Research Department, University College of Osteopathy, London, UK.
Research Department, University College of Osteopathy, London, UK
BMJ Open. 2020 Feb 25;10(2):e035405. doi: 10.1136/bmjopen-2019-035405.
To conduct a systematic review of systematic reviews and national guidelines to assess the effectiveness of four treatment approaches (manual therapy, probiotics, proton pump inhibitors and simethicone) on colic symptoms including infant crying time, sleep distress and adverse events.
We searched PubMed, Embase, Cochrane and Mantis for studies published between 2009 and 2019. Inclusion criteria were systematic reviews and guidelines that used evidence and expert panel opinion. Three reviewers independently selected articles by title, abstract and full paper review. Data were extracted by one reviewer and checked by a second. Selected studies were assessed for quality using modified standardised checklists by two authors. Meta-analysed data for our outcomes of interest were extracted and narrative conclusions were assessed.
Thirty-two studies were selected. High-level evidence showed that probiotics were most effective for reducing crying time in breastfed infants (range -25 min to -65 min over 24 hours). Manual therapies had moderate to low-quality evidence showing reduced crying time (range -33 min to -76 min per 24 hours). Simethicone had moderate to low evidence showing no benefit or negative effect. One meta-analysis did not support the use of proton pump inhibitors for reducing crying time and fussing. Three national guidelines unanimously recommended the use of education, parental reassurance, advice and guidance and clinical evaluation of mother and baby. Consensus on other advice and treatments did not exist.
The strongest evidence for the treatment of colic was probiotics for breastfed infants, followed by weaker but favourable evidence for manual therapy indicated by crying time. Both forms of treatment carried a low risk of serious adverse events. The guidance reviewed did not reflect these findings.
CRD42019139074.
系统评价系统评价和国家指南，以评估四种治疗方法（手法治疗、益生菌、质子泵抑制剂和二甲硅油）对绞痛症状（包括婴儿哭闹时间、睡眠困扰和不良事件）的有效性，这四种治疗方法包括手法治疗、益生菌、质子泵抑制剂和二甲硅油。
我们在 2009 年至 2019 年期间检索了 PubMed、Embase、Cochrane 和 Mantis 中的研究。纳入标准为使用证据和专家小组意见的系统评价和指南。三名评审员独立通过标题、摘要和全文审查来选择文章。一名评审员提取数据，另一名评审员进行检查。两名作者使用改良的标准化清单评估选定研究的质量。我们感兴趣的结局的meta 分析数据被提取，并对叙述性结论进行评估。
共选择了 32 项研究。高水平证据表明，益生菌对减少母乳喂养婴儿的哭闹时间最有效（24 小时内减少 25-65 分钟）。手法治疗具有中等至低质量证据，表明哭闹时间减少（24 小时内减少 33-76 分钟）。二甲硅油具有中等至低证据表明无益处或负面影响。一项荟萃分析不支持使用质子泵抑制剂减少哭闹时间和烦躁不安。三项国家指南一致建议使用教育、父母安慰、建议和指导以及母婴临床评估。关于其他建议和治疗方法没有达成共识。
治疗绞痛的最强证据是益生菌治疗母乳喂养的婴儿，其次是手法治疗，这两种治疗方法均表明哭闹时间减少，但证据较弱但有利。这两种形式的治疗都有较低的严重不良事件风险。综述的指南没有反映这些发现。
PROSPERO 注册号：CRD42019139074。
