Kliničke studije

EKSPERTSKO MIŠLJENJE PROF.DR NEĐE RADLOVIĆA

A Trial of Lactase in the Management of Infant Colic

P.J. Kearney, A.J. Malone, T. Hayes, M.Cole* and M.Hyland
Departments of Child Health and *Statistics, University College, Cork, Ireland

Objective:To investigate transient lactose intolerance as a factor in the aetiology of infant colic.

Design: We undertook a randomised, double-blind, crossover trail of lactase and placebo drops added to milk formula to determine whether this method of reducing lactose intake affected infant colic.

Subjects: Infants with colic were referred from clinics in keeping with Wessel's modified criteria.

Interventions: Infants were randomly allocated to add either lactase or placebo drops to their formula feeds for 1 week, followed by 2 days "wash out". The addition was changed for the second week so that subjects served as their own control. The formulas were kept refrigerated for 24 h before ingestion. The parents kept a diary of their baby's crying time.

Results: Thirteen babies completed the trial, of whom nine were boys. The mean birth weight was 3.7kg (8.2lbs). Colic symptoms began in less than 1 month in 12 babies. The effect of the lactase was to reduce crying time by 1.14 h per day (CI 0.23-2.05). The reduction in crying time was significant (t=2.75, d.f.=11,P=0.019).

Conclusion: Transient lactose intolerance may have a role in the aetiology of infant colic. Lactase drops require prior incubation with milk formula to be effective. The response to lactase in this study supports "colic", i.e. spasm of the large intestine as a factor in these infants' discomfort.

Keywords: formula feeds, infant colic, lactase, lactose intolerance.

Trial 2 - Improvement of Symptoms in Infant Colic Following the reduction of Lactose load with lactase

D. Kanabar,* M. Randhawa* and P. Clayton+
* Department of Paediatrics, Guy's Hospital, London, UK; +Crosscare Ltd, Dublin, Ireland.

Correspondence: P. Clayton, Crosscare Ltd., Dublin, Ireland, E-mail: paul@adrenalin.co.uk

Keywords: breath, hydrogen, hypolactasia, infant colic, lactose intolerance

Accepted: June 2001

Abstract: Transient lactose intolerance has been identified as a possible causative factor in infant colic. A double-blind randomised placebo-controlled crossover study to investigate this has been undertaken in 53 babies with symptoms of colic. Pre-incubation of the feed with lactase resulted in breath hydrogen levels and total crying time which were both at least 45% lower than figures with placebo treatment, in 26% of the full trail group (95% confidence interval 12.9% to 44.4%), and in 38% of compliers (95% confidence interval 18.8% to 59.4%). The remainder did not respond to the same extent. These findings suggest that infant colic may have a multiple aetiology, and that in a significant number of cases the immediate cause is transient lactose intolerance, in which cases pre-treatment of feeds with lactase can result in considerable symptomatic benefits