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Evidence Informed Clinical Practice 



Main body

Critical appraisal of 3 articles

Literature review

Description of your practice context

Evidence-informed practice recommendation

Approaches to implement evidence into practice and sustain changes



Introduction to Clinical Practice

This report is all about understanding whether the use of breast milk is more effective than formula feed in reducing necrotizing enterocolitis within premature babies. Therefore this overall report will consider several aspects like that of critical appraisal of the three articles which will cover the main parameters concerning whether breast milk is better or feed volumes are better to control infections and other factors for individuals who are premature and not yet developed. Again it will also consider cost-effective means, or substitute means when one is not viable than the other means, it has to be taken.

Again it will talk about feasibility factors and safety reasons showing which of the two methods available to be used by individuals. In some cases, breast milk is better while in other cases when breast milk is not available then feed volumes help. All these parameters would be developed and explain the path from the critical appraisal, literature review, and description from own practice context and evidence-based practice and recommendation to prove the statement regarding approaches towards how changes can be made possible.

Main body 

Critical Appraisal of 3 Articles

A critical review of the three articles related to an understanding of whether breast milk or hybrid milk feeding is better for premature babies or not have been considered. The first article talks about breast milk versus hybrid milk breeding for preterm babies and it will be understood through randomized control trial comparing time and other factors. The article talked about the cost-effectiveness of human milk to prevent necrotizing enterocolitis and based on the systematic review to understand the overall pattern. Again the third article is based on understanding the feasibility and safety of setting up toner breast milk in a neonatal stage in a resource-limited setting to understand and to do this, by use of observational longitudinal cohort study to understand the basic means.

In all the three means the critical review was to understand how far breast milk is essential and more effective than formula feed in reducing necrotizing enterocolitis within premature babies. It will conduct a review by a critical means to understand that if breast milk is insufficient in many means then under such cases the substitute is feed volumes that doctors prefer to continue for parenteral nutrition. This checked in a tertiary Care Unit in a South India based region in India from 2014 to April 2016. In other means mother milk was taken for analysis again hybrid feed for mother milk supplemented with formula feed was also taken to understand the comparative time to regain, intolerance, and necrotizing in colitis stage prevention and mitigation or fighting against diseases (Grummer-Strawn, 2018).

There are several other issues and growth restriction factors for more than other major factors that Healthcare looks at. Healthcare facilities and breast milk feeding rate or discharge retinopathy of prematurity requiring a laser therapy is also understood. Again in the case of the second article, it was explained that in some cases individuals can not undergo feeding, volume human feeding is adopted by them and the article used methods to explain formula milk which is the more expensive way in certain cases.

Doctors call for breast milk as compared to that of formula milk feeding two ways to deal with health and treatment costs. There are economic considerations also involved in this kind of cases and the overall research was done for 18 days on health care center in the economic figure and possibility checked for comparison between two ways. Again in the third article, it talked about the benefits social impact of human milk and how it can deal with infections leading to necrotizing enterocolitis as compared to speed volumes which have given supplements to premature babies that it should about the benefit choice and talked about the informed choice when mothers breast milk was not available even though it is nutritional. Therefore in many cases when mother’s milk is not available, feed volumes are used as a substitute means for children who have low birth rates or suffer from various modernity and other risk problems (Buckle & Taylor 2017).

Literature Review of Clinical Practice 

A research report from various articles as well as a practical report from various HSC based organization have proven that in case of individuals or newborn babies were breastfed, the probability of suffering from infections are much lower and in terms of babies were given hospitalized with infections and other problems dealt quite well, then patients or infants who feed on formula feed are checked. In most of the pieces of evidence, it shows that breast milk is much better in terms of breastfeeding, the infant can also fight with germs and deal with antibodies and other factors in an easy way which passes from a mother to the baby and helps in strengthening of the overall immune system within that infant. This is even more important for premature infants who have not developed body systems well in themselves to fight against diseases and because of this that are several problems like morbidity and mortality that they have to overcome quickly (Coutsoudis & Coutsoudis 2011).

Therefore the best way to do this is to solve them with breastfeeding so that this problem can be solved effectively and quickly, in terms of breastfeeding there are more chances that the baby can deal with infections and it may even be done through breast bottle feeding and several other means which is the best fit. Formula feeding is essential for mothers who cannot breastfeed that the children and when breastfeeding is not available again for individuals want to deal with the cost and who do not have sufficient money to deal with treatments another means for them the choice of having breastfeeding is much better than going for formula feed. Whatever means is adopted the means should consult a health and making an informed choice in several other means to understand which of the two ways is better for an infant.

Breast milk seals the newborn stomach lining and it helps to make a baby grow strong and it contains several components that can fight diseases and certain illnesses. It also helps by giving hormones, bonding in regulating appetite, and help themselves with support organ development and repaired at the same time in health and white blood cells that can fight infection and also there are certain beneficial bacteria which can protect the infant’s digestive system which is not yet developed. It also has certain prebiotics called that help to support the infant.

It also has certain fatty acids that help to develop the Infant brain nervous system and certainly results in some of the most beneficial areas that can be solved. In the case of breastfeeding again their presence of some enzymes to support the Infant digestive immune system and nucleotides and hormones help to develop good sleep patterns for the Infant(Martin & Blackburn 2016).

While feeding a preterm baby, there are certain factors of concern that one has to understand. Such babies are more subjected to infections random problems and this may be solved by feed volumes. However, most of the mothers are concerned about the problem that whether breastfeeding is the only way by which they can protect the baby from mortality problems and other problems. There have been several supplemented developed recently to help premature babies as a substitute for breast milk and give them vitamins and minerals for growth when they require. Some mothers are too weak to breastfeed, under such conditions it is viable that some alternative method is used for them. This kind of feed formula helps to weight gain and bring growth and give supplements for babies who need to be fed at the right time. Therefore these are very important factors of concern (Ozalkaya et al.,2018).

Description of Clinical Practice

While gathering information from the critical review of the 3 articles as well as other internet-based websites, website journals and several other resources come to a critical point that in most cases breast milk is essential and beneficial as compared to feed volume given to a newborn or premature baby. For example, my aunt delivered a premature baby last month and we had to face a lot of problems before the delivery because of hospitals and situations been under lockdown for coronavirus pandemic situation, even after delivery the doctor said that it was not possible to arrange for immediate or regular medication facility as things are under lockdown at this moment (Lee & No 2018). Therefore she advised my aunt to go for normal breastfeeding for the pre-term child so that it would be able to fight infection.

While I reviewed several articles I could understand that breastfeeding is beneficial for babies because they have not developed a well-defined system within themselves and can't control themselves. If antibodies, hormone stem cells, white blood cells, beneficial bacteria, prebiotics of fatty acids, enzymes, nucleotides can be put into their body utilizing breast milk, which comes in the form of a living fluid, from the Mother's body, it would benefit the child. While my answers been continuously met, breastfeeding her baby we have seen visual changes in the baby and the baby is not becoming ill right now because somehow it has been able to deal with the instructions that might have developed at this point.

Therefore we are thankful for this benefit and have also been able to understand the with evidence-based practice which is an important means to discover the essentials of lactation. However, the doctor also suggested us that incase my aunt was unable to deliver breast milk to the sufficient volume then we should try for feed volumes which is another substitute to this rather than suffering from urgent conditions of necrotizing enterocolitis which is the common feature in premature babies (Rahman & Gad 2019).

Evidence-Informed Practice Recommendation

Of the first few days, my aunt has been dependent on breastfeeding which was the means for her baby. However, when consulted the doctor over the phone after a brief period of fever and other problems, the doctor advised that unless there would be further medication or examination of her condition she should not breastfeed her baby because there are certain conditions when mothers suffering from severe problems like that of tuberculosis other infections in which breastfeeding is not recommended. Therefore it this point in time it was not sure whether she was suffering from any serious problem or not and hence it was not recommended for her to breastfeed her baby any more about this point of time. She was recommended for formula feed apply to her baby.

However, the sudden change to formula feed would also come up with the number of recommendations. For example, formula feed applied should be equal with certain means like that of a giving milk supply formula or other means which are best recommended by a doctor for babies. It also has to be done through the bottle and its corresponding impact on the baby in terms of prevention from infection or having a sound increase in weight and other factors from time to time because the way babies react after to formula-fed is different from one another. In some cases, it is positive while in some cases it is negative. These have to be strictly followed. In this case, as well, one recommendation area in terms of evidence-informed practice is mandatory in this means that she has to seek for advice about when she can resume breastfeeding her baby (Yu et al., 2019).

Approaches to Implement Evidence Into Practice and Sustain Changes

There are several important factors of concern that consider the substitute of breastfeeding by formula feed feeding and why it is essential under certain conditions and effective substitute. For example in this case of my aunt’s baby also, formula feed had to be adopted at a later stage even though she was breastfeeding at a substantially good condition initially. However, because of her health concerns as well as because of the baby’s health concerns, the doctor recommended at a later stage about referring to formula feed formula for development in the neonatal stage and it is the cost-effective strategy that has chances of reducing disease or burdens fro premature or infants. However, there are certainly best practices and target barriers which also have to be understood by formula feeding a baby (Nandakumar et al., 2020).

For example, formula feeding should be done to the right extent and there should not be an overdose. Mothers have to check whether any visible benefit can be checked out of formula feeding or not. Formula feeding uses interventions that are to be checked for modifying the barriers in case there is any bad issue from formula feeding to any baby and all such limitations of problems of immediately reporting to the doctor who is under concern have to check. The doctor who is looking into the case of that baby has to intervene. The ability to grow disease infections may retard after formula feeding.

It depends on one to another and this has to be given special concern. It has to be checked how far the baby can develop itself after formula feeding is done on the baby. Such means of support can help the baby, the mother, as well as the overall system in the baby, can suffer from low birth weight problem or prevention from being hospitalized for several other problems. In the current case also the baby should not be hospitalized due to some diseases or rather a fatal condition at this stage because every by hospitalizing the baby, where everyone is suffering from the coronavirus Pandemic, it is not safe according to me to put up that little child in hospital. Therefore to avoid that, it is to ensure that he gets the right formula feed to survive this condition and also grow well (Azad et al.,2018).

Conclusion on Clinical Practice 

The report has dealt with several factors to understand and formulate a comparative view about whether breast milk is essential or hybrid milk feeding is essential for preterm babies. It is used in several processes utilizing article review using randomized control trial method and several other methods been adopted to understand more about the advantages of each process. In some, it has been shown that targeted feed volumes have shown better results to fight with substitute problems when breast milk is not available.

Again another means it has been shown that natural nutrition in the form of breast milk has helped to regain the birthplace of tolerance fight from infections and deal with the mortality issues that breast milk has been suggested in several ways. Again in terms of cost-effectiveness also, it has been shown that breast milk is better because one does not have to include on feed volumes and also on the treatment of individuals from the various means in the case when one is affected with infections. Again it has been several aspects where resources are limited and breast milk has also known improved take. Therefore the report has been well informed to understand the main issues of concern (Santonicola et al.,2017).

References for Clinical Practice 

Nandakumar, A., Pournami, F., Prabhakar, J., Nair, P. M. C., & Jain, N. (2020). Exclusive Breast Milk vs. Hybrid Milk Feeding for Preterm Babies-A Randomized Controlled Trial Comparing Time to Full Feeds. Journal of Tropical Pediatrics, 66(1), 38-45.

Buckle, A., & Taylor, C. (2017). Cost and cost-effectiveness of donor human milk to prevent necrotizing enterocolitis: systematic review. Breastfeeding Medicine, 12(9), 528-536.

Coutsoudis, I., Adhikari, M., Nair, N., & Coutsoudis, A. (2011). Feasibility and safety of setting up a donor breastmilk bank in a neonatal prem unit in a resource limited setting: An observational, longitudinal cohort study. BMC Public Health, 11(1), 356.

Azad, M. B., Vehling, L., Chan, D., Klopp, A., Nickel, N. C., McGavock, J. M., ... & Taylor, M. S. (2018). Infant feeding and weight gain: separating breast milk from breastfeeding and formula from food. Pediatrics, 142(4), e20181092.

Grummer-Strawn, L. M. (2018). Clarifying the definition of breast-milk substitutes. Journal of pediatric gastroenterology and nutrition, 67(6), 683.

Martin, C. R., Ling, P. R., & Blackburn, G. L. (2016). Review of infant feeding: key features of breast milk and infant formula. Nutrients, 8(5), 279.

Yu, F., Cao, B., Wen, Z., Li, M., Chen, H., & Xie, G. (2019). Is Donated Breast Milk Better Than Formula for Feeding Very Low Birth Weight Infants? A Systematic Review and Meta‐Analysis. Worldviews on Evidence‐Based Nursing, 16(6), 485-494.

Santonicola, S., De Felice, A., Cobellis, L., Passariello, N., Peluso, A., Murru, N., ... & Mercogliano, R. (2017). Comparative study on the occurrence of polycyclic aromatic hydrocarbons in breast milk and infant formula and risk assessment. Chemosphere, 175, 383-390.

Lee, J. Y., & No, S. H. (2018). Effects of Breastfeeding Interventions Program on Breastfeeding for Premature babies: A Systematic Review and Meta-analysis. Korean Parent-Child Health Journal, 21(1), 50-60.

Gallegos-Martínez, J., & Reyes-Hernández, J. (2018). Maternal representations about health and breastfeeding of the premature child in hospitals with and without baby and mother friendly hospital initiative certification. Acta Pediátrica de México, 39(2), 99-108.

(Gallegos-Martínez & Reyes-Hernández 2018)

Rahman, S., Ghribi, A., Alabdulghani, M. H., & Gad, M. T. (2019). Perforated Bowel after Obstruction in a Neonate with Milk Curd Syndrome following Ready to Feed Infant Formula. Dr. Sulaiman Al Habib Medical Journal.

Ozalkaya, E., Aslandoğdu, Z., Özkoral, A., Topcuoğlu, S., & Karatekin, G. (2018). Effect of a galactagogue herbal tea on breast milk production and prolactin secretion by mothers of preterm babies. Nigerian journal of clinical practice, 21(1), 38-42.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help.

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