Microbiota intestinal y cólicos infantiles: ¿hay lugar para los prebióticos, probióticos y posbióticos? / Gut Microbiota and Infant Colic: is there a Place for Prebiotics, Probiotics, and Postbiotics?

El consumo de probióticos, prebióticos y posbióticos, o su combinación, puede contribuir a mantener una microbiota intestinal saludable ya que permite la regulación de su disbiosis en el caso de algunas enfermedades o trastornos, principalmente en los trastornos gastrointestinales funcionales (TGIF). El microbioma intestinal es protagonista esencial en la fisiopatología de los TGIF a través de sus funciones metabólicas y nutricionales, el mantenimiento de la integridad de la mucosa intestinal y la regulación de la respuesta inmunitaria. Las investigaciones realizadas hasta la fecha indican que los probióticos, prebióticos y posbióticos pueden tener efectos inmunomoduladores directos y clínicamente relevantes. Existen pruebas del uso de esta familia de bióticos en individuos sanos para mejorar la salud general y aliviar los síntomas en una serie de enfermedades como los cólicos infantiles. La colonización y establecimiento de la microbiota comienza en el momento del nacimiento; los primeros 2-3 años de vida son fundamentales para el desarrollo de una comunidad microbiana abundante y diversa. Diversos estudios científicos realizados mediante técnicas tradicionales dependientes de cultivo y más recientemente por técnicas moleculares han observado diferencias en las poblaciones bacterianas de bebés sanos y aquellos que sufren TGIF, estos últimos caracterizados por un aumento de especies patógenas y una menor población de bifidobacterias y lactobacilos, en comparación con los primeros. En tal contexto, se considera que la microbiota intestinal como protagonista en el desarrollo de esos trastornos, entre ellos los cólicos infantiles, a través de sus funciones metabólicas, nutricionales, de mantenimiento de la integridad de la mucosa intestinal y regulación de la respuesta inmunitaria. Esto ha abierto la puerta al estudio de la utilización de prebióticos, probióticos y posbióticos en el tratamiento y/o prevención de los TGIF infantiles. El parto vaginal y de término así como la lactancia son fundamentales en la constitución de una microbiota saludable. Como herramientas de apoyo, existen estudios de eficacia que sustentan la administración de esta familia de bióticos, principalmente en los casos en que la lactancia no sea posible o esté limitada. (AU)

The consumption of probiotics, prebiotics, and postbiotics, or a combination of them, can contribute to maintaining a healthy intestinal microbiota as it allows the regulation of its dysbiosis in the case of some diseases or disorders, mainly in functional gastrointestinal disorders (FGIDs). The gut microbiome is an essential player in the pathophysiology of FGIDs through its metabolic and nutritional functions, the maintenance of intestinal mucosal integrity, and the regulation of the immune response. Research results thus far indicate that probiotics, prebiotics, and postbiotics may have direct and clinically relevant immunomodulatory effects. There is evidence regarding the prescription of this family of biotics in healthy individuals to improve overall health and alleviate symptoms in many conditions like infantile colic. The colonization and microbiota establishment begins at birth; the first 2-3 years of life are critical for developing an abundant and diverse microbial community. Several scientific studies performed by traditional culture-dependent techniques and more recently by molecular techniques have observed differences in the bacterial populations of healthy infants and those suffering from FGIDs, the latter characterized by an increase in pathogenic species and a lower population of bifidobacteria and lactobacilli, compared to the former. In this context, the intestinal microbiota plays a leading role in the onset of these disorders, including infantile colic, through its metabolic and nutritional functions, maintenance of the integrity of the intestinal mucosa, and regulation of the immune response. That has opened the door to the study of prebiotics, probiotics, and postbiotics usage in the treatment and or prevention of infantile FGIDs. Vaginal and term delivery and breastfeeding are fundamental in the constitution of a healthy microbiota. As supportive tools, there are efficacy studies that support the administration of this family of biotics, mainly in cases where lactation is not possible or is limited.

Behavioral Outcomes of Infant Colic in Toddlerhood: A Longitudinal Study.

OBJECTIVE: To assess whether infants with colic that resolved before 6 months of age have poorer medium-term outcomes than infants without colic. STUDY DESIGN: Comparative study of 2 prospective, community-based cohorts of children aged 2-3 years in Melbourne, Australia: children from the Baby Biotics study, with previously diagnosed Wessel criteria of colic without problem crying at 6 months (True Colic Cohort), vs children from the Baby Business trial, without problem crying at 1, 4, and 6 months (No Colic Cohort). Caregiver report of child internalizing and externalizing behaviors (primary outcome), temperament, regulatory (crying/sleeping/feeding) problems, and family functioning at child age 2-3 years was collected. We conducted regression analyses of mean differences/ORs adjusted for child sex, age, social disadvantage, parental education, and maternal mental health. RESULTS: In total, 74% of the original Baby Biotics (n = 124) sample and 75% of the Baby Business (n = 503) sample completed questionnaires. In adjusted analyses, there were no significant differences between the True Colic Cohort (n = 99) and No Colic Cohort (n = 182) in internalizing behavior problems (adjusted mean difference 0.73; 95% CI -3.96 to 5.43, P = .76) or externalizing behavior problems (adjusted mean difference -1.53; 95% CI -6.02 to 2.97, P = .51). There were no statistically significant differences between groups in temperament, parental perception of regulatory problems, or family functioning. CONCLUSIONS: Infants with colic whose crying self-resolves do not experience adverse effects regarding child behavior, regulatory abilities, temperament, or family functioning in the medium term. Parents and clinicians can be reassured that infant crying as the result of colic, and related stress, is short-lived and will likely resolve.

Excessive crying in infants / Excessive crying in infants

ABSTRACT Objective: Review the literature on excessive crying in young infants, also known as infantile colic, and its effects on family dynamics, its pathophysiology, and new treatment interventions. Data source: The literature review was carried out in the Medline, PsycINFO, LILACS, SciELO, and Cochrane Library databases, using the terms “excessive crying,” and “infantile colic,” as well technical books and technical reports on child development, selecting the most relevant articles on the subject, with emphasis on recent literature published in the last five years. Summary of the findings: Excessive crying is a common symptom in the first 3 months of life and leads to approximately 20% of pediatric consultations. Different prevalence rates of excessive crying have been reported, ranging from 14% to approximately 30% in infants up to 3 months of age. There is evidence linking excessive crying early in life with adaptive problems in the preschool period, as well as with early weaning, maternal anxiety and depression, attention deficit hyperactivity disorder, and other behavioral problems. Several pathophysiological mechanisms can explain these symptoms, such as circadian rhythm alterations, central nervous system immaturity, and alterations in the intestinal microbiota. Several treatment alternatives have been described, including behavioral measures, manipulation techniques, use of medication, and acupuncture, with controversial results and effectiveness. Conclusion: Excessive crying in the early months is a prevalent symptom; the pediatrician's attention is necessary to understand and adequately manage the problem and offer support to exhausted parents. The prescription of drugs of questionable action and with potential side effects is not a recommended treatment, except in extreme situations. The effectiveness of dietary treatments and use of probiotics still require confirmation. There is incomplete evidence regarding alternative treatments such as manipulation techniques, acupuncture, and use of the herbal supplements and behavioral interventions.

RESUMO Objetivo: Revisar a literatura sobre choro excessivo em bebês pequenos e cólicas infantis e suas repercussões na família e a fisiopatologia e as estratégias de tratamento. Fonte dos dados: Revisadas as principais bases de dados, Medline, PsycINFO, Lilacs e SciELO e Cochrane Library com o uso das expressões “choro excessivo do lactente” e “cólicas do lactente”. Foram selecionadas as publicações mais relevantes com ênfase nos últimos cinco anos. Síntese dos dados: É um sintoma comum nos primeiros meses de vida e é motivo de cerca de 20% das consultas pediátricas. As prevalências de choro excessivo variam de 14 a 30% nesses lactentes. Existem evidências que ligam o choro excessivo nos primeiros meses de vida com problemas futuros, bem como ao desmame precoce, à ansiedade, à depressão materna, ao transtorno do déficit de atenção/hiperatividade (TDAH) e a outros problemas comportamentais. Distintos mecanismos fisiopatológicos podem explicar esse quadro clínico, como alterações no ritmo circadiano, imaturidade do SNC e alterações na microbiota intestinal. São descritas opções de tratamento, desde medidas comportamentais, técnicas manipulativas e uso de medicação até acupuntura, com resultados e eficácia controversos. Conclusão: Para o choro excessivo nos primeiros meses é necessária a atenção do pediatra para o entendimento e manejo do problema e oferecer apoio para pais em exaustão. A prescrição de drogas de efeitos duvidosos e potenciais efeitos colaterais não é terapêutica preconizada, a não ser em situações extremas. A eficácia dos tratamentos dietéticos e o uso de probióticos ainda necessitam de confirmação. Existem evidências incompletas a respeito de tratamentos opcionais, como técnicas manipulativas, acupuntura, uso de suplemento à base de ervas e intervenções comportamentais.

Excessive crying in infants.

OBJECTIVE: Review the literature on excessive crying in young infants, also known as infantile colic, and its effects on family dynamics, its pathophysiology, and new treatment interventions. DATA SOURCE: The literature review was carried out in the Medline, PsycINFO, LILACS, SciELO, and Cochrane Library databases, using the terms "excessive crying," and "infantile colic," as well technical books and technical reports on child development, selecting the most relevant articles on the subject, with emphasis on recent literature published in the last five years. SUMMARY OF THE FINDINGS: Excessive crying is a common symptom in the first 3 months of life and leads to approximately 20% of pediatric consultations. Different prevalence rates of excessive crying have been reported, ranging from 14% to approximately 30% in infants up to 3 months of age. There is evidence linking excessive crying early in life with adaptive problems in the preschool period, as well as with early weaning, maternal anxiety and depression, attention deficit hyperactivity disorder, and other behavioral problems. Several pathophysiological mechanisms can explain these symptoms, such as circadian rhythm alterations, central nervous system immaturity, and alterations in the intestinal microbiota. Several treatment alternatives have been described, including behavioral measures, manipulation techniques, use of medication, and acupuncture, with controversial results and effectiveness. CONCLUSION: Excessive crying in the early months is a prevalent symptom; the pediatrician's attention is necessary to understand and adequately manage the problem and offer support to exhausted parents. The prescription of drugs of questionable action and with potential side effects is not a recommended treatment, except in extreme situations. The effectiveness of dietary treatments and use of probiotics still require confirmation. There is incomplete evidence regarding alternative treatments such as manipulation techniques, acupuncture, and use of the herbal supplements and behavioral interventions.

Encarceramento de intestino delgado em anel inguinal após orquiectomia em equinos: relato de caso / Equine inguinal ring incarceration of small intestine after orchiectomy: a case report / Encarcelamiento de intestino delgado en anillo inguinal después orquiectomia en caballos: report de un caso

O encarceramento de alças intestinais em anel inguinal após uma orquiectomia não é uma complicação usual na casuística hospitalar, caracterizado pelo deslocamento da porção final do jejuno ou do íleo através do canal inguinal, é observado com maior frequência em garanhões após monta natural ou congenitamente em potros. Nas hérnias irredutíveis, a terapêutica é cirúrgica e emergencial e o prognóstico reservado devido às lesões estrangulantes nas alças intestinais. Um equino, macho, 10 anos da raça Puro Sangue Lusitano foi encaminhado ao hospital veterinário da Universidade Metodista de São Paulo para realização de orquiectomia eletiva,e cerca de 2 horas após o procedimento o animal apresentou sintomas de síndrome cólica com evolução aguda,mucosas congestas, sudorese, secreção sero-sanguinolenta na região da incisão cirúrgica e através da palpação escrotal constatou-se a presença de intestino delgado com reflexo doloroso à palpação. O animal foi imediatamente encaminhado para a cirurgia, onde foi realizada a redução da alça intestinal encarcerada, enterectomia de aproximadamente 1,8 metros da porção do jejuno e herniorrafia completa do anel inguinal. A recuperação pós-operatória foi satisfatória, sendo que o animal retornou à atividade atlética e recuperou o seu peso corporal inicial.(AU)

The bowel incarceration in the inguinal ring after an orchiectomy is an unusual complication in thecase series, characterized by the displacement of the end portion of the jejunum or ileum through the inguinalcanal, is more frequently observed in stallions after natural mating or congenitally in foals. In the irresolvable hernias, surgical treatment is urgrently required and still the prognosis is poor due to estrangulation of the intestinal wall. One male pure blood horse, 10 years old and Lusitano breed was taken to the Methodist University of SãoPaulo's Veterinary Hospital, for elective orchiectomy - about 2 hours after the procedure the animal presented symptoms of acute colic syndrome with acute, congested mucous, sweating, sero-bloody discharge at the incisionarea and through scrotal palpation was possible to observe the presence of small bowel in the scrotum with painful reflex on touch. The animal was immediately taken to surgery, in which a reduction of the incarceratedbowel loop took place - enterectomy of approximately 1.8 meters from the jejunum part and complete herniarepair of the inguinal ring were performed. Postoperative recovery was satisfactory, since the animal returned toits athletic activity and regained its initial body weight.(AU)

El encarcelamiento de los intestinos en el anillo inguinal después de una orquiectomía es una complicación inusual que se caracteriza por el des plazamiento de Ia parte final dei yeyuno o el íleon a través del canal inguinal. Este se observa con mayor frecuencia en los sementales después dei apareamiento natural ocongenitamente en los potros. La hernia irreductible se trata quirúrgicamente y de emergencia y debido a lesionesestrangulantes en Ia pared intestinal el pronóstico es reservado. Un caballo macho de 10 anos de raza Lusitanofue remitido ai hospital veterinário de Ia Universidad Metodista de São Paulo para una orquiectomía electiva,alrededor de 2 horas después dei procedimiento el animal mostró síntomas de síndrome cólico agudo, mucosa congestionada, sudoración, secreción sero-sanguinolenta en el área de Ia incisión y mediante Ia palpación del escroto se pudo observar Ia presencia de intestino delgado en el mismo. AI animal se le practico una enterectomia de emergencia, seccionando aproximadamente 1,8 metros dei yeyuno y cerrando el anillo inguinal. La recuperación posto peratoria fue satisfactoria y el animal regresó a Ia actividad deportiva recuperando su peso corporal inicial.(AU)

Encarceramento de intestino delgado em anel inguinal após orquiectomia em equinos: relato de caso / Equine inguinal ring incarceration of small intestine after orchiectomy: a case report / Encarcelamiento de intestino delgado en anillo inguinal después orquiectomia en caballos: report de un caso

O encarceramento de alças intestinais em anel inguinal após uma orquiectomia não é uma complicação usual na casuística hospitalar, caracterizado pelo deslocamento da porção final do jejuno ou do íleo através do canal inguinal, é observado com maior frequência em garanhões após monta natural ou congenitamente em potros. Nas hérnias irredutíveis, a terapêutica é cirúrgica e emergencial e o prognóstico reservado devido às lesões estrangulantes nas alças intestinais. Um equino, macho, 10 anos da raça Puro Sangue Lusitano foi encaminhado ao hospital veterinário da Universidade Metodista de São Paulo para realização de orquiectomia eletiva,e cerca de 2 horas após o procedimento o animal apresentou sintomas de síndrome cólica com evolução aguda,mucosas congestas, sudorese, secreção sero-sanguinolenta na região da incisão cirúrgica e através da palpação escrotal constatou-se a presença de intestino delgado com reflexo doloroso à palpação. O animal foi imediatamente encaminhado para a cirurgia, onde foi realizada a redução da alça intestinal encarcerada, enterectomia de aproximadamente 1,8 metros da porção do jejuno e herniorrafia completa do anel inguinal. A recuperação pós-operatória foi satisfatória, sendo que o animal retornou à atividade atlética e recuperou o seu peso corporal inicial.

The bowel incarceration in the inguinal ring after an orchiectomy is an unusual complication in thecase series, characterized by the displacement of the end portion of the jejunum or ileum through the inguinalcanal, is more frequently observed in stallions after natural mating or congenitally in foals. In the irresolvable hernias, surgical treatment is urgrently required and still the prognosis is poor due to estrangulation of the intestinal wall. One male pure blood horse, 10 years old and Lusitano breed was taken to the Methodist University of SãoPaulo's Veterinary Hospital, for elective orchiectomy - about 2 hours after the procedure the animal presented symptoms of acute colic syndrome with acute, congested mucous, sweating, sero-bloody discharge at the incisionarea and through scrotal palpation was possible to observe the presence of small bowel in the scrotum with painful reflex on touch. The animal was immediately taken to surgery, in which a reduction of the incarceratedbowel loop took place - enterectomy of approximately 1.8 meters from the jejunum part and complete herniarepair of the inguinal ring were performed. Postoperative recovery was satisfactory, since the animal returned toits athletic activity and regained its initial body weight.

El encarcelamiento de los intestinos en el anillo inguinal después de una orquiectomía es una complicación inusual que se caracteriza por el des plazamiento de Ia parte final dei yeyuno o el íleon a través del canal inguinal. Este se observa con mayor frecuencia en los sementales después dei apareamiento natural ocongenitamente en los potros. La hernia irreductible se trata quirúrgicamente y de emergencia y debido a lesionesestrangulantes en Ia pared intestinal el pronóstico es reservado. Un caballo macho de 10 anos de raza Lusitanofue remitido ai hospital veterinário de Ia Universidad Metodista de São Paulo para una orquiectomía electiva,alrededor de 2 horas después dei procedimiento el animal mostró síntomas de síndrome cólico agudo, mucosa congestionada, sudoración, secreción sero-sanguinolenta en el área de Ia incisión y mediante Ia palpación del escroto se pudo observar Ia presencia de intestino delgado en el mismo. AI animal se le practico una enterectomia de emergencia, seccionando aproximadamente 1,8 metros dei yeyuno y cerrando el anillo inguinal. La recuperación posto peratoria fue satisfactoria y el animal regresó a Ia actividad deportiva recuperando su peso corporal inicial.

Infants with colic have a normal sleep structure at 2 and 7 months of age.

OBJECTIVE: To compare nighttime sleep structure between infants with colic and a control group. STUDY DESIGN: Sleep and cry times of 15 infants with colic and 16 infants in a control group were recorded with the use of a daily diary at the ages of 5 weeks and 6 months. The diary was kept at home for a 1-week period. Overnight polygraphic sleep recordings in a sleep laboratory were performed when the infants were 2 months of age and were repeated for 11 infants with colic and 14 infants in a control group at 7 months of age. RESULTS: Daily sleep time was shorter in infants with colic compared with the control group at 5 weeks of age (P =.001). Polygraphic data showed a similar sleep structure between the study groups at 2 and 7 months of age. Infants with colic had somewhat more obstructive apneas during rapid eye movement sleep at the age of 2 months (P =.04), and they had fewer awakenings at the age of 7 months than the control group (P =.003). CONCLUSION: Infants with colic had normal sleep polygraphic finding at 2 and 7 months of age including sleep structure, movements, and breathing. Despite the shorter reported daily sleep times, the polygraphic data did not suggest infantile colic to be associated with a sleep disorder.

Time course of allergy to extensively hydrolyzed cow's milk proteins in infants.

We report on the follow-up of 22 infants allergic to cow's milk proteins who did not tolerate extensively hydrolyzed protein formulas. After successful use of an amino acid-based diet for a duration of 11.8 +/- 8.7 months, evolution differed according to the presence or absence of associated allergy to other foods. Cow's milk protein tolerance occurred earlier in the patients (n = 9) whose allergy was limited to cow's milk proteins and to extensively hydrolyzed protein formulas.

Factores asociados "cólico infantil" / Factors associated to infantile colic

Se revisan los factores a los que se atribuye el "cólico infantil". Si bien algunos de carácter gastrointestinal explican que el cólico esté presente en algunos casos, se hace notar que lo más factible es que el cólico obedece a interacciones conductuales y biológicas

Bloqueo del décimo segundo nervio intercostal como tratamiento del cólico renoureteral / Blockage of the 12th intercostal nerve as treatment for renourethral cholics

El tratamiento del cólico reno-ureteral y los síntomas neurovegetativos que le acompañan son ciertamente de difícil tratamiento y la aplicación de dipirona, butilhioscina, indometacina y otros fármacos, en la gran mayoría de los casos, no mejoran rápidamente el cuadro doloroso y tienen reacciones secundarias. En el servicio de urología y nefrología del Hospital General de México SSA, se trató a 240 pacientes con cuadro de cólico renoureteral mediante la aplicación de bloqueo del décimo segundo nervio intercostal con xylacaína simple al 2 por ciento en cantidad de 10 cc encontrando remisión de dolor y de los síntomas neurovegetativos en todos los casos

[Infant colic]. / Cólico infantil.

The literature regarding infantile colic is reviewed. It is characterized by difficulties in definition. Different theories have been implied as to its etiology: behavioral and developmental as well as gastrointestinal causes are considered. The management and treatment based on both theories were revised. Most of them have proven to be effective in many cases. We recognize that future research is needed so that better management and treatment can be designed and prepared for this condition.

Cólico infantil / Infant colic

Al revisar la literatura, encontramos que hay varias teorías implicadas en el síndrome de "cólico infantil". Tanto las causas gastrointestinales como las de interacción, comportamiento y temperamento han sido consideradas. Se han revisado recomendaciones para el manejo y tratamiento basado en ambas teorías. Estas han probado ser útiles y exitosas en muchos casos. Finalmente, reconocemos la necesidad de más investigación en el futuro en torno a esta condición