Минимальные расстройства пищеварения: когда проблемы есть, а лечить еще рано
Аннотация
Анатомо-физиологические особенности и функциональная незрелость пищеварительной системы новорожденных являются факторами риска развития функциональных расстройств пищеварения. При этом повышенная тревожность и беспокойство родителей даже при наличии у ребенка минимальных расстройств пищеварения являются причиной частого обращения к врачу. В статье обсуждаются аспекты этиологии гастроинтестинальных симптомов, ассоциированных с продолжающимся развитием пищеварительного тракта у детей раннего возраста. Освещены методы профилактики и коррекции пищеварительного дискомфорта у детей первого года жизни.
Об авторах
Е. Г. Макарова
Нестле Россия, ООО; Северо-Западный государственный медицинский университет им. И.И. Мечникова
Россия
Раскрытие интересов:
Россия
Макарова Евгения Георгиевна - медицинский научный советник ООО «Нестле Россия»
115054, Москва, Павелецкая площадь, д. 2, стр. 1, тел.: +7 (495) 725-70-00
Раскрытие интересов:
Авторы статьи являются сотрудниками ООО «Нестле Россия»
Т. В. Клепикова
Нестле Россия, ООО
Россия
Раскрытие интересов:
Россия
Москва
Раскрытие интересов:
Авторы статьи являются сотрудниками ООО «Нестле Россия»
С. Е. Украинцев
Нестле Россия, ООО
Россия
Раскрытие интересов:
Россия
Москва
Раскрытие интересов:
Авторы статьи являются сотрудниками ООО «Нестле Россия»
Список литературы
1. Vandenplas Y, Gutierrez-Castrellon P Velasco-Benitez C, et al. Practical algorithms for managing common gastrointestinal symptoms in infants. Nutrition. 2013;29(1):184-194. doi: 10.1016/j.nut.2012.08.008.
2. Vandenplas Y, Alarcon P Alliet P et al. Algorithms for managing infant constipation, colic, regurgitation and cow's milk allergy in formula-fed infants. Acta Paediatr. 2015;104(5):449-457. doi: 10.1111/apa.12962.
3. Vandenplas Y, Abkari A, Bellaiche M, et al. Prevalence and health outcomes of functional gastrointestinal symptoms in infants from birth to 12 months of age. J Pediatr Gastroenterol Nutr. 2015;61(5):531-537. doi: 10.1097/MPG.0000000000000949.
4. Benninga MA, Faure C, Hyman PE, et al. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2016. pii: S0016-5085(16)00182-187. [Of print] doi: 10.1053/j.gastro.2016.02.016.
5. lacono G, Merolla R, D'Amico D, et al. Gastrointestinal symptoms in infancy: a population-based prospective study. Dig Liver Dis. 2005;37(6):432-438. doi: 10.1016/j.dld.2005.01.009.
6. Morais MB. Signs and symptoms associated with digestive tract development. J Pediatr (Rio J). 2016;92(3 Suppl 1):S46-56. doi: 10.1016/j.jped.2016.02.008.
7. Rosh JR. Recurrent abdominal pain and the pediatric gastroenterologist: how are we functioning? J Pediatr Gastroenterol Nutr. 2010;50(1):6-7. doi: 10.1097/MPG.0b013e3181ae362b.
8. Vandenplas Y, Hauser B, Salvatore S. Functional gastrointestinal disorders in infancy: impact on the health of the infant and family. Pediatr Gastroenterol Hepatol Nutr. 2019;22(3):207-216. doi: 10.5223/pghn.2019.22.3.207.
9. Hinds R, Loveridge N, Lemberg DA, et al. Functional gastrointestinal disorders in infants: practice, knowledge and needs of Australian pharmacists. J Paediatr Child Health. 2019. [Of print] doi: 10.1111/jpc.14536.
10. Raiha H, Lehtonen L, Huhtala V, et al. Excessively crying infant in the family: mother-infant, fatherinfant and mother-father interaction. Child Care Health Dev. 2002;28(5):419-429. doi: 10.1046/j.1365-2214.2002.00292.x.
11. Akman I, Kuscu K, Ozdemir N, et al. Mothers' postpartum psychological adjustment and infantile colic. Arch Dis Child. 2006;91(5):417-419. doi: 10.1136/adc.2005.083790.
12. Kurth E, Kennedy HP Spichiger E, et al. Crying babies, tired mothers: what do we know? A systematic review. Midwifery. 2011;27(2):187-194. doi: 10.1016/j.midw.2009.05.012.
13. Vik T, Grote V, Escribano J, et al. Infantile colic, prolonged crying and maternal postnatal depression. Acta Paediatr. 2009;98(8): 1344-1348. doi: 10.1111/j.1651-2227.2009.01317.x.
14. Keefe MR, Kotzer AM, Froese-Fretz A, Curtin M. A longitudinal comparison of irritable and nonirritable infants. Nurs Res. 1996; 45(1):4-9. doi: 10.1097/00006199-199601000-00002.
15. Howard CR, Lanphear N, Lanphear BP, et al. Parental responses to infant crying and colic: the effect on breastfeeding duration. Breastfeed Med. 2006;1(3):146-155. doi: 10.1089/bfm.2006.1.146.
16. Nevo N, Rubin L, Tamir A, et al. Infant feeding patterns in the first 6 months: an assessment in full-term infants. J Pediatr Gastroenterol Nutr. 2007;45(2):234-239. doi: 10.1097/MPG.0b013e31803e1706.
17. Barr RG. Crying as a trigger for abusive head trauma: a key to prevention. Pediatr Radiol. 2014;44 Suppl 4:S559-564. doi: 10.1007/s00247-014-3100-3.
18. Simonnet H, Laurent-Vannier A, Yuan W, et al. Parents' behavior in response to infant crying: abusive head trauma education. Child Abuse Negl. 2014;38(12):1914-1922. doi: 10.1016/j.chiabu.2014.06.002.
19. Indrio F, Di Mauro A, Riezzo G, et al. Infantile colic, regurgitation, and constipation: an early traumatic insult in the development of functional gastrointestinal disorders in children? Eur J Pediatr. 2015;174(6):841-842. doi: 10.1007/s00431-014-2467-3.
20. Rautava P, Lehtonen L, Helenius H, Sillanpaa M. Infantile colic: child and family three years later. Pediatrics. 1995;96(1 Pt 1):43-47.
21. Brown M, Heine RG, Jordan B. Health and well-being in school-age children following persistent crying in infancy. J Paediatr Child Health. 2009;45(5):254-262. doi: 10.1111/j.1440-1754.2009.01487.x.
22. Forsyth BW, Canny PF. Perceptions of vulnerability 3 1/2 years after problems of feeding and crying behavior in early infancy. Pediatrics. 1991;88(4):757-763.
23. Canivet C, Jakobsson I, Hagander B. Infantile colic. Follow-up at four years of age: still more «emotional». Acta Paediatr. 2000; 89(1):13-17. doi: 10.1080/080352500750028988.
24. Savino F, Castagno E, Bretto R, et al. A prospective 10-year study on children who had severe infantile colic. Acta Paediatr. 2005;94:129-132. doi: 10.1111/j.1651-2227.2005.tb02169.x.
25. Neu M, Robinson J. Infants with colic: their childhood characteristics. J Pediatr Nurs. 2003;18(1):12-20. doi: 10.1053/jpdn.2003.3.
26. Santos IS, Matijasevich A, Capilheira MF, et al. Excessive crying at 3 months of age and behavioural problems at 4 years age: a prospective cohort study. J Epidemiol Community Health. 2015;69(7):654-659. doi: 10.1136/jech-2014-204568.
27. Partty A, Kalliomaki M, Salminen S, Isolauri E. Infant distress and development of functional gastrointestinal disorders in childhood: is there a connection? JAMA Pediatr. 2013;167(10):977-978. doi: 10.1001/jamapediatrics.2013.99.
28. Lightdale JR, Gremse DA. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics. 2013;131(5): e1684-1695. doi: 10.1542/peds.2013-0421.
29. Savino F. Focus on infantile colic. Acta Paediatr. 2007;96(9): 1259-1264. doi: 10.1111/j.1651-2227.2007.00428.x.
30. Shamir R, St James-Roberts I, Di Lorenzo C, et al. Infant crying, colic, and gastrointestinal discomfort in early childhood: a review of the evidence and most plausible mechanisms. J Pediatr Gastroenterol Nutr. 2013;57 Suppl 1:S1-45. doi: 10.1097/MPG.0b013e3182a154ff.
31. Pijpers MA, Bongers ME, Benninga MA, Berger MY. Functional constipation in children: a systematic review on prognosis and predictive factors. J Pediatr Gastroenterol Nutr. 2010;50(3): 256-268. doi: 10.1097/MPG.0b013e3181afcdc3.
32. van den Berg MM, Benninga MA, Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol. 2006;101(10):2401-2409.
33. Wells JM, Spence JR. How to make an intestine. Development. 2014;141(4):752-760. doi: 10.1242/dev.097386.
34. Commare CE, Tappenden KA. Development of the infant intestine: implications for nutrition support. Nutr Clin Pract. 2007; 22(2):159-713. doi: 10.1177/0115426507022002159.
35. Якушин А.С., Украинцев С.Е., Денисов М.Ю. Кишечная микробиота: формирование в раннем возрасте, влияние на здоровье, способы коррекции // Вопросы современной педиатрии. — 2017. — Т. 16. — № 6. — С. 487-492. doi: 10.15690/vsp.v16i6.1821.
36. Neu J, Douglas-Escobar M, Lopez M. Microbes and the developing gastrointestinal tract. Nutr Clin Pract. 2007;22(2):174-182. doi: 10.1177/0115426507022002174.
37. Булатова Е.М., Богданова Н.М., Лобанова Е.А., Габрусская Т.В. Кишечная микробиота: современные представления // Педиатрия. Журнал им. Г.Н. Сперанского. — 2009. — Т. 87. — № 3. — С. 104-109.
38. Groer MW, Luciano AA, Dishaw LJ, et al. Development of the preterm infant gut microbiome: a research priority. Microbiome. 2014;2:38. doi: 10.1186/2049-2618-2-38.
39. Bercik P, Collins SM, Verdu EF. Microbes and the gut-brain axis. Neurogastroenterol Motil. 2012;24(5):405-413. doi: 10.1111/j.1365-2982.2012.01906.x.
40. Marsland BJ, Trompette A, Gollwitzer ES. The gut-lung axis in respiratory disease. Ann Am Thorac Soc. 2015;12 Suppl 2:S150-156. doi: 10.1513/AnnalsATS.201503-133AW.
41. Das P Makharia GK. Makharia. Gut-liver axis and disease infidelity: a subject worth exploring. Indian J Gastroenterol. 2014; 33(6):503-506. doi: 10.1007/s12664-014-0503-x.
42. Fernandez L, Langa S, Martin V, et al. The human milk microbiota: origin and potential roles in health and disease. Pharmacol Res. 2013;69(1):1-10. doi: 10.1016/j.phrs.2012.09.001.
43. Scarpellini E, Ianiro G, Attili F, et al. The human gut microbiota and virome: potential therapeutic implications. Dig Liver Dis. 2015;47(12):1007-1012. doi: 10.1016/j.dld.2015.07.008.
44. Wopereis H, Oozeer R, Knipping K, et al. The first thousand days — intestinal microbiology of early life: establishing a symbiosis. Pediatr Allergy Immunol. 2014;25(5):428-438. doi: 10.1111/pai.12232.
45. Guaraldi F, Salvatori G. Effect of breast and formula feeding on gut microbiota shaping in newborns. Front Cell Infect Microbiol. 2012;2:94. doi: 10.3389/fcimb.2012.00094.
46. Ouwehand A, Isolauri E, Salminen S. The role of the intestinal microflora for the development of the immune system in early childhood. Eur J Nutr. 2002;41 Suppl 1:32-37. doi: 10.1007/s00394-002-1105-4.
47. Lu L, Walker WA. Pathologic and physiologic interactions of bacteria with the gastrointestinal epithelium. Am J Clin Nutr. 2001; 73(6):1124-1130. doi: 10.1093/ajcn/73.6.1124S.
48. Orrhage K, Nord CE. Factors controlling the bacterial colonization of the intestine in breastfed infants. Acta Paediatr Suppl. 1999; 88(430):47-57. doi: 10.1080/080352599750029736.
49. Belmer SV. The use of prebiotics for the prevention and treatment of microflora disorders in children: a study method. allowance. Moscow: GOU VUNMTS MZiSR RF; 2005. 24 р. (In Russ).
50. Chassard C, de Wouters T, Lacroix C. Probiotics tailored to the infant: a window of opportunity. Curr Opin Biotechnol. 2014;26: 141-147. doi: 10.1016/j.copbio.2013.12.012.
51. Thompson FM, Catto-Smith AG, Moore D, et al. Epithelial growth of the small intestine in human infants. J Pediatr Gastroenterol Nutr. 1998;26(5):506-512. doi: 10.1097/00005176-199805000-00004.
52. Neu J. Gastrointestinal maturation and implications for infant feeding. Early Hum Dev. 2007;83(12):767-775. doi: 10.1016/j.earlhumdev.2007.09.009.
53. Chen IL, Gao WY, Johnson AP, et al. Proton pump inhibitor use in infants: FDA reviewer experience. J Pediatr Gastroenterol Nutr. 2012;54(1):8-14. doi: 10.1097/MPG.0b013e31823890b4.
54. Gieruszczak-Bialek D, Konarska Z, Skorka A, et al. No effect of proton pump inhibitors on crying and irritability in infants: systematic review of randomized controlled trials. J Pediatr. 2015;166(3): 767-770.e3. doi: 10.1016/j.jpeds.2014.11.030.
55. Akhnikh S, Engelberts AC, van Sleuwen BE, et al. The excessively crying infant: etiology and treatment. Pediatr Ann. 2014;43(4): e69-75. doi: 10.3928/00904481-20140325-07.
56. Soares AC, de Freitas CL, de Morais MB. [Knowledge and practice of Brazilian pediatricians concerning gastroesophageal reflux disease in infants. (In Portuguese)]. Rev Paul Pediatr. 2015;33(1):12-18. doi: 10.1016/j.rpped.2014.11.005.
57. Lightdale JR, Gremse DA, Section on Gastroenterology, et al. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics. 2013;131(5):e1684-1695. doi: 10.1542/peds.2013-0421.
58. Tabbers MM, DiLorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from espghan and naspghan. J Pediatr Gastroenterol Nutr. 2014;58(2):258-274. doi: 10.1097/MPG.0000000000000266.
59. Vandenplas Y, Rudolph CD, Di Lorenzo C, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the north American society for pediatric gastroenterology, hepatology, and nutrition (naspghan) and the european society for pediatric gastroenterology, hepatology, and nutrition (espghan). J Pediatr Gastroenterol Nutr. 2009;49(4):498-547. doi: 10.1097/MPG.0b013e3181b7f563.
60. Аллергия к белкам коровьего молока у детей. Клинические рекомендации [интернет]. — М.: Союз педиатров России, 2018. Доступно по: https://mirvracha.ru/article/klinicheskie_rekomendatsii_allergiya_k_belkam_korovego_moloka_u_detey. Ссылка активна на 12.05.2019.
61. Salvatore S, Savino F, Singendonk M, et al. Thickened infant formula: what to know. Nutrition. 2018;49:51-56. doi: 10.1016/j.nut.2017.10.010.
62. Indrio F, Riezzo G, Giordano P et al. Effect of a partially hydrolysed whey infant formula supplemented with starch and lactobacillus reuteri DSM 17938 on regurgitation and gastric motility. Nutrients. 2017;9(11). pii: E1181. doi: 10.3390/nu9111181.
63. Savino F, Cresi F, Maccario S, et al. «Minor» feeding problems during the first months of life: effect of a partially hydrolysed milk formula containing fructo- and galacto-oligosaccharides. Acta Paediatr Suppl. 2003;91(441):86-90. doi: 10.1080/08035320310018736.
64. Gonzalez-Bermudez CA, Frontela-Saseta C, Lopez-Nicolas R, et al. Effect of adding different thickening agents on the viscosity properties and in vitro mineral availability of infant formula. Food Chem. 2014;159:5 11. doi: 10.1016/j.foodchem.2014.02.168.
65. Horvath A, Dziechciarz P, Szajewska H. The effect of thickened-feed interventions on gastroesophageal reflux in infants: systematic review and meta-analysis of randomized, controlled trials. Pediatrics. 2008;122(6):e1268-1277. doi: 10.1542/peds.2008-1900.
66. Savino F, Cordisco L, Tarasco V, et al. Molecular identification of coliform bacteria from colicky breastfed infants. Acta Paediatr. 2009;98(10):1582-1588. doi: 10.1111/j.1651-2227.2009.01419.x.
67. de Weerth C, Fuentes S, Puylaert P de Vos WM. Intestinal microbiota of infants with colic: development and specific signatures. Pediatrics. 2013;131(2):e550-558. doi: 10.1542/peds.2012-1449.
68. Rhoads JM, Fatheree NY, Norori J, et al. Altered fecal microflora and increased fecal calprotectin in infants with colic. J Pediatr. 2009;155(6):823-828.e1. doi: 10.1016/j.jpeds.2009.05.012.
69. Partty A, Kalliomaki M, Endo A, et al. Compositional development of bifidobacterium and Lactobacillus microbiota is linked with crying and fussing in early infancy. PLoS One. 2012;7(3):e32495. doi: 10.1371/journal.pone.0032495.
70. Roos S, Dicksved J, Tarasco V, et al. 454 pyrosequencing analysis on faecal samples from a randomized DBPC trial of colicky infants treated with lactobacillus reuteri DSM 17938. PLoS One. 2013;8(2):e56710. doi: 10.1371/journal.pone.0056710.
71. Hatakka K, Savilahti E, Ponka A, et al. Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. BMJ. 2001; 322(7298):1327. doi: 10.1136/bmj.322.7298.1327.
72. Lehtonen L, Korvenranta H, Eerola E. Intestinal microflora in colicky and noncolicky infants: bacterial cultures and gas-liquid chromatography. J Pediatr Gastroenterol Nutr. 1994;19(3): 310-314. doi: 10.1097/00005176-199410000-00009.
73. Gupta SK. Is colic a gastrointestinal disorder? Curr Opin Pediatr. 2002;14(5):588-592. doi: 10.1097/00008480-200210000-00005.
74. Acs N, Bagi Z, Rakhely G, et al. Bioaugmentation of biogas production by a hydrogen-producing bacterium. Bioresour Technol. 2015;186:286-293. doi: 10.1016/j.biortech.2015.02.098.
75. de Weerth C, Fuentes S, de Vos WM. Crying in infants: on the possible role of intestinal microbiota in the development of colic. Gut Microbes. 2013;4(5):416-421. doi: 10.4161/gmic.26041.
76. Lindberg AA, Weintraub A, Zahringer U, Rietschel ET. Structure-activity relationships in lipopolysaccharides of bacteroides fragilis. Rev Infect Dis. 1990;12 Suppl 2:S133-141. doi: 10.1093/clinids/12.supplement_2.s133.
77. Benson S, Kattoor J, Wegner A, et al. Acute experimental endotoxemia induces visceral hypersensitivity and altered pain evaluation in healthy humans. Pain. 2012;153(4):794-799. doi: 10.1016/j.pain.2011.12.001.
78. Moriez R, Salvador-Cartier C, Theodorou V, et al. Myosin light chain kinase is involved in lipopolysaccharide-induced disruption of colonic epithelial barrier and bacterial translocation in rats. Am J Pathol. 2005;167(4):1071-1079. doi: 10.1016/S0002-9440(10)61196-0.
79. Wegner A, Elsenbruch S, Rebernik L, et al. Inflammation-induced pain sensitization in men and women: does sex matter in experimental endotoxemia? Pain. 2015;156(10):1954-1964. doi: 10.1097/j.pain.0000000000000256.
80. van Baarlen P, Troost FJ, van Hemert S, et al. Differential NF-kappaB pathways induction by lactobacillus plantarum in the duodenum of healthy humans correlating with immune tolerance. Proc Natl Acad Sci U S A. 2009;106(7):2371-2376. doi: 10.1073/pnas.0809919106.
81. Verdu EF. Probiotics effects on gastrointestinal function: beyond the gut? Neurogastroenterol Motil. 2009;21(5):477-480. doi: 10.1111/j.1365-2982.2009.01297.x.
82. Chichlowski M, Rudolph C. Visceral pain and gastrointestinal microbiome. J Neurogastroenterol Motil. 2015;21(2):172-181. doi: 10.5056/jnm15025.
83. Wadher K, Mahore J, Umekar J. Probiotics: living medicines in health maintenance and disease prevention. Int J Pharma Bio Sci. 2010;(1):1-9.
84. Savino F, Cresi F, Pautasso S, et al. Intestinal microflora in breastfed colicky and non-colicky infants. Acta Paediatr. 2004; 93(6):825-829. doi: 10.1111/j.1651-2227.2004.tb03025.x
85. Indrio F, Di Mauro A, Riezzo G, et al. Prophylactic use of a probiotic in the prevention of colic, regurgitation, and functional constipation: a randomized clinical trial. JAMA Pediatr. 2014;168(3):228-233. doi: 10.1001/jamapediatrics.2013.4367.
86. Davis EC, Wang M, Donovan SM. The role of early life nutrition in the establishment of gastrointestinal microbial composition and function. Gut Microbes. 2017;8(2):143-171. doi: 10.1080/19490976.2016.1278104.
87. Ong TG, Gordon M, Banks SS, et al. Probiotics to prevent infantile colic. Cochrane Database Syst Rev. 2019;3:CD012473. doi: 10.1002/14651858.CD012473.pub2.
88. Garofoli F, Civardi E, Indrio F, et al. The early administration of Lactobacillus reuteri DSM 17938 controls regurgitation episodes in full-term breastfed infants. Int J Food Sci Nutr. 2014;65(5): 646-648. doi: 10.3109/09637486.2014.898251.
89. Saavedra JM, Abi-Hanna A, Moore N, Yolken RH. Long-term consumption of infant formulas containing live probiotic bacteria: tolerance and safety. Am J Clin Nutr. 2004;79(2):261-267. doi: 10.1093/ajcn/79.2.261.
90. Корниенко Е.А., Козырева Л.С., Нетребенко О.К. Микробный метаболизм и кишечное воспаление у детей первого полугодия жизни в зависимости от вида вскармливания // Педиатрия. Журнал им. Г.Н. Сперанского. — 2016. — Т. 95. — № 6. — С. 19-26.
91. Assathiany R, Lesaint L, Hanh T, Piloquet H. Evaluation de l'efficacite et de la tolerance d'une formule infantile epaissie et contenant des fructo-oligosaccharides et galacto-oligosaccharides en cas de troubles digestifs associes du nourrisson de moins de 6 mois: resultats d'une enquete observationnelle realisee par Nestle Nidal sur 1127 nourrissons. Med Enfance. 2016;36(5-6).
Рецензия
При поддержке: Статья опубликована при поддержке компании ООО «Нестле Россия»
Для цитирования:
Макарова Е.Г., Клепикова Т.В., Украинцев С.Е. Минимальные расстройства пищеварения: когда проблемы есть, а лечить еще рано. Вопросы современной педиатрии. 2019;18(4):247-256. https://doi.org/10.15690/vsp.v18i4.2041
For citation:
Makarova E.G., Klepikova T.V., Ukraintsev S.E. Minimal Gastrointestinal Disorders in Infants: When It Is Too Early to Treat. Current Pediatrics. 2019;18(4):247-256. (In Russ.) https://doi.org/10.15690/vsp.v18i4.2041
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