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2 de junio de 2024
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Artículo

Infant formulas for the treatment of functional gastrointestinal disorders: A position paper of the ESPGHAN Nutrition Committee

Publicado en: Journal Of Pediatric Gastroenterology And Nutrition. 79 (1): 168-180 - 2024-07-01 79(1), DOI: 10.1002/jpn3.12240

Autores:

Haiden, N; Savino, F; Hill, S; Kivelae, L; De Koning, B; Köglmeier, J; Luque, V; Moltu, SJ; Norsa, L; De Pipaon, MS; Verduci, E; Bronsky, J
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Afiliaciones

ASST Papa Giovanni XXIII, Pediat Hepatol Gastroenterol & Transplantat Unit, Bergamo, Italy - Autor o Coautor
Azienda Osped Univ Citta Salute & Sci Torino, Regina Margher Regina Margher Children Hosp, Dept Patol & cura bambino, Turin, Italy - Autor o Coautor
Erasmus MC Sophia Childrens Hosp, Dept Pediat Gastroenterol, Rotterdam, Netherlands - Autor o Coautor
Great Ormond St Hosp Children NHS Fdn Trust, Dept Paediat Gastroenterol, Unit Nutr & Intestinal Failure Rehabil, London, England - Autor o Coautor
Great Ormond St Hosp Children NHS Fdn Trust, Gastroenterol Dept, Nutr & Intestinal Failure Div, London, England - Autor o Coautor
Helsinki Univ Hosp, Childrens Hosp, Helsinki, Finland - Autor o Coautor
Kepler Univ Hosp, Dept Neonatol, Krankenhausstr 26-30, A-4020 Linz, Austria - Autor o Coautor
Oslo Univ Hosp, Dept Neonatal Intens Care, Norway Pediat, Oslo, Norway - Autor o Coautor
Tampere Univ Hosp, Dept Pediat, Tampere, Finland - Autor o Coautor
Tampere Univ, Celiac Dis Res Ctr, Tampere, Finland - Autor o Coautor
Univ Autonoma Madrid, Neonatol Hosp La Paz Inst Hlth Res IdiPAZ, Madrid, Spain - Autor o Coautor
Univ Hosp Motol, Dept Paediat, Prague, Czech Republic - Autor o Coautor
Univ Milan, Vittore Buzzi Hosp, Dept Pediat, Metab Dis Unit, Milan, Italy - Autor o Coautor
Univ Oslo, Res Inst, Oslo, Norway - Autor o Coautor
Univ Rovira & Virgili IISPV, Paediat Nutr & Dev Res Unit, Tarragona, Spain - Autor o Coautor
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Resumen

Functional gastrointestinal disorders (FGID), such as infant regurgitation, infant colic, and functional constipation, are common and typically physiological phenomena during the early months of an infant's life and account for frequent consultations with pediatricians. Various infant formulas are marketed for their management and are frequently given by parents to infants before a medical consultation. However, the evidence supporting their effectiveness is limited and some have altered nutritional compositions when compared to standard formulas. Thus, these products should only be used under medical supervision and upon medical advice. Marketing and over-the-counter sales do not ensure proper medical guidance and supervision. The aim of this position paper is to review the current evidence regarding the safety and efficacy of formulas specifically formulated for addressing regurgitation, colic, and constipation, recognized as FGID. The objective is to provide guidance for clinical management based on the highest quality of available evidence. A wide search using Pubmed, MEDLINE, EMBASE and Cochrane Database of Systematic Reviews was performed including the MESH terms infant formula, colic, constipation, regurgitation, reflux, palmitate, lactase, lactose, magnesium, hydrolyzed protein, prebiotics or probiotics. 752 papers were identified and screened. Finally, 72 papers were included in the paper. In the absence of evidence, recommendations reflect the authors' combined expert opinion. Final consensus was obtained by multiple e-mail exchange and meetings of the Nutrition Committee. (1) For breastfed infants experiencing FGID such as regurgitation, colic, or constipation, transitioning from breastfeeding to commercial formulas is not recommended. (2) In general, whether an infant is breastfed or formula-fed, it's crucial to reassure parents that FGIDs are normal and typically do not necessitate treatment or change to a special formula. (3) Thickened formulas, often termed anti-reflux formulas, may be considered in specific cases of regurgitation. (4) The usage of specialized formulas for infants with colic is not advised due to a lack of clinical evidence. (5) In the case of constipation in infants, the use of formulas enriched with high beta-palmitate and increased magnesium content may be considered to soften the stool. Generally, there is limited evidence supporting the use of specialized formulas for FGID. Breastfeeding should never be discontinued in favor of formula feeding. What is Known Functional gastrointestinal disorders, such as infant regurgitation, infant colic, and functional constipation, are common and typically physiological phenomena during the early months of an infant's life. The infant food industry provides a wide range of formulas designed for managing these mild functional gastrointestinal disorders. Despite the widespread use of these formulas, their effectiveness in treating mild functional gastrointestinal disorders remains uncertain.What is New Weaning from breastfeeding is not advised for infants experiencing any or several functional gastrointestinal disorders. In majority of formula-fed infants, no specific formulas are indicated. In breastfed infants with regurgitation, breast milk can be expressed and supplemented with thickening agents and in formula fed infants, industrially thickened infant formulas often referred to as "anti-reflux formulas," or formulas with appropriately added thickeners can be considered in special cases under medical guidance. Special anti-colic formulas do not usually benefit infants with colic. In cases of infant constipation, considering formulas with high beta-palmitate and an elevated magnesium content may be an option to soften stool consistency. It is generally not recommended to use formulas for combined functional gastrointestinal disorders.
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Palabras clave

ConstipationDouble-blindEuropean-societyFgidGastroesophageal-refluxHydrolyzed formulaInfant colicLactoseMilNecrotizing enterocolitisPediatric gastroenterologyRegurgitatioRegurgitationReuteri dsm 17938Thickened formula

Indicios de calidad

Impacto bibliométrico. Análisis de la aportación y canal de difusión

El trabajo ha sido publicado en la revista JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION debido a la progresión y el buen impacto que ha alcanzado en los últimos años, según la agencia WoS (JCR), se ha convertido en una referencia en su campo. En el año de publicación del trabajo, 2024 aún no existen indicios calculados, pero en 2023, se encontraba en la posición 33/191, consiguiendo con ello situarse como revista Q1 (Primer Cuartil), en la categoría Pediatrics.

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

Según las diferentes agencias de indexación, el número de citas acumuladas por esta publicación hasta la fecha 2026-04-05:

  • WoS: 6
  • Scopus: 12
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Impacto y visibilidad social

Desde la dimensión de Influencia o adopción social, y tomando como base las métricas asociadas a las menciones e interacciones proporcionadas por agencias especializadas en el cálculo de las denominadas “Métricas Alternativas o Sociales”, podemos destacar a fecha 2026-04-05:

  • El uso, desde el ámbito académico evidenciado por el indicador de la agencia Altmetric referido como agregaciones realizadas por el gestor bibliográfico personal Mendeley, nos da un total de: 48.
  • La utilización de esta aportación en marcadores, bifurcaciones de código, añadidos a listas de favoritos para una lectura recurrente, así como visualizaciones generales, indica que alguien está usando la publicación como base de su trabajo actual. Esto puede ser un indicador destacado de futuras citas más formales y académicas. Tal afirmación es avalada por el resultado del indicador “Capture” que arroja un total de: 48 (PlumX).

Con una intencionalidad más de divulgación y orientada a audiencias más generales podemos observar otras puntuaciones más globales como:

  • El Score total de Altmetric: 20.
  • El número de menciones en la red social Facebook: 1 (Altmetric).
  • El número de menciones en la red social X (antes Twitter): 30 (Altmetric).

Es fundamental presentar evidencias que respalden la plena alineación con los principios y directrices institucionales en torno a la Ciencia Abierta y la Conservación y Difusión del Patrimonio Intelectual. Un claro ejemplo de ello es:

  • El trabajo se ha enviado a una revista cuya política editorial permite la publicación en abierto Open Access.
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Análisis de liderazgo de los autores institucionales

Este trabajo se ha realizado con colaboración internacional, concretamente con investigadores de: Austria; Czech Republic; Finland; Italy; Netherlands; Norway; United Kingdom.

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Reconocimientos ligados al ítem

No funding was obtained for this study.
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