Brain Scans Show The Real Impact Love Has On A Child’s Brain.

You comfort them over a skinned knee in the playground, and coax them to sleep with a soothing lullaby. But being a nurturing mother is not just about emotional care – it pays dividends by determining the size of your child’s brain, scientists say.

Both of these images are brain scans of a two three-year-old children, but the brain on the left is considerably larger, has fewer spots and less dark areas, compared to the one on the right.

According to neurologists this sizable difference has one primary cause – the way each child was treated by their mothers.

But the child with the shrunken brain was the victim of severe neglect and abuse.

Babies’ brains grow and develop as they interact with their environment and learn how to function within it.

When babies’ cries bring food or comfort, they are strengthening the neuronal pathways that help them learn how to get their needs met, both physically and emotionally. But babies who do not get responses to their cries, and babies whose cries are met with abuse, learn different lessons.

The neuronal pathways that are developed and strengthened under negative conditions prepare children to cope in that negative environment, and their ability to respond to nurturing and kindness may be impaired.

According to research reported by the newspaper, the brain on the right in the image above worryingly lacks some of the most fundamental areas present in the image on the left.

The consequences of these deficits are pronounced – the child on the left with the larger brain will be more intelligent and more likely to develop the social ability to empathise with others.

This type of severe, global neglect can have devastating consequences. The extreme lack of stimulation may result in fewer neuronal pathways available for learning.

The lack of opportunity to form an attachment with a nurturing caregiver during infancy may mean that some of these children will always have difficulties forming meaningful relationships with others. But studies have also found that time played a factor–children who were adopted as young infants have shown more recovery than children who were adopted as toddlers.

But in contrast, the child with the shrunken brain will be more likely to become addicted to drugs and involved in violent crimes, much more likely to be unemployed and to be dependent on state benefits.
The child is also more likely to develop mental and other serious health problems.

Some of the specific long-term effects of abuse and neglect on the developing brain can include:

  • Diminished growth in the left hemisphere, which may increase the risk for depression
  • Irritability in the limbic system, setting the stage for the emergence of panic disorder and posttraumatic stress disorder
  • Smaller growth in the hippocampus and limbic abnormalities, which can increase the risk for dissociative disorders and memory impairments
  • Impairment in the connection between the two brain hemispheres, which has been linked to symptoms of attention-deficit/hyperactivity disorder

Professor Allan Schore, of UCLA, told The Sunday Telegraph that if a baby is not treated properly in the first two years of life, it can have a fundamental impact on development.

He pointed out that the genes for several aspects of brain function, including intelligence, cannot function.
And sadly there is a chance they may never develop and come into existence.

These has concerning implications for neglected children that are taken into care past the age of two.
It also seems that the more severe the mother’s neglect, the more pronounced the damage can be.

The images also have worrying consequences for the childhood neglect cycle – often parents who, because their parents neglected them, do not have fully developed brains, neglect their own children in a similar way.

But research in the U.S. has shown the cycle can be successfully broken if early intervention is staged and families are supported.

The study correlates with research released earlier this year that found that children who are given love and affection from their mothers early in life are smarter with a better ability to learn.

The experiences of infancy and early childhood provide the organizing framework for the expression of children’s intelligence, emotions, and personalities.

When those experiences are primarily negative, children may develop emotional, behavioral, and learning problems that persist throughout their lifetime, especially in the absence of targeted interventions.

The study by child psychiatrists and neuroscientists at Washington University School of Medicine in St. Louis, found school-aged children whose mothers nurtured them early in life have brains with a larger hippocampus, a key structure important to learning, memory and response to stress.

The research was the first to show that changes in this critical region of children’s brain anatomy are linked to a mother’s nurturing, reports.

The research is published online in the Proceedings of the National Academy of Sciences Early Edition.
Lead author Joan L. Luby, MD, professor of child psychiatry, said the study reinforces how important nurturing parents are to a child’s development.



Exercise while pregnant may boost baby’s brain.

This week, Baby V and I have joined more than 30,000 neuroscientists in San Diego for the annual Society for Neuroscience meeting. We’ve wandered the miles of posters, dropped in on talks and generally soaked up the brain waves floating around this massive meeting of minds.

We’ve worked up a sweat more than once rushing around the meeting, so it’s nice to be reminded of all the exciting research on the benefits of physical exercise on the brain. Evidence is piling up that a fit body is one of the absolute best things you can do for a fit mind. And a study presented November 10 shows that if you’re pregnant, the benefits of exercise extend to your baby’s brain too.

Researchers from the University of Montreal asked pregnant women to exercise three times a week for 20 minutes until they were slightly short of breath. Other pregnant women didn’t exercise.  Eight to 12 days after the babies were born, the team recorded the electrical activity in sleeping babies’ brains.

Babies born to moms who exercised showed more localized brain activity patterns in response to sounds, the researchers found. This targeted brain activity is a sign of brain maturity, indicating that the brain is becoming more efficient. Babies whose mothers didn’t exercise during pregnancy showed more diffuse brain responses to sounds. The scientists plan on looking for lasting benefits by testing the babies at age 1.

Studies in rodents have found benefits of exercise during pregnancy: Rats born to moms who worked out have brains that are more resistant to low oxygen conditions, for instance. Maternal exercise boosts levels of cellular powerhouses called mitochondria in rat pups’ brains.  And exercise during pregnancy resulted in more newborn neurons in the mouse hippocampus, a brain region involved in learning and memory. Now, this new study suggests that some of these benefits might extend to people, too.

So, exercise is good for mom and good for baby. Now Baby V and I just need to find a study that reports exercise — specifically, walking miles and miles at a neuroscience conference — helps a baby to sleep through the night.

Babies can learn their first lullabies in the womb.

An infant can recognise a lullaby heard in the womb for several months after birth, potentially supporting later speech development. This is indicated in a new study at the University of Helsinki.

The study focused on 24 women during the final trimester of their pregnancies. Half of the women played the melody of Twinkle Twinkle Little Star to their fetuses five days a week for the final stages of their pregnancies. The brains of the babies who heard the melody in utero reacted more strongly to the familiar melody both immediately and four months after birth when compared with the control group. These results show that fetuses can recognise and remember sounds from the outside world.

This is significant for the early rehabilitation, since rehabilitation aims at long-term changes in the brain.

“Even though our earlier research indicated that fetuses could learn minor details of speech, we did not know how long they could retain the information. These results show that babies are capable of learning at a very young age, and that the effects of the learning remain apparent in the brain for a long time,” expounds Eino Partanen, who is currently finishing his dissertation at the Cognitive Brain Research Unit.

“This is the first study to track how long fetal memories remain in the brain. The results are significant, as studying the responses in the brain let us focus on the foundations of fetal memory. The early mechanisms of memory are currently unknown,” points out Dr Minna Huotilainen, principal investigator.

The researchers believe that song and speech are most beneficial for the fetus in terms of speech development. According to the current understanding, the processing of singing and speech in the babies brains are partly based on shared mechanisms, and so hearing a song can support a baby’s speech development. However, little is known about the possible detrimental effects that noise in the workplace can cause to a fetus during the final trimester. An extensive research project on this topic is underway at the Finnish Institute of Occupational Health.

The study was published by the esteemed American scientific journal PLoS ONE. The research was conducted at the Academy of Finland’s Finnish Centre of Excellence in Interdisciplinary Music Research as well as the Cognitive Brain Research Unit at the University of Helsinki Institute of Behavioural Sciences.

Active Versus Passive Cooling During Neonatal Transport.

BACKGROUND AND OBJECTIVE: Therapeutic hypothermia is now the standard of care for hypoxic-ischemic encephalopathy. Treatment should be started early, and it is often necessary to transfer the infant to a regional NICU for ongoing care. There are no large studies reporting outcomes from infants cooled passively compared with active (servo-controlled) cooling during transfer. Our goal was to review data from a regional transport service, comparing both methods of cooling.

METHODS: This was a retrospective observational study of 143 infants referred to a regional NICU for ongoing therapeutic hypothermia. Of the 134 infants transferred, the first 64 were cooled passively, and 70 were subsequently cooled after purchase of a servo-controlled mattress. Key outcome measures were time to arrival at the regional unit, temperature at referral and arrival at the regional unit, and temperature stability during transfer.

RESULTS: The age cooling was started was significantly shorter in the actively cooled group (46 [0–352] minutes vs 120 [0–502] minutes; P <.01). The median (range) stabilization time (153 [60–385] minutes vs 133 [45–505] minutes; P = .04) and age at arrival at the regional unit (504 [191–924] minutes vs 452 [225–1265]) minutes; P = .01) were significantly shorter in the actively cooled group. Only 39% of infants passively cooled were within the target temperature range at arrival to the regional unit compared with 100% actively cooled.

CONCLUSIONS: Servo-controlled active cooling has been shown to improve temperature stability and is associated with a reduction in transfer time.


Active Cooling Improves Transport of Infants With Hypoxic-Ischemic Encephalopathy.

Newborns with hypoxic-ischemic encephalopathy (HIE) do better with active cooling during transport, a new paper says.

Servo-controlled active cooling during transport of full-term infants with HIE improved their temperature stability and reduced their transfer time in comparison to passive cooling, researchers said October 21 in Pediatrics.

All babies cooled using the active approach were within the target temperature range when they arrived at the regional unit for treatment, versus 39% of the passively controlled infants, Dr. Topun Austin of Rosie Hospital in Cambridge, UK, and his colleagues found.

HIE occurs in two of every 1,000 newborns in developed countries, and in 10-20 per 1,000 babies in the developing world, Dr. Austin explained in an interview with Reuters Health. Therapeutic hypothermia, which involves cooling babies from their normal temperature of 37 degrees C to 33.5 degrees C, has been shown to help prevent brain damage in these infants.

“If you cool them by just a few degrees, a lot of these babies will have a normal neurological outcome at 18 months,” the investigator said. “It’s quite a dramatic improvement with quite an inexpensive treatment.”

One approach to cooling babies with HIE is to simply remove their clothes, Dr. Austin added, but this “passive cooling” approach can lead to overcooling. With active cooling, the baby is placed on a fluid-filled mattress. A rectal probe monitors the infant’s temperature, and the mattress is automatically heated or cooled to ensure that the target temperature is maintained.

Until now, no studies have compared outcomes with passive vs active cooling. To do so, Dr. Austin and his team reviewed data from a regional neonatal transfer team for 134 infants. The first 64 were treated with passive cooling; the other 70 infants were treated with active cooling after the purchase of a servo-controlled mattress.

Cooling started at an average of 46 minutes of age for the active group, vs 120 minutes for the control group. Median stabilization time was 153 minutes for the control group versus 133 minutes for the active group, while age at arrival was 504 minutes for the control group and 452 for the active group.

Dr. Austin and his colleagues are now investigating strategies for identifying infants with HIE as early as possible.

“It is important for the policy maker to make active cooling available during transport and maybe in the areas at medium and far distance from the referral centers,” said Dr. Mohamed Tagin, a neonatal fellow at the Hospital for Sick Children in Toronto, in email to Reuters Health. Dr. Tagin did not participate in the new study.

“I do agree that the active cooling process should be monitored at a tertiary care facility where appropriate monitoring and expertise are available for such complicated management,” Dr. Tagin added. “It is however very important to commence cooling as soon as the criteria for moderate to severe HIE have been fulfilled, given the available evidence about the improvement of the long-term outcome for those newborns.”

Dr. Tagin continued, “It is important when we discuss the issue of cooling to highlight that patient identification and early management is the most important step and often times it is done by a midwife or a family physician far away from further support. As the situation is stressful enough to those individuals, I believe there should be a system in place to give clear advice over the phone and maybe this already should be preceded with some training to different scenarios.”

But while active cooling should be the standard of care, he said, in the meantime “cooling should not be delayed, and passive cooling with frequent / continuous monitoring should be commenced once the patient has been identified.”

Snoring mothers-to-be linked to low birth weight babies.

Experts say snoring may be a sign of breathing problems that could deprive an unborn baby of oxygen

A newborn baby. Scientists found that women who snored both before and during pregnancy were more likely to have smaller babies and elective C-sections. Photograph: Christopher Furlong/Getty Images

Mothers-to-be who snore are more likely to give birth to smaller babies, a study has found. Snoring during pregnancy was also linked to higher rates of Caesarean delivery.

Experts said snoring may be a sign of breathing problems that could deprive an unborn baby of oxygen.

Previous research has shown women who start to snore during pregnancy are at risk from high blood pressure and the potentially dangerous pregnancy condition pre-eclampsia.

More than a third of the 1,673 pregnant women recruited for the US study reported habitual snoring.

Scientists found women who snored in their sleep three or more nights a week had a higher risk of poor delivery outcomes, including smaller babies and Caesarean births.

Chronic snorers, who snored both before and during pregnancy, were two-thirds more likely to have a baby whose weight was in the bottom 10%.

They were also more than twice as likely to need an elective Caesarean delivery, or C-section, compared with non-snorers.

Dr Louise O’Brien, from the University of Michigan’s Sleep Disorders Centre, said: “There has been great interest in the implications of snoring during pregnancy and how it affects maternal health but there is little data on how it may impact the health of the baby.

“We’ve found that chronic snoring is associated with both smaller babies and C-sections, even after we accounted for other risk factors. This suggests that we have a window of opportunity to screen pregnant women for breathing problems during sleep that may put them at risk of poor delivery outcomes.”

Women who snored both before and during pregnancy were more likely to have smaller babies and elective C-sections, the researches found. Those who started snoring only during pregnancy had a higher risk of both elective and emergency Caesareans, but not of smaller babies.

Snoring is a key sign of obstructive sleep apnoea, which results in the airway becoming partially blocked, said the researchers, whose findings appear in the journal Sleep.

This can reduce blood oxygen levels during the night and is associated with serious health problems, including high blood pressure and heart attacks.

Sleep apnoea can be treated with CPAP (continuous positive airway pressure), which involves wearing a machine during sleep to keep the airways open.

Dr O’Brien added: “If we can identify risks during pregnancy that can be treated, such as obstructive sleep apnoea, we can reduce the incidence of small babies, C-sections and possibly NICU (neo-natal intensive care unit) admission that not only improve long-term health benefits for newborns but also help keep costs down.”

Swaddling resurgence ‘damaging hips’


Parents are risking their babies‘ health because of a surge in the popularity of swaddling, according to an orthopaedic surgeon.

The technique involves binding the arms and legs with blankets and is used to help calm a baby and prevent crying.

But Prof Nicholas Clarke, of Southampton University Hospital, said swaddling was damaging developing hips.

The Royal College of Midwives and other experts advised parents to avoid tightly swaddling a child.

Restricts movement

Swaddling has been widely used in many cultures globally. It is thought the blanket wrapping can simulate the feelings of being in the womb and calm the child.

But the technique holds the legs out straight and restricts movement, which can alter the development of the hip joint.

“Start Quote

Swaddling should not be employed in my view as there is no health benefit but a risk for adverse consequences of the growing and often immature hips”

Andreas Roposch Great Ormond Street Hospital

Writing in the journal Archives of Disease in Childhood, Prof Clarke argued: “There has been a recent resurgence of swaddling because of its perceived palliative effect on excessive crying, colic and promoting sleep.

“In order to allow for healthy hip development, legs should be able to bend up and out at the hips. This position allows for natural development of the hip joints.

“The babies’ legs should not be tightly wrapped in extension and pressed together.”

Jane Munro, of the Royal College of Midwives, said it was a “seemingly innocuous” thing to do, but it posed “significant problems” for the baby.

She said there was also the risk of the baby overheating and a raised risk of cot death.

She added: “We advise parents to avoid swaddling, but it is also crucial that we take into account each mother’s cultural background, and to provide individualised advice to ensure she knows how to keep her baby safe, able to move and not get overheated.”

Video guidance

Andreas Roposch, a consultant orthopaedic surgeon at Great Ormond Street Hospital, said: “Similar effects may be seen in all devices or manoeuvres that place the legs in a purely straight position for prolonged periods in this critical age of early infancy.

“Swaddling should not be employed in my view, as there is no health benefit but a risk for adverse consequences of the growing and often immature hips.”

Rosemary Dodds, of parenting charity the NCT, advised against tight swaddling.

“It is helpful to raise awareness of hip dysplasia in relation to swaddling. Some parents and babies seem to like swaddling, but it is important that babies do not overheat and their legs are not restricted.

“Videos are available on the NCT website showing parents who want to swaddle their baby how to do so safely.”

Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes

This Cochrane Review examines the effects of different policies for clamping the umbilical cord after birth for babies born at term. It compares early cord clamping, which usually takes place within 60 seconds of birth, versus later clamping that usually involves clamping the cord more than one minute after birth or when cord pulsation has ceased.

In the past, the umbilical cord has usually been clamped shortly following the birth of the baby, as part of the active management of the third stage of labour. This strategy might also involve the infant being placed on the mother’s abdomen, put to the breast or more closely examined on a warmed cot if resuscitation was required. However, more recent guidelines for management of the third stage of labour no longer recommend immediate cord clamping, and later clamping of the umbilical cord might take place when cord pulsation has ceased or beyond the first minute following the birth of the baby. However, there is ongoing uncertainty about the relative benefits, or harms, of the two approaches. There have been concerns that late cord clamping might increase the mother’s risk of a postpartum haemorrhage, that could outweigh potential benefits to the baby of delaying clamping which might arise from the extra time for a transfer of the fetal blood in the placenta to the infant at the time of birth. This placental transfusion can provide the infant with an additional 30% more blood volume and up to 60% more red blood cells.

The authors of this updated Cochrane Review searched the Cochrane Pregnancy and Childbirth Group’s Trials Register in February 2013. This Register is maintained through electronic searching of the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE; along with dedicated searching of dozens of journals and the proceedings of major conferences. After checking 74 reports representing 58 studies, they excluded 37 studies and included 15 in the review. A further 4 studies are awaiting assessment and 2 ongoing studies were also identified. The 15 included randomized trials recruited a total of 3911 mother and baby pairs.

The primary outcome measures for the review included maternal death and severe maternal morbidity as a composite outcome, but none of the included studies reported data on these. However, in the five trials (2066 women) that reported another of the primary outcome measures, severe postpartum haemorrhage (PPH) (blood loss of ≥1000 ml blood), there were no significant differences between early versus late cord clamping (risk ratio (RR): 1.04, 95% confidence interval (CI): 0.65 to 1.65). There were also no significant differences for PPH of ≥500 ml (RR: 1.17, 95% CI: 0.94 to 1.44, 5 trials, 2260 women), mean blood loss (mean difference (MD): 5.11 ml, 95% CI: -23.18 to 33.39, 2 trials, 1345 women), or maternal haemoglobin values at 24 to 72 hours after the birth (MD: -0.12 g/dl, 95% CI: -0.30 to 0.06, 3 trials, 1128 women).

The primary outcome measure for the babies was neonatal mortality but data were only available from two trials, in which four of the 381 babies died. There was no significant difference between the early and late cord clamping groups (RR: 0.37, 95% CI: 0.04 to 3.41). Other infant outcomes with no significant differences between early and late cord clamping were Apgar scores below 7 at 5 minutes (RR: 1.23, 95% CI: 0.73 to 2.07, 2 trials, 1342 neonates), and admission to a special care baby nursery or neonatal intensive care unit (RR: 0.79, 95% CI: 0.48 to 1.31, 4 trials, 1675 infants). Fewer infants in the early cord clamping group required phototherapy for jaundice than in the late cord clamping group (RR: 0.62, 95% CI: 0.41 to 0.96, 7 trials, 2324 infants), haemoglobin concentration was significantly lower in the early cord clamping group at 24 to 48 hours (MD: -1.49 g/dl, 95% CI: -1.78 to -1.21, 4 trials, 884 infants) and infants in the early cord clamping were more than twice as likely to be iron deficient at three to six months (RR: 2.65, 95% CI: 1.04 to 6.73, 5 trials, 1152 infants. On the negative side for late cord clamping, babies in the early clamping group were less likely to require phototherapy for jaundice (RR: 0.62, 95% CI: 0.41 to 0.96, 7 trials, 2324 infants). Unlike many of the outcomes of interest to the reviewers, birthweight was reported across a large proportion of the studies. The mean weight of babies was found to be significantly higher in the late cord clamping group (MD: 101 g increase, 95% CI 45 to 157, 12 trials, 3139 infants) but with high statistical heterogeneity (I2: 62%).

The authors write that a more liberal approach to delaying clamping of the umbilical cord in healthy term infants appears to be warranted, particularly in light of the growing evidence that delayed cord clamping increases early haemoglobin concentrations and iron stores in infants. They conclude that delayed cord clamping is likely to be beneficial, as long as access to treatment for jaundice requiring phototherapy is available.

Soure: Cochrane Library

A Natural Protein in Breast Milk That Fights HIV.

For decades, public health officials have puzzled over a surprising fact about HIV: Only about 10-20 percent of infants who are breastfed by infected mothers catch the virus. Tests show, though, that HIV is indeed present in breast milk, so these children are exposed to the virus multiple times daily for the first several months (or even years) of their lives.

Now, a group of scientists and doctors from Duke University has figured out why these babies don’t get infected. Human breast milk naturally contains a protein called Tenascin C that neutralizes HIV and, in most cases, prevents it from being passed from mother to child. Eventually, they say, the protein could potentially be valuable as an HIV-fighting tool for both infants and adults that are either HIV-positive or at risk of contracting the infection.

The research, published today in Proceedings of the National Academy of Sciences, was inspired by previous work by other researchers showing that, both in tissue cultures and live mice, breast milk from HIV-negative mothers was naturally endowed with HIV-fighting properties. Scientists suggested that a few different proteins in the milk could potentially be responsible, but no one knew which one.

As part of the study, the researchers divided breast milk into smaller fractions made up of specific proteins via a number of filters—separating the proteins by size, electrical charge and other characteristics—and tested which of these fractions, when added to a tissue culture, prevented the cells from being infected by HIV. Eventually, using mass spectrometry, they found that one particular protein was present in all the HIV-resistant fractions but in none of the others: Tenascin C.





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“The protein works by binding to the HIV envelope, and one of the interesting things is that we were even able to narrow down exactly where on the envelope it binds,” says Sallie Permar, the study’s lead author. Her team found that the protein binds to a crucial region on the virus’ envelope that normally locks onto a receptor called CCR5 on the outside of human T cells,allowing it to fuse its membrane with the cell’s. With the region covered up by Tenascin C, HIV’s normal route of attack is blocked, and the virus’ effectiveness is greatly diminished.

Still, the researchers say that other natural elements in milk might play a role in fighting HIV as well. “It’s clearly not the whole story, because we do have samples that have low amounts of this protein but still have HIV-neutralizing activity,” Permar says. ”So it may be acting in concert with other antiviral and antimicrobial factors in the milk.”

Whatever those other factors are, though, the finding vindicates recent changes to UN guidelines that recommend even HIV-positive mothers in resource-poor countries should breastfeed, if they’re taking anti-retroviral drugs to combat their own infection. That’s because—as statistics bear out—the immense nutritional and immune system-boosting benefits of breast milk outweigh the relatively small chance of transmitting HIV through breastfeeding. Tenascin C, it seems, is a big part of why that transmission rate is surprisingly low, and sufficient access to anti-retroviral drugs can help drive it even lower—as low as 2 percent.

The next steps, Permar says, are determining which area of Tenascin C is active in binding to HIV and whether it can effectively prevent transmission in a live animal, as opposed to a tissue culture. If it works, it could potentially be incorporated into an HIV drug with broader applications. Possible uses include giving it in a concentrated form to infants who can’t breastfeed or even administering it to those who do to increase their level or resistance. It’s even conceivable that it could someday be adapted to reduce the risk of HIV transmission in adults as well.

One immediate advantage, says Permar, is that “it’s like to be inherently safe, because it’s already a component for breast milk. It’s something babies eat everyday.” Other potential treatments, on the other hand, must be screened for toxicity.

Tenascin C’s presence in breast milk, though, prompts a deeper question: Why would milk naturally include a protein that battles HIV, a virus that evolved extremely recently in our evolutionary history, sometime in the early 20th century?

“I don’t think it’s in breast milk to combat HIV specifically, but there have been other, related infections that have passed through breastfeeding,” Permar says. “Our work has shown that Tenascin C’s activity isn’t specific to HIV, so we think it’s more of a broad-spectrum anti-microbial protein.”

In other words, Tenascin C is effective at combating a large variety of infections (perhaps related to its role in adults, where it holds various types of tissue together, necessitating receptors that can bind to a wide array of different cells). The fact that it happens to bind at just the right spot on HIV’s outer envelope so that it combats the virus’ transmission, as Permar puts it, is “a gift from evolution.”



Probiotics Likely Do Little to Soothe Colicky Babies.

Sad news for sleep-deprived parents: probiotics may not quiet their colicky babies, a new meta-analysis suggests.

Evidence is still insufficient “to support probiotic use to manage colic, especially in formula-fed infants, or to prevent infant crying,” lead author Valerie Sung, MPH, and colleagues report in an articlepublished online October 7 in JAMA Pediatrics.

Colic, defined as excessive crying or fussing for no apparent reason, affects up to 20% of infants younger than 3 months, but its etiology remains unclear, write Sung, from the Murdoch Children’s Research Institute and Royal Children’s Hospital, Parkville, Australia, and coauthors. Some evidence points to an association with food allergies, but other data show differences in gut microflora between babies with and without colic. “The logical next step is to determine whether intervening to alter gut microbiota can effectively prevent or reduce infant crying,” the authors write.

Use of probiotics, products that use live microorganisms to confer health benefits, can change the infant gut environment and has been shown to suppress intestinal inflammation, strengthen mucosal barriers, and modulate gut contractility, any of which could produce uncomfortable symptoms and contribute to an infant’s irritability. In a meta-analysis, the authors sought to determine whether probiotics were better than no or standard treatment at reducing the duration of infant crying or distress, number of episodes of crying or distress, and proportion of infants with colic (crying or fussing for at least 3 hours a day, at least 3 days a week, for at least 1 week).

The authors identified 12 randomized, clinical trials including 1825 infants: 271 term babies with colic, 1534 term infants without colic, and 20 preterm newborns without colic. Five studies focused on probiotics specifically to manage colic, and 7 examined the use of probiotics to reduce infant crying. Some of the studies examined use of a single product, whereas others looked at the use of multiple products administered together. The products were administered as drops, capsules, or formula in a range of doses. All of the studies were placebo-controlled. Daily infant crying time was the most common reported outcome. The analysis was conducted according to guidelines from the Cochrane Handbook for Systematic Reviews of Interventions.

Mean daily crying time was significantly less in 2 of 7 trials in which probiotics were used to prevent colic; there were no differences between probiotics and placebo in the other 5 trials. Of the 5 trials examining probiotics in the management of colicky episodes, probiotics were significantly more effective than placebo in 3 trials in which Lactobacillus reuteri was administered in drops to breast-fed, full-term infants. Compared with placebo, probiotics were associated in those trials with a median reduction in daily crying time of 62.10 minutes (95% confidence interval [CI], −85.82 to −44.38 minutes; P < .001), but there was substantial heterogeneity among the trials. The authors conclude that the effect of probiotics in treating colic remains unclear because of the difficulty in comparing studies that examined vastly different products on different populations.

At least one outside expert agrees with this conclusion, despite some reservations about the authors’ methods. “The definition of colic was not rigorously controlled; there is likely to be no single cause of colic and no single treatment that is effective,” said Frank R. Greer, MD, professor of pediatrics, Wisconsin Perinatal Center, Meriter Hospital, Madison, Wisconsin. “The dosages and specific probiotic preparations were too variable[, and] whether they were given prenatally or not to both mother and infant after delivery also was extremely variable.” In addition, Dr. Greer told Medscape Medical News, “the authors did not use a validated methodology for recording the primary outcome, which was length of crying time.”

In Dr. Greer’s opinion, there is currently no place for probiotics in the management of infant colic. In contrast, he said, it has no serious adverse effects, “other than it adds unnecessarily to the cost of infant formula.”