Remgeld syndrome, aerophagia);
- preparation for diagnostic studies of the abdominal and pelvic organs (radiography, sonography, gastroscopy and duodenoscopy - to prevent the formation of foam). from 164

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Enzyme-enriched preparations

Enzymes are special substances that help break down nutrients (in particular milk sugar) in the intestines.

Modern medicines mainly contain digestion catalysts such as amylases, lipases and proteases. Of all the drugs containing enzymes, infants are most often prescribed:

Mezim;
Creon;
Lactazar (the latter is recommended exclusively for lactose deficiency and may be completely useless in all other cases).

Baby Calm

A plant-based product made from oil extracts. Baby Calm breaks down certain food substances so that they do not turn into gases. The medicine can be used as a prophylaxis for colic.

Bobotik

Medana Pharma SA (Medana Pharma), Poland

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Medicines against colic. Auxiliary products and drug therapy.

Gas tubes and microenemas

If all your previous actions have not brought relief, we use auxiliary means - gas tubes and microenemas. They help get rid of excess gas in the abdomen, which reduces pain. Modern gas outlet tubes have an insertion limiter - the tip of the tube is thickly lubricated with Vaseline oil or cream and inserted up to the limiter. If the effect is insufficient, use an enema with 10-15 ml of clean water at room temperature (take the smallest syringe, don’t forget to lubricate the tip and insert shallowly 1 cm). Kabrita recommends the Windi straw.

Drug therapy

Among the means of drug therapy for colic, simethicone preparations - antifoam agents - are widely used. Simethicone helps to collapse gas bubbles in the intestine, reducing bloating. Herbal remedies based on fennel, mint, and dill also reduce spasms and gas formation. The history of their use is the longest. But be careful with herbs, if you have allergies in your family, your child may also have an allergic reaction to such remedies.

Probiotics

Some probiotics have an analgesic and preventive effect on infant colic. Probiotics containing reuteri have shown good effectiveness.

Bebinos

An herbal preparation that relieves the baby of gas. “Bebinos” contains extracts of chamomile flowers, fennel and coriander seeds. The main difference between this herbal preparation is that it is prescribed not only for the prevention, but also for the effective treatment of intestinal spasms.

Bobotik

Medana Pharma SA (Medana Pharma), Poland

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Preventive measures - what to do

"Plantex" - an old proven remedy

Intestinal problems begin in all newborns on the first day of their life. One of the best medications will help you cope with colic - Plantex for newborns, the instructions for use of which state that the medicine can be given from the first days of the baby's life.

Instructions on how to take the drug are included in each package to learn how to give the drug to an infant. Small children from 2 weeks of life are given 1 sachet per day. How to dilute medicine for an infant? Dividing the contents of the product into 3 equal parts, the tea should be given to the baby immediately after preparation. Many parents make a big mistake by giving the drug to their child incorrectly. So, when should you give the product to your baby, before or after meals? It is better to take the drug after meals or in between feedings. Take 1 part of granules, dilute with water or add to feeding bottle

When the drug begins to act depends on the severity of colic and the duration of use of the drug. If parents constantly give Plantex to their child (as required 3 times a day), then it will act faster. Colic does not have time to manifest itself strongly, so the drug acts faster. If parents give the drug only at a time when the child begins to cry, draw in his legs, arch his back from pain in the tummy, then the drug will act within half an hour.

You should also remember about possible allergies to fennel extract or fruits and any excipients contained in the drug. The list of contraindications includes impaired glucose absorption mechanisms and lactase deficiency.

"Baby Calm" - natural and safe

Like the above colic remedies, Israeli-made drops are made from natural ingredients. Essentially, it is a mixture of oils designed to eliminate bloating and normalize the passage of gas. "Baby Calm" contains anise, dill, mint, the effect of which enhances and complements each other:

Anise relieves spasms by stimulating intestinal activity.
Dill also has a carminative effect, relieves abdominal pain, and relieves inflammation.
Mint calms and relaxes the baby's nervous system.

For ease of use, the oily liquid is available in a glass bottle with a special dispenser. Sensitivity to the components depends on the individual child, so the speed of action of the drug against colic may differ. Purified water is used to dilute oils and prepare emulsions. Her temperature should not be high. Water is poured to the mark and act according to the instructions - give the child 10 drops of the medicinal solution before feeding, adding it to milk, artificial formula, or directly dripping it into the mouth.

An overdose of the medicine is impossible. We can only talk about allergic reactions to plant components. Baby Calm contains a certain amount of alcohol, so long-term use is undesirable, despite the manufacturer’s assurances about the absence of side effects and the low ratio of the substance to the oil mixture.

"Bebinos"

This drug contains fennel, coriander and chamomile. This is a combined remedy, the indications for which are colic, stomach disorders, and digestive problems. Available in the form of drops.

Chamomile extract is indispensable for inflammatory processes in the gastrointestinal tract, the presence of pathogenic intestinal flora, relieves spasms, fights allergies, stimulates the production of digestive juices necessary for the correct functioning of all organs.

Fennel, as mentioned above, eliminates bloating, activates the digestion process, normalizing the condition of the intestines.

Coriander, in addition to carminative, also has a choleretic effect.

If the baby is too sensitive to the components of the drops, including sorbitol and alcohol, Bebinos should be used with caution and consult a pediatrician. Chamomile in the composition prevents allergies, so side effects are extremely rare.

For children under one year old, 3-6 drops should be dissolved in 30 mg. water - this dose should be repeated three times a day. First you need to shake the bottle with drops to get rid of possible sediment.

The product is convenient to store and use - the bottle has a convenient dispenser.

Like any natural remedy, Bebinos does not have an expected effect time; it is characterized by an individual reaction and the speed of onset of the therapeutic effect.

Acipol baby

Ideal from the first days of a child's life. “Acipol baby” improves the microflora in the oral cavity, which helps improve immunity. This is a balanced anti-colic drug.

Atsipol Baby

PJSC OTCPharm, Russia

A probiotic for children from the first days of life, containing a complex of beneficial bacteria that help reduce the risk of dysbiosis in infants and normalize intestinal microflora from birth.
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Typical symptoms of colic in a baby

They can occur slightly differently, there are no strict mandatory signs, but there is a “classic”, most common picture. For many children, colic begins and ends at the same time of day, often in the afternoon, after feeding. Mothers quickly begin to distinguish them from ordinary screams.

During a colic baby:

The crying becomes shrill, like a cry of pain, inconsolable.
Muscle tone increases: he knocks his legs, presses them to his stomach, clenches his fingers into fists, and arches.
There may be bloating, rumbling in the stomach, sometimes it becomes easier after the gas passes.

Probiotics and prebiotics in newborns and infants (literature review)

Authors : Smagin A.Yu.

Introduction

The problem of intestinal microecology has attracted much attention from neonatologists in recent years. According to the International Classification of Human Diseases (ICD-10), published in 1997, the microecological system of the body is defined as a very complex, phylogenetically established, dynamic complex, which includes associations of microorganisms and products of their biochemical activity (metabolites) that are diverse in quantitative and qualitative composition in certain areas. environmental conditions [1]. There are many reasons why the ratio of normal microflora of the digestive tract changes. These changes can be either short-term—dysbacterial reactions—or persistent—dysbacteriosis [3]. The so-called dysbacterial reactions, or dysbiosis, are a state of the ecosystem in which the functioning of all its components is disrupted - the human body, its microflora and the environment, as well as the mechanisms of their interaction, which leads to the occurrence of disease. Intestinal dysbiosis (ID) is understood as qualitative and quantitative changes in the normal flora of a person characteristic of a given biotype, entailing pronounced clinical reactions of the macroorganism or resulting from any pathological processes in the body. DC should be considered as a symptom complex, but not as a disease. It is quite obvious that DC is always secondary and mediated by the underlying disease. This explains the absence of such a diagnosis as “dysbiosis” or “intestinal dysbiosis” in ICD-10, adopted in our country, as well as throughout the world [1,3]. As is known, during intrauterine development the fetal gastrointestinal tract is sterile [9]. During birth, the newborn colonizes the gastrointestinal tract through the mouth, passing through the mother's birth canal, but a few hours after birth, E. Coli and streptococci bacteria can already be found in the baby's intestines, and they spread from top to bottom. And only 10 days after birth, various strains of bifidobacteria and bacteroides appear in the newborn’s gastrointestinal tract [4, 5]. Normal microflora is a qualitative and quantitative ratio of various microbes of individual organs and systems, maintaining the biochemical, metabolic and immune balance of the macroorganism, necessary for maintaining human health [6]. Back in 1981, Hansson showed that children born by cesarean section have a significantly lower content of lactobacilli than those born naturally [36]. Roberfroid in 2000 finally proved that only in children who are breastfed (breast milk), bifidobacteria predominate in the intestinal microflora, which is associated with a lower risk of developing gastrointestinal infectious diseases [17, 51, 52]. It has long been known that with artificial feeding a child does not develop a predominance of any group of microorganisms [14]. MacNelly, in a 1999 monograph, provides data that the composition of the intestinal flora of a child after 2 years is practically no different from that of an adult: more than 400 species of bacteria, most of which are anaerobes that are difficult to cultivate [2].

Causes of dysbiosis

Bengmark S. in 2000 presented factors influencing the density of microflora in various parts of the gastrointestinal tract in a newborn. These are: individual characteristics of intestinal motility; structural features of the neuromuscular apparatus of the infant’s intestines; congenital gastrointestinal diseases (small intestinal diverticulum, ileocecal valve defects, strictures, adhesions, etc.); slowing down the passage of chyme through the colon (gastroduodenitis, scleroderma, Crohn's disease, necrotizing enterocolitis, etc.) [10]; changing the pH of the environment to the alkaline side; changes in the enzyme composition of the intestines (pancreas, liver); disturbance of the level of secretory IgA and iron; poor nutrition of the mother of a breastfed child; features and mode of feeding of a newborn [52]. It should be noted that the diet of a child older than one year, a teenager, an adult is not as important as during the neonatal period and the first year of life [12]. The textbook of Neonatology (Shabalov N.P., 2004) describes the functions of normal intestinal microflora in newborns. This is participation in the final stages of digestion (breakdown of fiber, lactose, deconjugation of bile acids and transformation into fatty acids); synthesis of vitamins (B12, K, B1, B2, PP, biotin, folic acid) [7]. Positive microflora has a powerful antagonistic effect due to high enzymatic activity; it affects the structure of the intestinal mucosa and the rate of regeneration and absorption, and also stimulates the local immune system (lymphatic follicles, production of lymphocytes, immunoglobulins) [16]. The influence of normal intestinal flora on the health and development of the newborn is of enormous importance. This includes the fight against vitamin deficiency and enzymatic disorders; endogenous synthesis of nucleotides, essential amino acids (tryptophan) and peptides; regulation of adaptation processes; reducing the risk of intestinal infections and forming a protective barrier of the intestinal mucosa. [36, 37, 64]. The reasons for the development of microflora imbalance in newborns, first of all, should be considered late breastfeeding, as well as: artificial feeding, malnutrition of the mother, decreased reactivity of the child’s body, decreased acidity of gastric juice, intestinal hypoxia, intestinal obstruction, immunodeficiency states, thoughtless and uncontrolled use antibiotics, leading to the death of a significant part of the normal microflora and the proliferation of pathogenic and opportunistic microflora [7]. Dysbiosis is a qualitative and quantitative change in the composition of the intestinal microflora with an expansion of its sphere of influence.

Breast milk factors affecting microflora colonization

Only breastfeeding can prevent the newborn baby’s intestines from undesirable consequences [28]. The composition of breast milk is very complex. Its factors are compounds responsible, on the one hand, for stimulating the growth of normal microflora, and on the other hand, for suppressing foreign microflora [32]. Stimulate the growth of commensal bacteria: oligosaccharides (bifidus factor) and lactose [23]. Fermentation of lactose reduces the pH of the intestinal contents, leading to the evolutionary selection of bacteria capable of utilizing it [20]. Inhibit the colonization of pathogenic bacteria: secretory IgA, nutrients (fatty acids, lactoferrin), complex carbohydrate structures (glycoproteins, glycosaminoglycans, glycolipids, mucins, oligosaccharides) [55]. As was clarified above, the formation of a child’s intestinal biocenosis occurs under the influence of the intestinal microflora and the mother’s birth canal, breastfeeding and further nutrition. Correction of the resulting biocenosis can be carried out in two ways: by introducing pro- and prebiotics [33, 48].

Classification

Currently, biologically active substances used to improve the functioning of the digestive tract, regulate gastrointestinal microbiocenosis, prevent and treat certain specific infectious diseases are divided into dietary supplements, functional nutrition, probiotics, prebiotics, synbiotics, bacteriophages and biotherapeutic agents [2, 59]. According to the literature, the first three groups are combined into one - probiotics. The use of probiotics and prebiotics leads to the same result - an increase in the number of lactic acid bacteria, natural inhabitants of the intestines [35]. Thus, these drugs should be primarily prescribed to infants, the elderly, and those receiving hospital treatment [45]. Since probiotics have complex effects, including immunomodulatory ones, their administration should be carried out according to indications. For the formation of intestinal biocenosis and the prevention of dysbiosis, the use of prebiotics is more acceptable. Prebiotics are food for obligate saccharolytic flora and are divided into mono-, oligo- and polysaccharides. For the formation of bifidus-predominant flora in children of the first year of life, it is important to introduce prebiotics containing galactose [18, 49].

PROBIOTICS

Definition

Probiotics are live microorganisms: lactic acid bacteria, often bifidobacteria, or lactobacilli, sometimes yeast, which, as the term “probiotic” implies, belongs to the normal inhabitants of the intestines of a healthy person [60]. Mechanism of action of probiotics: synthesis of AB substances, organic acids, proteases that inhibit the growth of intestinal flora; competition for adhesion receptors; stimulation of the immune response (increased phagocytic activity and increased content of IgA, T-killers, interferon concentration; correction of the production of anti-inflammatory cytokines; increased cytoprotection due to increased mucin production, decreased mucosal permeability [10, 39].

Classification of probiotics

Lactobacilli L. acidophilus L.casei L. delbrueckii subsp. Bulgaricus L. reuteri L. brevis L. cellobiosus L. curvatus L. fermentum L. plantarum Gram-positive cocci Lactococcus lactis subsp. cremoris Streptococcus salivarius subsp. thermophilus Enterococcus faecium S. diaacetylactis S. intermedius Bifidobacteria B. bifidum B. adolescentis B. animalis B. infantis B. longum B. Thermophilum Such a variety of drugs indicates a highly developed industry and the demand for probiotics [24]. However, one cannot discount the fact that the pharmaceutical industry of Western countries and the countries of the former socialist camp is different. Therefore, the studies presented below cannot be unconditionally applied to Russian neonatology. The microorganisms that make up probiotics are non-pathogenic, non-toxic, contained in sufficient quantities, and remain viable when passing through the gastrointestinal tract and during storage [26]. Probiotics must meet the following requirements: contain strains of microbes whose effects have been clinically proven, meet the age-related characteristics of the intestinal microbiocenosis, be acid-resistant, antibiotic-resistant and safe. They are not considered drugs and are considered as means that have a beneficial effect on people's health [34, 45, 54].

Review

A recent controlled 6-month study assessed the effects of a probiotic mixture (Lactobacillus rhamnosus GG, L. rhamnosus LC705, Bifidobacterium breve Bb99, and Propionibacterium freudenreichii ssp. shermanii JS) on irritable bowel syndrome symptoms. Based on the results obtained, the authors conclude that this type of treatment is effective for IBS. Given the widespread prevalence of the disease and the lack of effective drugs to treat it, even a small reduction in symptoms can have positive implications for public health goals [41]. Last year, a randomized controlled trial (RCT) at 14 Israeli Beer-Sheva pediatric centers demonstrated the effectiveness of long-term formula supplementation with Bifidobacterium lactis (BB-12) and Lactobacillus reuteri in children with respiratory disorders. Moreover, in infants the duration of fever significantly decreased, episodes of diarrhea became shorter, and indications for AB therapy were reduced. This study demonstrated the important role of lactobacilli against bifidobacteria [61]. During the first 2 weeks after birth, there are practically no microbes in the intestines of premature babies that are beneficial for the healthy maturation and functional adaptation of their immune system, namely bifidobacteria and lactobacilli. A decrease in the “normal” intestinal microflora and colonization by opportunistic pathogens in very low birth weight (VLBW) infants (7–1500 g) are, along with immaturity, artificial feeding and intestinal ischemia, risk factors for the development of necrotizing enterocolitis (NEC) [11 ]. A recent RCT in Taiwan among 367 (180/187) very low birth weight (VLBW) infants showed that twice daily administration of probiotics in the form of Infloran (Lactobacillus acidophilus and Bifidobacterium infantis) during breastfeeding reduced the incidence and severity of NEC ( 2\180 versus 10\187) [44]. In a similar double-blind PKC study at the Shaare Zedek Perinatal Center (Israel), 3 of 72 (4%) VLBW infants receiving a probiotic formula (0.35 x 109 CFU Bifidobacteria infantis, 0.35 x 109 CFU Streptococcus thermophilus and 0.35 x 109 CFU Bifidobacteria bifidus) achieved NEC versus 12 out of 73 (16.4%) control groups who were breastfed or mixed fed. Although there was no significant difference between the two groups in the incidence of stage 1 NEC, the incidence of severe NEC (Bell stage 2 or 3) in the study group was 1 of 72 (1%) versus 10 of 73 (14%) in the control group (P =0.013) [11]. The authors of the PKK study in Finland concluded that the use of probiotics in the mother's diet before delivery and then in breastfed infants has a positive effect on the maturation of intestinal immunity in children in the first year of life. Total IgM, IgA, and IgG levels at 12 months were higher in those infants who were exclusively breastfed for 8–3 months and received a probiotic. The authors showed that some components of breast milk (CD14) are probiotics and stimulate humoral immune responses, and also promote the active interaction of innate and acquired (adaptive) immune responses during the maturation of the normal immune response in the gastrointestinal tract in young children [50]. The latest study by Italian scientists from the University of Turin shows the high role of Lactobacillus reuteri in the treatment of intestinal colic (infantile colicky) in newborns. So-called infantile intestinal colic is a common problem in children in the first months of life, but more than 70% have functional intestinal colic. In the vast majority of cases, these colics are not a disease, but an adaptation of the baby’s gastrointestinal tract to new conditions [67]. Despite more than 40 years of experience in the fight against infantile colic, scientists cannot figure out what comes first: colic or disorders of the intestinal microflora [66]. Until recently, the proven effect of relieving this condition belonged to dicycloverine, as well as simethicone, a drug that promotes the breakdown of foam and the release of gases in the usual way or resorption through the intestinal wall. And since this drug does not affect the functioning of the stomach and intestines, is not absorbed and is excreted unchanged, it is approved for use in newborns from the moment of birth. Francesco Savino and colleagues found that the intestinal microflora of children suffering from colic contains much less lactobacilli and more often anaerobic gram-negative microorganisms. Over 7 days of administration of 100 million live L. reuteri bacteria in their randomized, blinded, prospective study, colic symptoms were significantly reduced in 95% of infants, compared with only 7% responding to 60 mg/day simethicone (p < .001) [65].

PREBIOTICS

Definition

Prebiotics are non-digestible food ingredients that promote health by selectively stimulating the growth and/or metabolic activity of one or more groups of bacteria found in the colon [53]. The effect of prebiotics is as follows: they reduce the pH of stool; reduce ammonia production; activate the immune system; reduce the growth potential of clostridia, candida, listeria, etc.; increase the absorption of Ca from food by 40-60%; enhance energy supply and regeneration of the colon epithelium [29].

Classification of prebiotics

Fructose-oligosaccharides
Inulin
Galacto-oligosaccharides
Lactulose
Lactitol

To date, the properties of prebiotics such as mannose-, maltose-, xylose- and glucose-oligosaccharides have been little studied. Prebiotics are food for obligate saccharolytic flora and are divided into mono-, oligo- and polysaccharides [56]. For a food component to be classified as a prebiotic, it must have: the ability not to be broken down or absorbed in the upper gastrointestinal tract; the possibility of use as a selective substrate for beneficial microorganisms, stimulating their growth or metabolic activity; the ability to normalize the composition of the intestinal microflora and induce local and systemic responses that are beneficial for the body as a whole [52].

Oligosaccharides

The most important function of the newborn's intestinal bifid flora is the fermentation of dietary fiber - oligosaccharides. The functions of dietary fiber are extensive. These include: stimulation of the growth of bifidobacteria and lactobacilli acidophilus; "bifidus factor" of mother's milk; adsorption of toxic products and their excretion in feces; meeting energy needs by 6-9%; antioxidant activity (protecting the intestinal mucosa from free radicals); creation of fixation sites for intestinal microorganisms, which determine a favorable intestinal ecology; increased peristalsis [58].

Inulin

Inulin is a polysaccharide found in the tubers and roots of dahlias, artichokes and dandelions. It is a fructosan because its hydrolysis produces fructose. It has been shown that inulin, in addition to stimulating the growth and activity of bifidobacteria and lactobacilli, increases calcium absorption in the large intestine, i.e. reduces the risk of osteoporosis, affects lipid metabolism, reducing the risk of atherosclerotic changes in the cardiovascular system and, possibly, preventing the development of type II diabetes mellitus; there is preliminary evidence of its anticarcinogenic effect [42, 63].

Lactulose

Lactulose is a synthetic disaccharide not found in nature, in which each galactose molecule is linked by an u-1,4 bond to a fructose molecule [27, 38]. Lactulose enters the large intestine unchanged (only about 0.25-2.0% is absorbed unchanged in the small intestine) and serves as a nutrient substrate for saccharolytic bacteria. Lactulose has been used in pediatrics for more than 40 years to stimulate the growth of lactobacilli in infants [21, 46]. The drug Duphalac, registered on the Russian market and approved for use in infants, can be used at any age in a prebiotic dose of 3 ml per day for both the prevention and treatment of dysbiosis, in the latter case, together with probiotics.

Other prebiotics

Calcium pantothenate is involved in the processes of acetylation and oxidation in cells, carbohydrate and fat metabolism, acetylcholine synthesis, and stimulates the formation of corticosteroids in the adrenal cortex. It is utilized by bifidobacteria and helps to increase their biomass. PAMBA is para-amino-methyl-benzoic acid (analogue of Ambien), inhibiting the action of proteolytic enzymes of opportunistic bacteria and fungi, stimulating the growth and reproduction of bifido- and lactoflora. Lysozyme helps normalize disturbed microflora. Most active against gram-positive pathogenic and opportunistic bacteria. Lysozyme has a bifidogenic, immunomodulatory, anti-inflammatory effect, stimulates metabolic and reparative processes and erythropoiesis, improves digestion, increases the body's anti-infective and antitoxic resistance, has an antibacterial effect and exhibits synergism with many antibiotics.

Review

Several RCTs conducted on adult volunteers have shown a pronounced stimulating effect of oligosaccharides, especially those containing fructose, on the growth of bifidobacteria and lactobacilli in the large intestine [30]. Oligosaccharides, including N-acetylglucosamine, glucose, galactose, fucose oligomers or other glycoproteins, which constitute a significant proportion of breast milk, are specific factors for the growth of bifidobacteria [57]. One double-blind RCT in Hungary showed the effectiveness of adding oligosaccharides (a mixture of galacto- and fructooligosaccharides) to an early infant feeding formula at a dose of 0.4 g/100ml. At the beginning of the study, there was no statistically significant effect (p < 0.05) in the groups, but already on the 14th day the number of bifid flora colonies increased, relative to the control group, almost 2 times (9 x 1012 versus 5 x 1010) and remained the same and on day 28 [19]. Belgian scientists believe that adding a mixture of inulin and galactooligosaccharide in a 1:9 ratio to the early feeding formula throughout the neonatal period improves the bifidogenic effect in the postnatal period and reduces incidents of atopic diathesis in children in the late neonatal period [61]. A study by German scientists confirms the role of prebiotic supplements in breast and bottle feeding as modulators of the immune system in the postnatal development of infants [13]. And Italian researchers prove that with the introduction of galacto-oligosaccharides and fructo-oligosaccharides into the early nutritional formula, fecal pH becomes significantly higher, which leads to a decrease in the activity of pathogenic microflora [22]. This year's double-blind RCCT in Chile showed the positive role of prebiotics in increasing the population of Lactobacillus and Bifidobacteria during antibiotic therapy in 140 children. In the nutritional formula, the prebiotic was prescribed in a course for 21 days during AB therapy and subsequently [15].

Synbiotics

A mixture of probiotics and prebiotics are combined into a group of synbiotics that have a beneficial effect on the health of the host organism, improving the survival and engraftment of live bacterial supplements in the intestine and selectively stimulating the growth and activation of metabolism of endogenous lactobacilli and bifidobacteria [52]. Only 3 drugs of this series are registered on the territory of the Russian Federation: biovestin-lacto (contains bifidogenic factors and biomass of B. bifidum, B. adolescentis, L. plantarum); maltidophilus (contains maltodextrin and biomass of B. bifidum, L. acidophilus, L. bulgaricus); bifido-bak (includes fructooligosaccharides from Jerusalem artichoke and a complex of bifidobacteria and lactobacilli). The Institute of Nutrition in the Netherlands conducted a double-blind RPCT on a small cohort of infants (19\19\63), dividing them into 3 groups: probiotic group, prebiotic group and control. The study showed a statistically significant decrease in bifid flora in the control group in the first month, however, by the 4th month of life, the effect of the metabolic activity of the flora was similar in all groups [8].

Side effects of pro- and prebiotics

Despite many studies, as well as more than 50 years of use of these drugs in clinical medicine, there remain a number of unresolved problems associated with long-term consequences. Gastroenterologists from France consider and prove 4 potential side effects of probiotics: the development of infectious complications, the production of harmful metabolites, excessive immune stimulation, transgenic reactions. Such effects are excluded from prebiotics, which are not microbial agents. However, prebiotics may cause osmotic effects in the liver and enzymatic disturbances in the colon. Some of the prebiotics can cause intestinal colic, flatulence, and diarrhea, which can be relieved by increasing the dose [47].

conclusions

Conclusion

Much research in the last decade has been devoted to improving the intestinal microecology of newborns; in Japan, prebiotics have been added to early feeding formulas for more than 20 years and have only recently become officially introduced in Europe [31]. However, there is a potential risk of long-term effects from using early formula feeding. Prolonged administration of pro- and prebiotics to premature infants can generate an increase in specific IgA and IgM antibodies against them [43]. Thus, the fact that recently the problem of dysbiosis has begun to be considered by clinicians from the positions accepted in international medical practice should be considered positive. An important fact is that ways to normalize the intestinal microflora are being reviewed and scientifically substantiated, with pro- and prebiotics coming first rather than biotherapeutic agents, bacteriophages or antibiotics [41].

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probiotics, prebiotics

published 12/17/2011 01:35 updated 03/20/2013 — Medicines