Oral lactase for infantile colic: a randomized double-blind placebo-controlled trial.

Manish Narang, Dheeraj Shah

Journal: BMC pediatrics 2022;22(1):468

PMID: 35922776

Plain Language Summary

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Infantile colic – unexplained and inconsolable crying episodes without any identifiable cause in otherwise healthy infants - is a common problem. It has been postulated to be caused due to painful intestinal contractions, lactose intolerance, altered gut microbiota, aerophagy, food hypersensitivity and behavioural factors. Currently, there is no well-established treatment of infantile colic. The aim of this study was to evaluate the efficacy and safety of oral lactase enzyme supplements in management of infantile colic. The primary objectives were to compare crying or fussing duration and number of colic days, and the secondary objectives were to compare the parent satisfaction and adverse effects in children receiving lactase or placebo. This study is a randomised, double-blind, placebo-controlled trial. The enrolled infants (n = 162 children - 99 boys and 63 girls) were randomly assigned to receive five drops (0.2 mL) of the lactase enzyme preparation or placebo. Results show a significant reduction in crying and fussing duration in children receiving lactase drops prior to feeding in comparison to those receiving placebo during the entire 4-week treatment period. Furthermore, results show lesser number of days with colic, and better parental satisfaction in terms of positive change in child’s mood, alertness, activity and oral intake. Additionally, the treatment with lactase was well tolerated by all the infants as no serious adverse event was reported during the treatment. Authors conclude that oral lactase drops may result in significant symptomatic relief in infantile colic in terms of reducing the crying or fussing duration and number of colic days, resulting in better parental satisfaction.

Abstract

BACKGROUND

Infantile colic is a common problem during the first three months of life. This randomized, double-blind, placebo-controlled trial conducted in an urban hospital in Delhi, India evaluated the efficacy and safety of oral lactase in management of infantile colic.

METHODS

One hundred sixty-two clinically healthy infants aged < 5 months age [mean (SD) = 63.5 (30.5) days] fulfilling the Rome-IV diagnostic criteria for infantile colic were enrolled. Eligible children were randomly allocated to receive 5 drops of lactase (600 FCC units/mL) (n = 80) or placebo (n = 82) mixed with breast milk or formula feed four times a day for a duration of 4 weeks. Primary outcomes were duration of crying or fussing (min/d), and number of days with colic lasting > 3 h/d; secondary outcomes were parental satisfaction and adverse events.

RESULTS

At the end of four weeks, mean (SD) crying or fussing time (min/d) was significantly shorter in infants receiving lactase in comparison to placebo [89.9 (115.2) vs.178.5 (153.2); P = 0.001]. The mean (SD) number of days with colic was also significantly less in the lactase group as compared to placebo group at the end of the treatment [12.1 (7.8) vs 17.6 (8.4); P < 0.001]. By the end of 4 week, parental satisfaction in terms of infant's mood, activity, alertness, comfort and oral intake was better in intervention group. The adverse event profile was comparable between two groups.

CONCLUSIONS

Oral lactase treatment in infantile colic results in symptomatic relief in terms of shortening of duration of crying or fussing, and better parental satisfaction.

TRIAL REGISTRATION

Clinical trial registry of India (CTRI/2017/12/010930) registered on 20/12/2017.

© 2022. The Author(s).

Address: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University College of Medical Sciences (University of Delhi) and Guru Teg Bahadur Hospital, Delhi, India. [email protected].; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University College of Medical Sciences (University of Delhi) and Guru Teg Bahadur Hospital, Delhi, India.

Patient Centred Factor

Physical Environment

Laboratory Testing

Modifiable Lifestyle Factors

Jadad Score

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