Metabolomic approach to evaluating the effectiveness of Lactobacillus reuteri LR92 probiotic treatment for infantile colic in breastfed children

Introduction. Symptoms typically peak around the sixth week of life and resolve spontaneously by 4–6 months of age, which is why colic is generally considered a benign and self-limiting condition. The need for treatment arises from the negative impact of excessive crying on the infant’s family, as well as the potential long-term consequences of colic. The effectiveness of Lactobacillus reuteri DSM 17938 in breastfed infants has been demonstrated. Recently, there has been growing interest in the LR92 strain; however, its mechanism of action remains unclear. Aim. To study the urine metabolome in 1–4 month-old breastfed infants receiving Lactobacillus reuteri LR92 probiotic (Maxilac ® Baby drops) for the treatment of infantile colic, identify probable mechanisms of action of this probiotic, and assess its safety. Materials and methods. A clinical post-registration open observational prospective single-center study with minimal intervention and a comparison group was conducted: 38 children aged 1 to 5 months who were breastfed and diagnosed with infantile colic. Patients were divided into two groups: the main group (17 children) received Maxilac ® Baby probiotic drops for oral administration, the comparison group (21 children) did not receive probiotics. Urine metabolome analysis was performed using gas chromatography-mass spectrometry (GC-MS) with modern chromatographic equipment. Results and discussion. Children with colic showed significant changes in urine metabolome, reflecting impaired intestinal absorption, energy metabolism, and microbiocenosis. Following treatment with probiotic, complete resolution of colic by day 14 was observed in 100% of children in the main group (compared to only 20% in the comparison group); decreased urine content of short-chain fatty acids; changes in neurotransmitter levels indicating suppression of excitatory and stimulation of inhibitory neurotransmitters; absence of side effects. Conclusions. Maxilac ® Baby probiotic demonstrated high efficacy and safety in treating infantile colic, confirmed by clinical and metabolomic studies. The mechanism of action is associated with normalization of microbiocenosis, metabolic processes, and neurotransmitter status.