Breastfeeding is undisputedly the best way to feed a baby. The nutritional benefits of breast feeding are innumerable however there might be case sin which breastfeeding is not possible and the mother might have to consider formula-based solution ot feed their baby. In this paper, Maria Quigley, Nicholas D Embleton, and William McGuire have created a study in which they analyse the contrast between formula feeding or breast milk feeding for pre term or low birth weight babies.
For the low birth weight Breast milk from donors may still have some of the non-nutritive benefits despite not being maternal breast milk. The feeding with artificial formula is helpful and more reliable because it provides consistent delivery and far a greater number of nutritional benefits. The debate around the actual risk associated with drinking only artificial formula is still unresolved.
This is systematic review that has used Cochrane Neonatal search strategy. It is comprehensive and follows a definite flow in collection of data and analysis. It is knowledgeable and insightful whilst listing out some important ideas about feeding pre term babies. The objective of this paper was to determine the effect of formula-based solution versus breastfeeding option on low birth weight babies and the study showcases some important statistics for the same.
The question being reviewed in this study is:
When a mother's own breast milk is not available, does feeding preterm or low birth weight infants with formula rather than donor breast milk affect digestion and growth and the risk of severe bowel problems?
Artificial formula is more difficult to digest than breast milk and pre term babies often face this problem. But another concern surrounding the artificial versus breast milk feeding debate is how artificial milk can also cause sever bowel problems. The only solution to this is acquisition of donor breast milk when the mother’s own breast milk is somehow insufficient or not available. In this situation however, the donor breast milk ends up being more expensive and there is no guarantee that it actually has all the nutrients required for a bay’s optimal growth.
In this study the authors have reviewed every available evidence form clinical trials that had been conducted to understand the formula versus donor breast milk feeding pattern for low birth weight infants.
There is a lot of uncertainty around the benefits and harms to each feeding pattern for babies. This review is an attempt to detect, appraise and synthesise evidence from randomised controlled trials (RCTs) .
The problem has been clearly identified by the researcher. this is an important question as it is relevant to the current context of overall health in babies. Feeding babies with artificial milk is associated with. The of the risk of developing necrotising enterocolitis. Moreover, trials on bigger and more elaborate scale could provide much stronger and useful evidence to help clinicians and families make informed choices about this issue. It is relevant to nursing and provides key insights.
A proper literature review as per the format was not included. However, the study has ample references and intext citation that refer to related and relevant articles that elaborate more on the topic.
The review should have included a proper scope pf the secondary data applied for the clinical trials. The data should have been indicative of exact numbers in babies and the effect of artificial formula-based solution effects. The data included in this review is elaborate but lacks clarity and flow.
There is a certain lack of coherence in the flow of references as a lot of clinical trials have been referred to. It can be assessed that though this is huge and important topic, all the sites and trials mentioned here are nit extremely pivotal to the research question in hand.
All the secondary analysis should have been put forward in a more lucid manner so that the relation between the trials and assumptions could be made more clearly.
The lack of a clear written literature review makes the critical analysis incomplete. The review has a lot of data and has covered a lot of information but the review is not in depth.
The theoretical framework for the data has not been identified clearly. It is evident that the clinical trials from various years are being analysed to come to the conclusion but the actual scope of the theories referred to is not mentioned.
The objective and the result of the review are closely tied therefore the variable in this case – the formula of the other’s milk is also easily identified. But to understand the actual implications of the process. The graphs and data could have been more useful if the theoretical framework had been provided more distinctly with proper headings.
This review has followed an exploratory design while keeping in mind the need for collection of adequate data. It has used both qualitative and quantitative method to make an analysis.
It can be said that the researcher utilized the research design relevant to the study however the scope of effects of the variables included was not clearly mentioned.
The review lacked a lot of clarity because comparisons were provided without any simplified understanding of the comparison. The researcher did not try to control the external and internal threats but the study lacked the overall level of comprehension for us to make a conclusion.
Selective reporting and effect of interventions have been duly noted.
Standard search strategy of Cochrane Neonatal and controlled trials using random or quasi‐random participant allocation was used.
They studied the clinical trial through electronic searches, data extraction and management.
The methods and instruments have been mentioned clearly and this part of the review can actually be verified. Proper information about the methods employed has also been used.They also searched ClinicalTrials.gov and the World Health Organization’s International Trials Registry and Platform.
The selection of studies was thorough and their inclusion criteria for including these studies and trials was also extremely precise. The instruments used for measurement have also been mentioned. The assessment of risk bias is included in the studies. If the data was missing in any case , the researchers have contact the original study investigators to get actual inputs.
They have calculated risk ratios (RRs) and risk differences (RDs) for dichotomous data and mean differences (MDs) for continuous data, with respective 95% confidence intervals (CIs). When it was deemed appropriate to combine two or more study arms, they obtained the treatment effects from the combined data using the methods described in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011).
They also determined the number needed to treat to benefit (NNTB) or harm (NNTH) for a statistically significant difference in the RD.
A total of 1809 infants took part in the included trials. Most participants were clinically stable infants of gestational age at birth < 32 weeks' or birth weight < 1800 g. Most trials excluded infants who were small for gestational age at birth and infants with congenital anomalies or gastrointestinal or neurological problems.
The subject’s rights were protected but the inclusion criteria of the sample is known. Random sampling technique was used.
According to the study it revealed that most outcomes were growth parameters during the study period or until hospital discharge. Most reports gave information on adverse outcomes, including feeding intolerance and the incidence of necrotising enterocolitis. Four trials reported growth or neurodevelopmental outcomes assessed during and after infancy following hospital discharge
Meta‐analysis of data showed that the formula‐fed group regained birth weight more quickly
The data answers the research question quite thoroughly but it lacks the proper chronology required for such studies. The data analysis is relevant to the study provide some key insights. The statistical procedures are appropriate but the meaning of the results should have been discussed more clearly at the end of the study.
Meta‐analysis of data from eight trials shows that feeding with formula rather than donor breast milk increases the risk of necrotising enterocolitis in preterm and LBW infants.
However, the possibilities of the review being biased or not completely representative of the population as most if the data was taken only from high income countries. Substantial heterogeneity in the meta‐analyses of weight gain, linear growth, and head growth limits the validity of the pooled estimates of effect size. Also, many of the trials were undertaken more than 20 years ago and the trials used different inclusion criteria and varied with respect to the type of formula and donor breast milk which might be redundant as per today’s data collection methods.
Also, these findings should be applied only with extreme caution and the data is restricted to growth in preterm infants or sick infants. Since most of the infants, are at a high risk of developing necrotising enterocolitis, most were ineligible to participate in many of the included trials.
The review is elaborate and comprehensive but the language is unclear at times that makes studying of the actual data difficult. The methodology and use of studies for analysis is correct and efficient but the theoretical framework is not legible. The study might be including a few biases but the overall intention is clear and the research question is addressed. However the understanding of the concept and the flow should have been more succinct and precise. There are lots of grammatical and syntax errors that render an otherwise brilliant research incoherent at times.
Brown, A., Raynor, P., & Lee, M. (2011). Maternal control of child‐feeding during breast and formula feeding in the first 6 months post‐partum. Journal of Human Nutrition and Dietetics, 24(2), 177-186.
Quigley, M., & McGuire, W. (2014). Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database of systematic reviews, (4).
Gribble, K. D., & Hausman, B. L. (2012). Milk sharing and formula feeding: Infant feeding risks in comparative perspective?. The Australasian medical journal, 5(5), 275.
Lee, E. J. (2007). Infant feeding in risk society. Health, risk & society, 9(3), 295-309.
Gaull, G. E., Rassin, D. K., Räihä, N. C., & Heinonen, K. (1977). Milk protein quantity and quality in low-birth-weight infants: III. Effects on sulfur amino acids in plasma and urine. The Journal of Pediatrics, 90(3), 348-355.
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