PICO - This is a major assignment for Heiss\' class PDF

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This is a major assignment for Heiss' class...

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PICO LIT SEARCH Introduction Does breastfeeding help prevent infants from having diseases, compared to formula feeding? I came up with this question because I was curious on the benefits and differences

between breastfeeding and formula feeding. I focused my population on infants, my intervention was breastfeeding and I compared it with formula feeding. My outcome is preventing diseases. Table of Related Search Items P

I

C

O

Infants

Breastfeeding

Formula feeding

Diseases

Babies

Breastfed

Bottle feeding

Illness

Newborns

Breast milk

Infant formula

Hospitalization of children

Rationale for Search I searched my terms on a journal database called CINAHL. I individually searched each word of the table above. For my P section, I typed infants and clicked search. Then, I did the same for babies and newborns. I did the same process for the rest of my I, C, and O sections. Afterwards, I combined the terms in each section with the Boolean operator OR which will help expand the search. Then, I selected the total of each section and combined it with the Boolean operator AND. This process will help limit the search to certain articles that will have the terms in my PICO question. The result was 204 articles and it should be only between ten to fifty articles. In order to further narrow my search, I used a limiter which selected articles that were published on 2012 to 2017. The result was still greater than fifty articles. In order to reduce the number of articles in my results, I added another limiter to adjust the age because I noticed that

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PICO LIT SEARCH all of the articles have varying ages from infants to adults. Since my population is only infants, I selected the “all infant” box. By using two limiters, it narrowed my search and ensured that I have the correct population and the information of the articles were up to date. The end result was 47 articles which fits under the limit. Discussion of Results The first article, “The Cascade of Care to Prevent Mother-to-Child Transmission in Rio de Janeiro, Brazil, 1996-2013: Improving but Still Some Way to Go,” talks about the research of

Rio de Janeiro pediatric clinic on the cause of HIV transmission from the mother to her child. As it turns out, the cause of HIV transmission was breastfeeding (Hofer et al., 2017). However, the reason why breastfeeding was the culprit of HIV transmission is because mothers in Brazil did not have access to antiretroviral use during labor (Hofer et al., 2017). This article is somewhat relevant to my topic because breastfeeding can easily transmit disease from a mother to her child. In addition, the result of the authors’ research was affected by specific circumstances that only occurred in Brazil. It also does not address the difference between breastfeeding and bottle feeding. This article was included of the results because it consists three parts of my question (PIO) but not the comparison (C). The second article, “Breastfeeding, Childhood Asthma, and Allergic Disease,” discusses the benefits of breastfeeding during the first six months. The contents of breast milk improve the child’s health development and protect the child against lower respiratory tract infections (Oddy, 2017). It also talks about the difference between bottle-fed and breastfed infants. Formula-fed infants did not develop good gut flora which means they were more prone to acquire allergic diseases and childhood asthma (Oddy, 2017). This article is very relevant to my question because

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it covers the population (infants), compares my intervention which is breastfeeding and formula feeding, and mentions my outcome (preventing disease). This article was part of the result in my search because it had all four parts to my PICO question. The third article, “The Role of Hydrolyzed Formula in Allergy Prevention,” evaluates other methods for feeding infants other than breastfeeding. The author notes that hydrolyzed formula may reduce the risk of allergic diseases such as allergic rhinitis, food allergy, and asthma (Cabana, 2017). This article is relevant because it includes three out of the four parts to my PICO question. The article rarely talks about breastfeeding and focuses more on the benefits of hydrolyzed formulas. Cabana’s findings sound good in theory, however, there are so many different infant formulas from various companies that uses different methods of making their product. Therefore, it is hard to narrow down which type of infant formula is successful in preventing pediatric diseases. In the fourth article, “Evidence of a Preventive Effect of Breastfeeding on Obstructive Sleep Apnea in Children and Adults,” the authors analyze the positive effects of breastfeeding, one of which can prevent the child from acquiring obstructive sleep apnea (Vinha & de MelloFilho, 2017). They also discuss other benefits of breastfeeding such as providing adequate nutrition and helping improve the baby’s immune and cognitive development (Vinha & de Mello-Filho, 2017). This article is relevant to my question because it talks about the benefits of my intervention and how it can prevent other types of illness such as sleep apnea. However, it does not compare breastfeeding and bottle feeding. This article came up in my search because it had all four components to my question.

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In the fifth article, “Formula-Feeding of HIV-Exposed Uninfected African Children is Associated with Faster Growth in Length during the First 6 Months of Life in the Kesho Bora Study,” the authors present the idea that feeding methods may have an influence in growth of HIV-exposed infants in Africa. They gathered data from babies who were breastfed and bottlefed and the result was that bottle-fed infants grew faster than breastfed infants (Bork et al., 2017). This article was not relevant to my question because the outcome was measuring growth, not preventing diseases. The article was included in my results because it had three out of the four parts in my question. The sixth article, “Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants,” explains that there is an increased risk of necrotizing enterocolitis (NEC) for extremely low birth weight newborns who were formula-fed than for extremely low birth weight newborns who were breastfed (Colaizy et al., 2016). This article is somewhat relevant because the article states that there is a difference in risk for NEC in newborns who were breastfed or bottle-fed. However, the population is specifically babies who have extreme low birth weight, which excludes babies who have a normal birth weight. The population in my question includes all infants. This article was selected by the database because it consists of all four components in my question. In the seventh article, “Diarrhoea and Suboptimal Feeding Practices in Nigeria: Evidence from the National Household Surveys,” the authors analyze the effects of feeding methods in Nigeria. Nigeria is predominately a breeding ground for infectious diseases such as diarrhea. However, the studies have shown that babies who were not breastfed or had a mix of both breast milk and infant formula are at a greater risk for developing diarrhea (Ogbo et al., 2016).

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In contrast, babies who were breastfed has a significantly low risk of acquiring diarrhea (Ogbo et al., 2016). This article is relevant to my PICO question because it addresses that different feeding practices can either increase or decrease the risk of diarrhea for babies. The article was selected by the database because it has all of the components to my question. The eighth article, “Bioactive Proteins in Human Milk: Health, Nutrition, and Implications for Infant Formulas,” discusses the biology of breast milk and its benefits to infants. It explains the positive effects of breast milk: it reduces the risk for diseases such as obesity, diabetes and heart problems, decreases the incidence for infections, provides good bacteria for the gut, and enhances cognitive development (Lönnerdal, 2016). This article is relevant to my topic because it provides information about my breastfeeding and how it helps lower the risk for diseases. The article mentions infant formula briefly towards the end, however it does not compare the two feeding methods. The results of my search yielded this article because it contains all four parts of my question. In the ninth article, “The Role of Lactoferrin in Gastrointestinal and Immune Development and Function: A Preclinical Perspective,” the author explains that one of the contents of breast milk which is lactoferrin. Lactoferrin stimulates GI/immune development which helps lower the baby’s risk for infectious diseases (Donovan, 2016). In comparison to infant formula, the article states that there are more lactoferrin present in breast milk than in regular milk (Donovan, 2016). This article is relevant to my question because it compares the biology of breast milk and regular milk and provides evidence on how lactoferrin helps reduce the incidence of diseases. Since it has all the components to my question, this article was included in the result of my search.

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PICO LIT SEARCH In the tenth article, “Breastfeeding and Risk of Kawasaki Disease: A Nationwide

Longitudinal Survey in Japan,” the authors present some information about a common childhood disease in Japan called Kawasaki disease. They observed that babies who were solely or partially breastfed were less likely to be hospitalized for Kawasaki disease (Takashi, Hirokazu, & Hiroyuki, 2016). The article is relevant because it provides substantial evidence about the preventative effects of breastfeeding against Kawasaki disease. It compares the data of breastfed and formula-fed infants and the outcome was preventing diseases. This article was included in my results because it has all four parts to my question. Evaluation Before when I research for school projects and papers, I would use Google as my main source. When the time came for me to research and write papers for my nursing classes, Google alone is not sufficient. Many people can input information in Google, which makes it less reliable. Since I have never used the CINAHL database, it took a couple of tries for me to correctly do it. When I first used CINAHL, I forgot to search the items individually and the database only generated one to two articles. During this whole assignment, I found many articles that were interesting and applicable to my question. I learned that it is important to double check my search, terms, boolean operators, and limiters because one mistake can ruin the whole search. Future Searches The next time I use the CINAHL database, I would make my search terms less broad because there were so many articles in my result. Other than that, I was satisfied with my search and I found various articles that were useful and relevant to my question.

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PICO LIT SEARCH References Bork, K. A., Cames, C., Newell, M., Read, J. S., Ayassou, K., Musyoka, F., & ... Cournil, A. (2017). Formula-Feeding of HIV-Exposed Uninfected African Children is Associated with Faster Growth in Length during the First 6 Months of Life in the Kesho Bora Study. Journal Of Nutrition, 147(3), 453-461. doi:10.3945/jn.116.242339 Cabana, M. D. (2017). The Role of Hydrolyzed Formula in Allergy Prevention. Annals Of Nutrition & Metabolism, 7038-45. doi:10.1159/000460269 Colaizy, T. T., Bartick, M. C., Jegier, B. J., Green, B. D., Reinhold, A. G., Schaefer, A. J., & ... Stuebe, A. M. (2016). Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants. Journal Of Pediatrics, 175100-105.e2. doi:10.1016/j.jpeds.2016.03.040 Donovan, S. M. (2016). The Role of Lactoferrin in Gastrointestinal and Immune Development

and Function: A Preclinical Perspective. Journal Of Pediatrics, 173S16-S28. doi:10.1016/ j.jpeds.2016.02.072 Hofer, C. B., Egger, M., Davies, M., Frota, A. C., Oliveira, R. H., Abreu, T. F., & ... Cordeiro, J. R. (2017). The Cascade of Care to Prevent Mother-to-Child Transmission in Rio de Janeiro, Brazil, 1996-2013: Improving but Still Some Way to Go. Tropical Medicine & International Health, 22(10), 1266-1274. doi:10.1111/tmi.12925 Lönnerdal, B. (2016). Bioactive Proteins in Human Milk: Health, Nutrition, and Implications for Infant Formulas. Journal Of Pediatrics, 173S4-S9. doi:10.1016/j.jpeds.2016.02.070 Oddy, W. H. (2017). Breastfeeding, Childhood Asthma, and Allergic Disease. Annals Of Nutrition & Metabolism, 7026-36. doi:10.1159/000457920

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Ogbo, F. A., Page, A., Idoko, J., Claudio, F., & Agho, K. E. (2016). Diarrhoea and Suboptimal Feeding Practices in Nigeria: Evidence from the National Household Surveys. Paediatric & Perinatal Epidemiology, 30(4), 346-355. doi:10.1111/ppe.1229 Takashi, Y., Hirokazu, T., & Hiroyuki, D. (2016). Breastfeeding and Risk of Kawasaki Disease: A Nationwide Longitudinal Survey in Japan. Pediatrics, 137(6), 17. doi:10.1542/ peds.2015-3919 Vinha, P. P., & de Mello-Filho, F. V. (2017). Evidence of a Preventive Effect of Breastfeeding on Obstructive Sleep Apnea in Children and Adults. Journal Of Human Lactation, 33(2), 448-453. doi:10.1177/0890334416682006

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PICO LIT SEARCH Sources and Abstracts 1.

The Cascade of Care to Prevent Mother-to-Child Transmission in Rio de Janeiro, Brazil, 1996-2013: Improving but Still Some Way to Go.

Authors: Hofer, Cristina Barroso; Egger, Matthias; Davies, Mary-Ann; Frota, Ana Cristina Cisne; Oliveira, Ricardo Hugo; Abreu, Thalita Fernandes; Araújo, Lúcia Evangelista; Witthlin, Bernardo Bastos; Carvalho, Alice Weber; Cordeiro, Janaína Rivas; Lima, Giulia Pasqualini; Keiser, Olivia; de Oliveira, Ricardo Hugo; Araújo, Lúcia Evangelista; Cordeiro, Janaína Rivas Source: Tropical Medicine & International Health (TROP MED INT HEALTH), Oct2017; 22(10): 1266-1274. (9p) Abstract: Objective: To describe the cascade of care to HIV mother-to-child transmission (PMTCT) in a Rio de Janeiro reference paediatric clinic and evaluate the main factors possibly associated with HIV transmission.Methods: Data on antenatal care (ANC), perinatal and neonatal assistance to HIV-infected and HIV-exposed but uninfected children assisted in the clinic from 1996 to 2013 were collected. The cascade of care was graphically demonstrated, and possible factors associated with HIV infection were described using regression models for bivariate and multivariate analysis. We imputed missing values of explanatory variables for the final model.Results: A total of 989 children were included in the analysis: 211 were HIV and 778 HEU. Graphically, the HIV PMTCT cascade of care improved from 1996/2000 to the later periods, but not from 2001/2006 to 2007/2013. The main factor independently associated with the HIV infection over time was breastfeeding. In the period 1996/2000, the lack of antiretroviral use during labour was associated HIV transmission. While in 2001/2007, other modes of delivery

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but elective Caesarean section, and lack of maternal antiretroviral use during ANC were associated with HIV transmission. In the last period, the main factor associated with transmission was the lack of maternal ANC.Conclusions: The HIV PMTCT cascade improved over time, but HIV vertical transmission remains a problem, and better access to ANC is needed. DOI: http://dx.doi.org/10.1111/tmi.12925 2.

Breastfeeding, Childhood Asthma, and Allergic Disease.

Author: Oddy, Wendy H. Source: Annals of Nutrition & Metabolism (ANN NUTR METAB), 2017 Supplement; 70: 26-36. (11p) Abstract: The worldwide prevalence of childhood asthma has been increasing considerably, and the protection afforded by breastfeeding in its development has been the subject of controversy for more than 80 years. Previous systematic reviews have generally found a protective effect of breastfeeding on allergic outcomes, although many studies have methodological limitations. Although breastfeeding is protective against lower respiratory tract infection during infancy, such protection has not been demonstrated for asthma in all studies. Breastfeeding has health benefits for the mother and child. Exclusive breastfeeding for the first 6 months of an infant's life, with continued breastfeeding for up to 2 years or longer, is recognized as the "gold" standard for infant feeding because human milk is uniquely suited to the human infant, and its nutritional content and bioactivity promote a healthy development. There is increasing concern that the practice of delaying complementary foods until 6 months may exacerbate the risk of allergic disease. Breast milk contains immunological components that protect against infections and

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allergic disease in infancy. The composition of human breast milk is complex, containing factors that interact with the infant immune system and intestinal milieu including allergens, cytokines, immunoglobulins, polyunsaturated fatty acids, and chemokines. Transforming growth factor β is a cytokine in human milk involved in maintaining intestinal homeostasis, inflammation regulation, and oral tolerance development. Modern day society, with increased standards of hygiene, has changed the gut flora of Western infants, potentially impacting the risk of developing immune-mediated diseases including allergic disease and asthma. Microbial diversity is intrinsic to healthy immune maturation and function. Compared to breastfed infants, formulafed infants had lower bacterial diversity and an altered intestinal microbiota in the first few weeks of life associated with an increased risk of eczema and asthma. Favorable gut colonization through continued breastfeeding may promote tolerance as well as protection when complementary feeding is initiated. DOI: http://dx.doi.org/10.1159/000457920 3.

The Role of Hydrolyzed Formula in Allergy Prevention.

Author: Cabana, Michael D. Source: Annals of Nutrition & Metabolism (ANN NUTR METAB), 2017 Supplement; 70: 38-45. (8p) Abstract: Asthma, eczema, food allergy, and allergic rhinitis are some of the most common pediatric, chronic conditions in the world. Breastfeeding is the optimal way to feed all infants. For those infants who are exposed to infant formula, some studies suggest that certain partially hydrolyzed or extensively hydrolyzed formulas may decrease the risk of allergic disease

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compared to nonhydrolyzed formulas for children with a family history of atopic disease. Overall, there is some evidence to suggest that partially hydrolyzed whey formulas and extensively hydrolyzed casein formulas may decrease the risk of developing eczema for infants at high risk of allergic disease. The evidence for a preventive effect of hydrolyzed formulas on allergic rhinitis, food allergy, and asthma is inconsistent and insufficient. Finally, the qualitative changes to the peptides by the method of hydrolysis, not just the degree of protein hydrolysis, may have a large influence on the preventive effect of a particular infant formula for the potential risk of allergic disease. As a result, it may be difficult to generalize findings from clinical studies using a specific infant formula to other infant formulas from different manufacturers using different methods of hydrolysis. Further clinical studies are needed to help clinicians identify which infants may benefit from early intervention, as well as which specific hydrolyzed formulas are best suited to decrease the risk of future allergic disease. DOI: http://dx.doi.org/10.1159/000460269 4.

Evidence of a Preventive Effect of Breastfeeding on Obstructive Sleep Apnea in Children and Adults.
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