Cüneyt TAYMAN, M. Mansur TATLI, Alpaslan TONBUL, Müsemma KARABEL, Duran KARABEL

İnfantil Kolikte Risk Faktörlerinin ve Farmakolojik Tedavi Yaklaşımlarının Değerlendirilmesi

Giriş ve Amaç: İnfantil kolik 3 hafta ile 4 ay arası bebeklerde sık görülen kendini sınırlayan bir klinik durumdur. Etiyopatogenezi hala net olarak anlaşılamadığından tedavisi de tartışmalıdır. Bu çalışmada infantil koliğin risk faktörleri ve güncel tedavi seçeneklerinin etkinliği değerlendirildi. Gereç ve Yöntemler: Çocuk polikliniğinde, yaşları 6-9 ay arası değişen infantlar çalışmaya alındı. Wessel ölçütlerine uygun olan bebekler infantil kolik olarak değerlendirildi. Bebeklerin cinsiyet, doğum ağırlığı, doğum şekli, beslenme yöntemi, eşlik eden yapısal hastalık, kimin baktığı, sigara maruziyeti, besin alerjisi, hekime başvuru oranı, önerilen tedaviler ve tedaviye yanıtlar değerlendirildi. Bulgular: Çalışma süresi boyunca 170 bebek değerlendirildi. 170 bebeğin %75’inde kolik öyküsü vardı. İnfantil kolik tanımına uyan hastalar grup 1, uymayanlar grup 2 olarak ayrıldı. Doğum ağırlıkları, cinsiyet, doğum şekli, eşlik eden hastalıklar, ilk 3 ay anne bakımı, ilk 3 ay mama takviyesi, besin alerjisi sigara maruziyeti, anne yaşı açısından her iki grup arasında anlamlı farklılık yoktu. Hekim tarafından en sık önerilen tedaviler sırasıyla, çinko naturel, simetikon damla, nurse-harveys bitkisel yağ, rezene çayı, elma yağı olduğu görüldü. Hekime başvurmadan tercih edilen tedaviler ise sırasıyla rezene çayı, çinko naturel, simetikon damla, elma yağı, nurse harvey olduğu belirlendi. Kolik tedavisi alan ve almayan gruplar arasında düzelme süreleri açısından anlamlı bir farklılık izlenmedi. Sonuçlar: İnfantil koliğin tedavisinde bilinen güncel uygulamaların, semptomları azaltma ve iyileşme süresi üzerine olumlu etkisi bulunamamıştır. Olası yan etkiler nedeniyle farmakolojik tedaviden çok, ailenin hekim tarafından eğitimi daha önemlidir. Bu durumun geçici olması konusunda huzursuz ve uykusuz ailenin rahatlatılması tedavinin esas noktasını oluşturacaktır.

Anahtar Kelimeler:

İnfant, kolik, tedavi, eğitim

EVALUATION OF THE TREATMENT APPROACHES AND RISK FACTORS IN INFANTILE COLIC

Background and Aim: Infantile colic is a self-limiting condition that is frequently seen in babies ranging from 3 weeks to 4 months of age. Its treatment can not be clearly understood as its etiopathogenesis is still controversial. In this study, the risk factors for infantile colic and the effectiveness of current treatment options were evaluated.Materials and methods: Infants with 6 to 9 months of age, who admitted to the peadiatric outpatient services, were recruited to the study. Infants who met Wessel criteria were determined as infantile colic. Babies’ gender, birth weight, type of delivery, feeding style, accompaning structural diseases, daily caretaker, smoking exposure, food allergies, physician contact rate, mothers’age, the proposed treatment and treatment responses were evaluated.Results: 170 infants were evaluated during the study period. 75% of the infants had a history of infantile colic. Infants were grouped according to the presence of infantile colic. Birth weight, gender, type of delivery, accompanying diseases, maternal care in first 3 months, food supplementation in first 3 months, food allergy, smoking exposure, mothers’age were not significantly different between both groups. The most common treatments recommended by physicians were zinc natural, simetikon drops, nurse-harveys vegetable oil, fennel tea, apple oil extract in order of frequency. The preferred treatments without resorting to the physicians by parents were fennel tea, zinc natural, simetikon drops, apple oil extract, nurse harvey vegetable oil in order of frequency. There was no significant difference in recovery time between treated and untreated infantile colic patients.Conclusion: Current treatments of infantile do not have a positive effect on reducing symptoms and duration of the condition. Parents’ education by physicians is more important than pharmacological treatment, because of possible side-effects. The main point of the treatment would be to make sleepless and restless parents feel more comfortable about this temporary situation

Keywords:

Infant, colic, treatment, education,

PDF

___

Garrison MM, Christakis DA. A systematic review of treatments for infant colic. Pediatrics 2000; 106:184-190.
Lucassen PLBJ, Assendelft WJJ, van Eijk JThM, Gubbels JW, Douwes AC, van Geldrop WJ. Systematic review of the occurrence of infantile colic in the community. Arch Dis Child 2001;84:398-403.
Saavedra MAL, Dias da Costa JS, Garcias G, Horta BL. Infantile colic in- cidence and associated risk factors: a cohort study. J Pediatr 2003;79:115- 22:12.
Weissbluth L, Weissbluth M. Infant colic: the effect of serotonin and mela- tonin circadian rhythms on the intestinal smooth muscle. Med Hypotheses 1992;39:164-167.
Barr RG. Colic and crying syndromes in infants. Pediatrics 1998;88:450- 455.
Poole SR. Tke infant with acute, unexplained, excessive crying. Clin Pediatr 1969; 8:138-141.
Lucassen PLBJ, Asssendelft WJJ, Van Eijk JThM, Gubbels JW, Douwes AC, Van Geldrop WJ. Systematic Review of the occurance of infantile colic in the community. Arch Dis Child 2001;84:398-403.
Crowcroft NS, Strachan DP .The social origins of infantile colic: question- naire study covering 76,747 infants. BMJ 1997; 314:1325-1333.
Rautava P, Helenius H, Lehtonen L. Psychosocial predisposing factors for infantile colic. Br Med J 1993;307:600-604.
Forsyth BWC, Leventhal JM, McCarthy PL. Mothers’ perceptions of problems of feeding and crying behaviors. AJDC 1985;139:269-272.
Singer JL, Rosenberg NM. A fatal case of colic. Pediatr Emerg Care 1992; 8:171- 172.
Paradise JL. Maternal and other factors in the etiology of colic. JAMA. 1966; 197:123-131.
Ames E, Bradley C. Infant and parent characteristics related to parents’ reports of colic in one-month-old and three-month-old infants. Paper pre- sented at: Canadian Psychological Association Meeting; June 10, 1983; Winnipeg, Manitoba.
Hide DW, Guyer BM. Prevalence of infant colic. Arch Dis Child. 1982;7:559-560.
Thomas DW, McGillian K, Eisenberg LD, Lieberman HW, Rissman EM. Infantile colic and type of milk feeding. AJDC 1987; 141:451-453.
Canivet C, Hagander B, Jakobsson I, Lanke J. Infantile colic: less common than previously estimated? Acta Paediatr 1996;85:454-458.
Barr RG, Kramer MS, Pless IB, Boisjoly C, Leduc D. Feeding and tempe- rament as determinants of early infant crying/fussing behavior. Pediatrics 1989; 84:514-521.
Rautava P, Helenius H, Lehtonen L. Psychosocial predisposing factors for infantile colic. BMJ 1993; 307:600-604.
Lucas A, St James–Roberts I. Crying, fussing and colic behavior in breast- and bottle-fed infants. Early Hum Dev 1998; 53:9-18.
Pauli-Pott U, Becker K, Mertesacker T, Beckmann D. Infants with “colic”-mothers’ perspectives on the crying problem. J Psychosom Res 2000;48:125-132.
Clitford TJ, Campbell MK, Speechley KN, Gorodzinsky F. İnfantile colic:empirical evidence of the absence of an association with source of early infant nutrition . Arch Pediatr Adolesc Med 2002; 156:1123-1128.
American Academy of Pediatrics. Committee on Nutrition. Soy protein- based formulas: recommendations for use in infant feeding. Pediatrics 1998;101:149-153.
Metcalf TJ, Irons TG, Sher LD, Young PC. Simethicone in the treatment of infant colic: a randomized, placebocontrolled, multicenter trial. Pediatrics 1994;94:29-34.
Garrison MM, Christakis DA. A systematic review of treatments for infant colic. Pediatrics 2000;106:184-190.
Metcalf TJ,Irons TG, Sher LD,Young PC.Simethicone in the treatment of infantile colic: a randomized, placebo-controlled, multicenter trial. Pediatrics 1994;94:29-34.
Danielsson B, Hwang CP. Treatment of infantile colic with surface active substance (simethicone).Acta Paediatr Scand 1985;74:446-550.
Weizman Z, Alkrinawi S, Goldfarb D, Bitran C. Efficacy of herbal tea preparation in infantile colic. J Pediatr 1993;122:650–652.
Taubman B. Clinical trial of the treatment of colic by modification of parent-infant interaction. Pediatrics 1984;74:998-1003.
Parkin PC, Schwartz CJ, Manuel B A. Randomised Controlled Trial of Three Interventions in the Management of Persistent Crying of Infancy. Pediatrics 1993; 92: 197-201.