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Infant colic update 2004

 

Clinical bottom line

Pre-incubation of feed with lactase resulted in lower breath hydrogen levels and total crying time. In compliant families, four out of 10 infants had at least a 45% reduction in crying time.


A previous review of treatments for infant colic was pessimistic. It concluded that there really were no treatments that worked. Bandolier has performed a brief search for any newer trials published since that review in 2000, and found one. This suggests that pre-treatment of milk with lactase can help a minority of infants.

Reference


DJ Kanabar et al. Improvement of symptoms in infant colic following reduction of lactose load with lactase. Journal of Human Nutrition and Dietectics 2001 14: 359-363.

Study

This study was properly randomised, and blinded, and results were reported both as intention-to-treat and as per protocol. New mothers were given information in recovery rooms, and mothers whose babies developed colic during the following weeks were invited to participate if babies had full-force crying for more than three hours a day, for three or more days a week, together with spasm, lower limb flexure and diarrhoea over at least 14 days.

Formula or expressed fore milk had lactase or placebo added and incubated for a period before being given to the baby. Formula was refrigerated for four hours, then rewarmed. Fore milk was incubated during the feed and given at the end of the feed. The design was two 10-day periods with a five-day washout.

Symptoms were recorded by parents who filled in daily records of crying time (total per treatment), and feed details. Bottles of enzyme were collected at the end of treatment for measurement of compliance. At the end of each period infants had their breath hydrogen measured, as breath hydrogen is a marker of hypolactasia.

Results

Initial recruitment was 53 infants, with information on 46 for cry time analysis and breath tests on 34. The remainder changed address or could not understand the instructions. Of the 46 who could understand, lack of compliance (undefined), possibly because of a high proportion of non-native English speakers.

Breath hydrogen was significantly reduced in complaint and all infants with lactase compared with placebo (Figure 1). Total crying time over the 10-day treatment period was reduced in all 46 and in the 32 compliant families (Figure 2). Statistical significance was achieved in compliant families only.

Figure 1: Breath hydrogen measured at the end of each treatment period

Figure 2: Total 10-day crying time

A pre-determined outcome of clinical utility was that of at least 45% reduction in crying time and breath hydrogen. This was achieved in 26% of all infants, and 38% of compliant infants.

Comment

This is a well-conducted study. It is small, but there are more infants here than in the earlier review. Previous studies with lactase included in that review are criticised because they did not pre-incubate the milk. Apparently one other study exists of pre-incubation of formula milk with lactase being effective in cases of infant colic, but we were unable to obtain it.

Here we have at least a beginning. Transient relative lactase deficiency in younger infants may be a cause of some cases of infant colic. The suggestion here is that large reductions of 45% or more in both breath hydrogen and total crying time can be achieved in about 4 of 10 infants with colic by pre-incubating milk with lactase. In compliant families, the average reduction in crying time was almost an hour a day, which for those mums and dads who have experienced it will seem a very satisfactory outcome.

The paper has some useful comments about treatment protocols, starting with lactase trial, and, if negative, moving to hypoallergenic feed, or further investigations.