The effect of two types of minimal acupuncture on stooling, sleeping and feeding in infants with colic: secondary analysis of a multicentre RCT in Sweden (ACU-COL).

BACKGROUND: Evidence for the effect of minimal acupuncture in infants with colic is limited. AIM: To compare the effect of standardized minimal acupuncture, individualized acupuncture (where traditional acupuncture points were chosen according to the infant's symptoms) and no acupuncture on objective measures of stooling, feeding and sleeping in infants with colic (based on diaries) and perceived changes in these parameters (based on parental questionnaires). METHODS: This was a secondary analysis of a multicentre randomized controlled three-armed trial conducted in four counties in Sweden between January 2013 and May 2015 (ACU-COL). The effect on crying has already been published and showed a decrease in crying time for the acupuncture groups. Infants, 2-8 weeks old, who cried and fussed for more than 3 h/day for more than 3 days/week, and thereby fulfilled the criteria for infantile colic, received four extra visits to their ordinary child health centre. The infants (n = 147) were randomly allocated via a computer-generated list to standardized minimal acupuncture at LI4 for 5 s (group A, n = 48), semi-standardized individual acupuncture with a maximum of five insertions for up to 30 s (group B, n = 49), or no acupuncture (group C, n = 48). The parents and the ordinary staff were blinded. Data were collected using: (1) diaries at baseline, during the two intervention weeks and 1-week follow-up; and (2) questionnaires with quantitative and qualitative components used at the second and fourth visits and during a follow-up telephone call. Outcomes were the changes in frequency of stooling and in hours of sleep per day. RESULTS: There were no differences between groups for stooling, feeding, or sleeping at any time point according to data from the diaries. At the follow-up phone call, more parents in groups A and B (compared to group C) perceived that feeding and sleep had changed and that the symptoms of colic had improved.

The effect of chiropractic treatment on infantile colic: study protocol for a single-blind randomized controlled trial.

Background: Infantile colic is a common condition during early childhood affecting around one of six newborns. The condition is characterized by inconsolable crying and fussing in otherwise healthy and thriving infants. The most used definition is excessive crying for at least three hours a day for at least three days for at least three weeks. The cause of colic is still unknown although many hypotheses and thereby many different treatment modalities have been investigated. Chiropractic care is used increasingly in treatment of infants, including for infantile colic, although the evidence worldwide is sparse. A randomized, controlled trial was designed to evaluate the effect of chiropractic treatment on infantile colic. This paper describes the protocol as well as results from a pilot study examining the acceptability and feasibility of the intervention. Method: The study is designed as a single-blind randomized, controlled trial. The invited families are residents on the Island of Funen and information about the project is distributed from the maternity wards and health visitors. Children at the age of 2-14 weeks with unexplained excessive crying are screened for eligibility and recruited by the primary investigator through home visits. Eligible children are then randomized to chiropractic treatment or control. All children attend in the chiropractor clinic two times a week for two weeks. The parents are unaware of their child's allocation during the project period. The primary outcome measure is change in daily hours of crying based on the parental diaries.The study intends to include 200 children, and the intervention has, during a pilot study, been found acceptable and feasible among families with newborns. Discussion: In a single-blind randomized controlled design we will evaluate the effectiveness of chiropractic treatment on infantile colic. The study will contribute to determine the effect of chiropractic treatment on infantile colic in an area where limited evidence exists. Furthermore, the study aims to explore if subgroups of children with suspected musculoskeletal problems will benefit more from the intervention than others. If they obtain better results, this could imply the need for stratified care. Trial registration: Clinicaltrials.gov and Identifier: NCT02595515 (registered 2 November 2015).

Effect of Reflexology on Infantile Colic.

OBJECTIVE: The aim of this study was to explore the effect of reflexology on infantile colic. DESIGN: A total of 64 babies with colic were included in this study (n = 31: study group; n = 33: control group). Following a pediatrician's diagnosis, two groups (study and control) were created. Sociodemographic data (including mother's age, educational status, and smoking habits of parents) and medical history of the baby (including gender, birth weight, mode of delivery, time of the onset breastfeeding after birth, and nutrition style) were collected. The Infant Colic Scale (ICS) was used to measure the colic severity in the infants. Reflexology was applied to the study group by the researcher and their mother 2 days a week for 3 weeks. The babies in the control group did not receive reflexology. Assessments were performed before and after the intervention in both groups. RESULTS: The groups were similar regarding sociodemographic background and medical history. While there was no difference between the groups in ICS scores before application of reflexology (p > 0.05), the mean ICS score of the study group was significantly lower than that of control group at the end of the intervention (p < 0.001). CONCLUSION: Reflexology application for babies suffering from infantile colic may be a promising method to alleviate colic severity.

Impact of Lactobacillus reuteri colonization on gut microbiota, inflammation, and crying time in infant colic.

Infant colic is a distressing condition of unknown etiology. An aberrant gastrointestinal microbiota has been associated, and Lactobacillus reuteri supplementation has been shown to reduce crying and/or fussing time ('crying time') in some infants with colic. The relationship between L. reuteri gut colonization and crying time has not been examined. We investigated the relationship between L. reuteri colonization and fecal microbiota (microbial diversity and Escherichia coli), intestinal inflammation, and crying time in infants with colic, using a subset of 65 infants from the Baby Biotics trial, which randomized healthy term infants aged <13 weeks with infant colic to receive probiotic L. reuteri DSM 17938 (1 × 108 colony forming units) or placebo daily for 28 days. We observed an overall reduction in median crying time, regardless of L. reuteri colonization status (n = 14 colonized). There were no differences in E. coli colonization rates or densities, microbial diversity or intestinal inflammation by L. reuteri colonization status. We found that L. reuteri density positively correlated with crying time, and E. coli density negatively correlated with microbial diversity. As density of L. reuteri was associated with increased crying time, L. reuteri supplementation may not be an appropriate treatment for all infants with colic.

Effect of capsaicin supplementation on repeated sprinting performance.

Performance in many team sports is partially dependent on the ability to perform repeatedly at high intensity. Previous research demonstrates that capsaicin (CAP) has physiological and metabolic effects that could influence exercise performance and inflammation. The purpose of this study was to investigate the influence of CAP on performance of and the interleukin-6 (IL-6) response to repeated sprints. Nineteen healthy male experienced athletes, age 18-30 years, participated in a placebo (PCB)-controlled, crossover study. During 1 trial, they consumed 3 g·d(-1) cayenne (25.8 mg·d(-1) CAP) and the other a PCB for days. Directly after the supplementation period, they completed a repeated sprint test (RST) consisting of 15 30-m maximal effort sprints on 35-second intervals with sprint times measured via an electronic dual-beam timing system. Fasted blood draws for IL-6 were taken at baseline before supplementation, 45 minute pre-RST, and immediately post-RST. Rate of perceived exertion (RPE), muscle soreness (MS), and gastrointestinal distress (GD) for 5 symptom subscales were measured 1-minute pretest, during, posttest, and 1-minute posttest. The MS was additionally measured for 3-day posttest. Relative to the PCB, CAP significantly increased the sum of ratings of GD symptoms by 6.3-fold. There was no difference between treatments in fastest or mean sprint time, fatigue, IL-6 response, RPE, or MS. In summary, CAP did not influence repeated sprint performance or the IL-6 response but caused substantial GD. The CAP is not recommended for athletes involved in repeated sprinting.

Breastfeeding may improve nocturnal sleep and reduce infantile colic: potential role of breast milk melatonin.

UNLABELLED: Melatonin is secreted during the night in adults but not in infants. It has a hypnotic effect as well as a relaxing effect on the smooth muscle of the gastrointestinal tract. It is plausible that breast milk, which consists of melatonin, may have an effect on improving infants' sleep and reducing infantile colic. Our first goal was to assess the differences in the prevalence and severity of infantile colic and nocturnal sleep between breast-fed infants and supplement-fed infants. The second was to characterize the profile of melatonin secretion in human breast milk compared to artificial formulas. Ninety-four mothers of healthy 2 to 4-month-old infants filled a questionnaire regarding irritability/potential infantile colic and sleep characteristics. For the second part, we measured melatonin levels in breast milk of five women every 2 h during 24 h and in three samples of commonly used artificial formulas. Exclusively breast-fed infants had a significantly lower incidence of colic attacks (p = 0.04), lower severity of irritability attacks (p = 0.03), and a trend for longer nocturnal sleep duration (p = 0.06). Melatonin in human milk showed a clear circadian curve and was unmeasurable in all artificial milks. CONCLUSIONS: Exclusive breastfeeding is associated with reduced irritability/colic and a tendency toward longer nocturnal sleep. Breast milk (nocturnal) consists of substantial melatonin levels, whereas artificial formulas do not. We speculate that melatonin which is supplied to the infant via breast milk plays a role in improving sleep and reducing colic in breast-fed infants compared to formula-fed ones.

Infantile colic: exploring the potential role of maternal acupuncture.

Lack of knowledge about the pathophysiology of infantile colic limits the development of effective drugs and treatment modalities including acupuncture. Acupuncture research has targeted the baby without considering the mother. However, the pathophysiological clues indicate that infantile colic is a shared pathology between the mother and the baby, especially in the case of breastfeeding mothers. A new theory proposed in this paper involves levels of the cytokine tumour necrosis factor α in the mother's milk and its influences on melatonin and serotonin metabolism in the baby as major components of the pathophysiology of infantile colic. These can be normalised by applying acupuncture to the breastfeeding mother alone or also to the baby.

Feeding, stooling and sleeping patterns in infants with colic--a randomized controlled trial of minimal acupuncture.

BACKGROUND: The aim was to describe the feeding- and stooling patterns of infants with colic and evaluate the influence of minimal acupuncture. METHODS: A prospective, randomized, controlled, blind clinical study was conducted at a private acupuncture clinic in Sweden. 90 otherwise healthy 2-8 weeks old infants, born after gestational week 36, fulfilling the criteria for infantile colic and not medicated with dicyclomine, were included. 81 infants went through a structured program consisting of six visits to the clinic, twice weekly. Infants randomized to receive acupuncture were given minimal, standardized acupuncture for two seconds in LI4. Frequency and size of stooling, as well as duration of, and intervals between, feeding sessions were reported by parents in a diary. Parental assessment of sleep and comments on stooling and side effects were collected in a questionnaire. RESULTS: At baseline when the mean age was five weeks, infants in both groups were fed a median of eight times/day, 148 min/day, with considerable variations. No differences were found between groups in the frequency and duration of feeding during the intervention weeks. Furthermore there were no significant differences between the groups regarding the frequency of stooling, neither at baseline, at which point the infants of both groups had bowel movements 4.2 times/day, nor during the intervention weeks. There was an expected decrease in frequency of stooling in both groups, reaching 2.1 (p = 0.001) in the acupuncture group and 3.1 (p < 0.001) in the control group. The groups differed regarding large bowel movements which decreased linearly in the control group (p = 0.011) but not in the acupuncture group (p = 0.787). More parents in the acupuncture group than in the control group (28% and 15% respectively, p = 0.006) experienced the infant's sleep to be "better" or "much better." No other significant differences were found. However, parents described a normalized stooling and experienced an improvement in colic in their infants more frequently in the acupuncture group than in the control group. CONCLUSIONS: Infants with colic in the present study had a higher frequency of stooling than reported internationally in healthy infants. Minimal acupuncture had no major effect on feeding, stooling and sleep, although a minor effect of minimal acupuncture on stooling and sleep cannot be ruled out. TRIAL REGISTRATION: ClinicalTrials.govID NCT00860301.

Focus on infantile colic.

UNLABELLED: Infantile colic is a widespread clinical condition in the first 3 months of life, which is easily recognized, but incompletely understood and difficult to solve. The available evidence suggests that infantile colic might have several independent causes. The medical hypotheses include food hypersensitivity or allergy, immaturity of gut function and dysmotility, and the behavioural hypotheses include inadequate maternal-infant interaction, anxiety in the mother and difficult infant temperament. Other recent hypotheses, such as hormone alterations and maternal smoking, still need confirmation, whereas the new concept of alterations in the gut microflora, have been reported. A number of interventions, including pharmacological agents, are discussed, but it is probable that infants with colic require a graded strategy. CONCLUSION: Considering the favourable clinical course and the wide range of manifestations, a safe approach should be adopted, which is proportional to the intensity of the infantile colic. However, further research and guidelines are still needed.

Comparison of detomidine, butorphanol, flunixin meglumine and xylazine in clinical cases of equine colic.

Detomidine hydrochloride, butorphanol tartrate, flunixin meglumine and xylazine hydrochloride were evaluated in a blind multi-centre clinical trial in 152 horses with abdominal pain. The drugs were administered as follows: detomidine 20 or 40 micrograms/kg bodyweight (bwt); butorphanol 0.1 mg/kg bwt; flunixin meglumine 1.0 mg/kg bwt; xylazine hydrochloride 0.5 mg/kg bwt. Each centre compared responses to the two doses of detomidine with those to one of the other analgesics. The drugs were administered intravenously (i.v.) after clinical assessment of the degree of sweating, kicking, pawing, head and body movement, attitude, lip curling, stretching to urinate, pulse rate, respiratory rate and rectal temperature. Similar assessments were repeated at 15 min intervals for at least 1 h. The investigators ranked the response to treatment from 'not satisfactory' to 'highly satisfactory'. Significant differences in sweating, kicking, pawing, head and body movement, attitude, pulse rate and respiratory rate were noted between the horses receiving butorphanol and either dose of detomidine. The investigators' subjective evaluation of the analgesic and sedative effects of either dose of detomidine were significantly better than for butorphanol. Analgesia was rated as highly satisfactory or satisfactory in 93.3 per cent and 6.7 per cent of the horses receiving 40 micrograms/kg bwt of detomidine, 73.3 per cent and 26.7 per cent of the horses receiving 20 micrograms/kg bwt of detomidine, and none of the horses receiving butorphanol. There were no differences in the incidence of side effects with the two compounds. Significant differences were noted in kicking, pawing, head and body movement and attitude between the horses receiving flunixin meglumine and either dose of detomidine. Flunixin meglumine provided significantly less analgesia than either dose of detomidine. Analgesia was rated as highly satisfactory or satisfactory in 73.7 per cent and 21.0 per cent of the horses receiving 40 micrograms/kg bwt of detomidine, 42.9 per cent and 21.4 per cent of the horses receiving 20 micrograms/kg bwt of detomidine, and 6.3 per cent and 37.5 per cent of the horses receiving xylazine. Sedation was considered to be at least satisfactory in 84.2 per cent of the horses receiving 40 micrograms/kg of detomidine, 71.5 per cent of the horses receiving 20 micrograms/kg of detomidine and 53.3 per cent of the horses receiving xylazine.

Nifedipine for the relief of renal colic: a double-blind, placebo-controlled clinical trial.

Pain from ureteral stones is believed to be due to spasm and hyper-peristalsis of the involved ureter. Nifedipine has been shown to decrease human ureteral spasm in vitro. Conflicting results have been reported concerning the clinical efficacy of nifedipine in relieving acute renal colic. This prospective, double-blind, crossover clinical trial evaluated the acute pain relief obtained in 30 patients who had ureteral stones. All patients had ureteral stones documented either by plain abdominal radiograph (six), intravenous pyelogram (16), or passage of the stone(s) in the urine (eight). Each patient served as his own control. The mean pain relief scores for placebo versus 10 to 20 mg oral nifedipine were 0.7 +/- 1.8 and 1.2 +/- 2.5, respectively, as measured on a visual analogue scale (P = .404). Seven patients received clinically significant relief associated with nifedipine, and three patients received relief from placebo (P = .300). Twenty patients (66%) did not experience clinically significant relief from either treatment. We conclude that nifedipine does not differ significantly from placebo in providing relief from acute renal colic.

Nifedipine in the treatment of renal colic.

A double-blind randomized, clinical trial was conducted in 43 patients to evaluate the efficacy of sublingual nifedipine in the treatment of pain in renal colic. Comparison was made with a combination of dipyrone, pitofenone and fenpipramide, which is usually administered intravenously in Spain. With nifedipine, pain completely disappeared in 44% of the cases, and with the combination of drugs, in 89% (p less than 0.005). More adverse effects were noted with the combination than with nifedipine. Both treatments brought about a slight drop in arterial pressure without leading to hypotension in any case. There was no change in heart rate. The possible causes of the relatively low level of success with nifedipine were analyzed. The possibility of using nifedipine under certain circumstances in which other drugs are contraindicated or when their administration is unfeasible is suggested.