The Evidence Based Practice (EBP) Project: Literature Review and Nursing Implications

(Write citation using APA format, just as you would in a reference list. Put articles in alphabetical order by the first author’s last name)

(If the study doesn’t list one, write what the implied RQ or Hypothesis is and label as “implied.”)

(State independent and dependent variables using bullet points. Note: Participants are not variables)

(Include study design (i.e. meta-analysis, RCT), level of evidence (See the Evidence Hierarchy in Polit & Beck (2014)), other key design features such as use of placebo, blinding, etc.

(Do not put the actual data here. That belongs in the Findings column.)

(Include quantitative data. What are the researchers’ final conclusions based on the outcomes?)

To describe the first-week feeding patterns for breast- vs. bottle-fed babies, and their association with sustained breastfeeding and infant weight gain at 6 weeks.

Sample:

923 full-term mothers of infants that were born at the time of recruitment took part in the study. Out of 54% of the cohort study, the return of the usable diaries was 502.

Setting:

Urban, northeastern community in the United Kingdom
 

Do early infant feeding patterns relate to breastfeeding continuation and weight gain?

Early infant feeding patterns

Dependent variable(s):

Breastfeeding continuation and weight gain for infants at 6 weeks. The frequency of breastfeeding for both breastfed and bottle-fed infants was observed and recorded and also weight gain for both.

A longitudinal cohort study

Level of evidence:

Level 2

Key design features:

Placebo-controlled study

Interest was in breastfeeding continuation and weight gain for infants over a period of 6 weeks with regards to the frequency and patterns of breastfeeding. Mother’s midwives collected data through questionnaire dairies and collected it at routine screening visits made to the mothers each week for the 6 week period.

The frequency of breastfed infants was higher at 2.71 h between feeds as compared to infants that were bottle-fed that was at 3.25 h between feeds and for infants that received both types of breastfeeding it was 3.14 h between feeds (P<0.001) within week 1 of life, but the feed duration was the same for all. For the first week, only maternal education (P=0.004) and breastfeeding (P<0.001) were exclusively related to breastfeeding continuation over the period of 6 weeks. Feeding frequency in the first week was greater which indicated a higher 6-week weight gain for breastfed infants, however for bottle-fed infants no analyzed factors led to the incr4ease in weight gain (Casiday et al., 2004, pp. 1292-1293).

Conclusions:

First-week feeding patterns of the longitudinal cohort study indicate the significance and infant weight gain and breastfeeding continuation complicated issues, and education accorded to mothers on the feeding implications. At 6 weeks, breastfeeding was discontinued for supplementary bottle feeds. For infants that breastfed, frequent feeding led to higher weight gain during that period.

To evaluate whether breastfed infants, process speech differently from bottle-fed infants.

Sample:

12 infants at the age of 6 months were tested

Setting:

Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, USA

Breastfed infants and bottle-fed infants are the independent variables

Dependent variable(s):

Speech processing ability is the dependent variable

Retrospective cohort study design

Level of evidence:

Level 3

Key design features:

Placebo-controlled study

Interest was in Event-related potential (ERP) wavelength or speech processing measurement and recording of a range of behavioral measures. Data was collected through physical testing of the infants over a specified period.
 

The study sought to find out the breastfeeding differential impact against PUFA-enriched formula from a group of 12 infants aged 6 months that were well matched. Recording of data was done on ERP wavelengths and range of behavioral measures. Differences were identified in ERP wavelengths when the comparison was made between PUFA-fed infants and breastfed infants at the age of 6 months. Upon equating cognitive, biological, and perinatal factors, breastfed infants recorded ERPs were seen to change throughout the period of recording at 700 msec when the two groups were evaluated. Their ERPs also showed a difference in all speech sounds, and also recorded scalp recordings generated differences from all regions.

Conclusions:

In conclusion, differences observed in brain range responses possibly indicate an advantage in terms of later cognitive and linguistic development for infants that were breastfed as compared to infants that were bottle-fed.

To evaluate the effect of early breastfeeding and prenatal education of breastfeeding in the maintenance of breastfeeding practice after delivery.

Sample:

82 pregnant women that were recruited experienced virginal delivery and took part in the study.

Setting:

Soonchunhyang University Hospital, Department of Obstetrics and Gynecology in Bucheon, South Korea.
 

It is suggested that new-born infants’ early breastfeeding impacts the postpartum practice of breastfeeding and also related education effects on the practice of breastfeeding.

Early breastfeeding education is the Independent variable.

Dependent variable(s):

Breastfeeding practice maintenance is the dependent variable

Observational survey study design

Level of evidence:

Level 5

Key design features:

Placebo-controlled study

Interest was in education level and information provision effects on the types and maintenance of feeding. Data was collected through survey questionnaires that detailed information about mother and infant, breastfeeding patterns, and education level of the patient. After birth delivery in weeks 1 and 4, telephone survey interviews were conducted. Analysis of data was done using One-way ANOVA.
 

The 82 women sample size were separated into two groups with one having women that breastfed within 2 hours of delivery, and the second one breast-fed in between 2 hours and 24 hours after delivery. Women with degrees from college showed statistical significance in terms of maintaining a higher breastfeeding percentage even after discharge from hospital in the 4^th week (p=0.01). After provision of information, types of feeding (powder, breast milk) indicated differences that were statistically significant in the samples only before the discharge from hospital period by p=0.03. 1^st weeks p-value was 0.97 and 0.83 after the four week period. With this statistical data, it was clear there was no or little statistical significance in the relationship between breastfeeding of infants early and breastfeeding practice maintenance (Kim et al., 2013, pp.210-211)

Conclusions:

Education of post-partum and antenatal period with regards to breastfeeding is crucial for the maintenance of the breastfeeding practice. Recommended developing educational programs further studies.

To determine whether early nutrition in preterm infants results in later life lower blood pressure.

Sample:

216 (23%) children out of 926 born prematurely and that took part in two randomized trials that were parallel took part in the study in five UK based neonatal units.

Setting:

Medical Research Council Childhood Nutrition Research Centre, Institute of Child Health, London, UK.

Hypothesis:

It is suggested that early diet programmes blood pressure in later life in children randomly assigned different diets at birth.

Early nutrition is the independent variable

Operational definition:

Early nutrition refers to early breastfeeding where preterm infants were given dietary interventions such as preterm formula vs. donated banked breast milk and preterm formula vs. standard term formula.

Conceptual definition:

Early nutrition refers to the process of nourishing or provision of food (in this case breast milk) to infants (preterm) for growth and health.

Dependent variable(s):

Lower blood pressure is the dependent variable. Operational definition: lower blood pressure in this context refers to the presumed effect brought about by early breastfeeding in infants born prematurely.

Conceptual definition:

Low blood pressure also referred to as hypotension is a medical condition where the pressure in the arteries is less than 90/60 mmHg which is the measurement used to gauge blood pressure in the arteries.

Randomized controlled study design

Level of evidence:

Level 1

Key design features:

Placebo-controlled design

Interest was in blood pressure measurement. Data was collected from the 216 children aged between 13-16 years that were born prematurely through physical tests by medical practitioners.
 

Those children that were followed up at ages between 13 and 16 showed similar characteristics of anthropometry and social class at birth when compared to those that were not followed up. At this age group, 66 children that were given banked breast milk (together with the milk from the mother or alone) showed a lower arterial blood pressure mean as compared to the 64 children that were given preterm formula (mean 81·9 [SD 7·8] versus 86·1 [6·5] mm Hg; 95% CI for difference −6·6 to −1·6; p=0·001). Analysis done in the non-randomized sample showed that the human milk enteral intake proportion in the period of neonatal was related inversely to the arterial pressure later mean (β=−0·3 mm Hg per 10% increase [95% CI −0·5 to −0·1]; p=0·006). No conclusive difference was noticed in comparison of term formula (n=44) and preterm formula (n=42) (Singhal et al., 2001, pp. 416-417).

Conclusions:

Breast milk consumption was seen to reduce blood pressure in prematurely born children. Data retrieved from the study provides for experimental programming evidence of a risk factor in the cardiovascular through early nutrition and long-term positive breast milk effects were further supported.