Effects of breastfeeding as opposed to formula feeding

Identification of the Clinical Nursing Concern

Throughout the most of human history, breastfeeding has always been the norm with only a very small number of patient not being breastfed for a variety of reasons. However, over the last 100 years, the world has been struggling with periods of time when breast feeding was not well supported by the medical field, communities or individuals. Indeed, there is an ongoing struggle to increase support for breastfeeding. This has been complicated by issues of historical exploitation of poor women as wet nurses for wealthy families, support and acceptance of women in the workplace, social status, and body fashion/image (Rolfes, Pinna & Whitney, 2021). Towards the end of the 19th century, unsafe artificial feeding of babies was considered a public health concern since it was associated with infant mortality. Nursing care promoted breast feeding and use of pasteurized cows’ milk in order to address this concern. At the beginning of the 20th century, artificial baby milk was marketed by formula companies as a safe alternative to pasteurized cows’ milk (Sizer & Whitney, 2022)Effects of breastfeeding as opposed to formula feeding.

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Generally, the first year of a baby’s life is very important as the baby more than triples the total body weight during that time, with much of that gain coming from milk intake. At this time, milk intake is preferred as it is inexpensive, readily available and least likely to cause an allergic food reaction. Besides that, babies readily accept the taste of breast milk. Additionally, breast milk improves immunity thereby helping the babies to fight infection. Although breast milk is the ideal food for infants, it is not unusual for infant formula to replace breast milk. Still, there is a concern that formula is not a perfect replacement for breast milk as it fails to confer as much immunity as breast milk on the infants (Smolin & Grosvenor, 2019).

Granting that breast milk is preferred for infants owing to its benefits. Firstly, breast milk has a balanced nutrient composition that meets the nutrient needs of the infant and does not irritate the intestinal tract. Secondly, breast milk improves immunity as it contains infection-fighting antibodies from the mother. This helps in reducing the infant risk of many chronic and acute infections. Thirdly, it contains high cholesterol content that helps to promote brain growth and acts as building block for intestinal bile, vitamin D and hormones. Fourthly, breast milk is inexpensive. These benefits can be derived if the mother maintains good nutrition and takes nutritional supplements as recommended, such as mineral and vitamin supplements (Whitney & Rolfes, 2019)Effects of breastfeeding as opposed to formula feeding.

Besides being beneficial to the infant, breast feeding is beneficial to the mother. In helps the mother to lose weight as about 500 calories are lost every day through breastfeeding. Also, breastfeeding reduces the risk of postpartum bleeding, as well as reducing the risk of breast and ovarian cancer in breastfeeding mothers. Furthermore, it facilitates emotional and hormonal bonding between the baby and mother (Langley-Evans, 2021). In contrast, infant formula has a risk of eliciting an allergic reaction. Infants who develop allergy to a formula may have symptoms of skin rash, diarrhea, vomiting, nausea, crying after feeding, and irritability when fed using the formula. This does not imply that infant formula is not beneficial. In fact, it is beneficial when there is no enough breast milk or if for some reason the mother is unable to breast feed. Still, it is important to note that infant formula is a substitute that is less beneficial when compared to breast milk (DeBruyne & Pinna, 2020).

Given this awareness, this research seeks to explore the benefits of breast feeding over infant formula in improving the baby’s immune function. The PICOT question is presented that: In infants (P), how does breastfeeding (I) compared to infant formula feeding (C) affect immune function (O) within six months (T)? Effects of breastfeeding as opposed to formula feeding

Search Process

A systematic literature search was conducted as a critical component of the systematic review process. In this case, a systematic search was conducted for peer-reviewed research studies that relate to breastfeeding, infant formula and immune function as the key word searches. The instructions for the search were infants and mothers as the patient group, and immunity as the condition. The search was conducted on PubMed, Medline, CINAHL, and Cochrane databases. The four databases were considered appropriate and relevant because they contain peer-reviewed research articles on nursing research (Harvey & Land, 2017).

The inclusion criteria for articles were publications from 2018 onwards, as this is material published in the last five years thus making it current information. The population of interest is infants with the review focused on fed with breast milk and formula. The intervention was the effect of breast milk on the infant’s immune function. The comparison was infant formula. The outcome was effect on the infant’s immune function. The exclusion criteria were articles published in language other than English. Also, it excluded publications only in abstract form, and non-peer reviewed publications (Harvey & Land, 2017).

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The results of the database searches were evaluated and relevant publications selected according to the eligibility criteria using a two-step process. The first step evaluated the title and abstract to ascertain the eligibility of retrieving the full text. The second step screened the fill text by analyzing whether then met the inclusion and exclusion criteria (Harvey & Land, 2017)Effects of breastfeeding as opposed to formula feeding.

Because the study has a heterogeneous focus, the outcome measures and inclusion criteria of the included research articles were thematically analyzed. A narrative account of the results presented in each article explored the methodological quality thus evaluating the studies by weight of evidence. The results of the search process were six articles that met the inclusion criteria, three of them being primary studies while three were secondary studies (Harvey & Land, 2017).

Literature Review

As earlier indicated, the results of the literature search identified six peer-reviewed journal articles that met the inclusion criteria. Firstly, Fonvig et al. (2021) presents the results of a primary research study on how oligosaccharides found in human milk modulate fecal microbiota and are safe for helping overweight children to lose weight. Using a randomized controlled trial methodology that recruited 75 children, the study revealed that human milk contains beneficial bacteria. With this awareness, the researchers sought to determine if human milk modulates intestinal microbiota, is safe and has good digestive tolerance. The results of the study revealed that bifidobacteria increased significantly for the participants using human milk while those using placebo did not have any significant change in microbiota. Also, a review of biochemical markers indicated that there are no safety concerns, and there are no issues of digestive tolerance when using human milk. The author conclude that human milk is beneficial for children as it increases bifidobacteria amounts, and is safe and well tolerated, thus making it an ideal food choice for improving immune response.

Fonvig et al. (2021) adopts a primary research approach that engages participants to collect data thereby collecting data directly. This ensures that the information is specific, relevant and up-to-date. However, this article has the weakness of engaging children participants between 6 and 12 years of age. This is a weakness since the present study focuses on infants as the population of interest, thus making it difficult to generalize the results Effects of breastfeeding as opposed to formula feeding.

Secondly, Narayanaswamy et al. (2022) presents the results of a primary research study that explores the transfer of immunity between a mother and infant through breast milk. It postulates that mothers who have antibodies and cytokines against Covid-19 from mRNA vaccination are able to pass on the immunity to breast milk. The study enrolled 30 lactating mothers who had been vaccinated for Covid-19 using mRNA vaccine. Samples of the breast milk were collected before vaccination, at 2-3 weeks after the first vaccine dose, and 3 weeks after the second vaccine does. Also, blood samples were collected from the women. Besides that, stool samples were collected from breast fed infants at 21 days after their mothers had received the second dose of the vaccine. The collected samples were tested. The results revealed that breastfed infants had higher amounts of anti-RDB IgG and anti-RBD IgA. This was considered a side effect of the mother being vaccinated. The authors concluded that breast milk helps to improve immune response in infants by passing on antibodies thereby conferring passive immunity.

Narayanaswamy et al. (2022) adopts a primary research approach in which samples are collected from a sample of the population of interest then tested. This allows the researchers to collect relevant, up-to-date information that is specific to the study objectives. Still, this study has the weakness of exploring immune response focusing on a health concern for which the lactating mother is vaccinated. Vaccination increases the amount of antibodies in the body, at least for a short period of time such as weeks or months. This raises questions about whether other antibodies can be passed on through milk and if they would be enough to confer passive immunity.

Thirdly, Wood et al. (2021) presents the results of a primary research study that explores the health benefits of breast feeding on infants, particularly promoting early neonatal regulatory T-cell expansion and immune tolerance of non-inherited maternal antigens. The authors concede that breast feeding is associated with lower incidences of autoimmune disorders, obesity, asthma, and childhood infections. To understand how breastfeeding affects the neonatal immune system, the study recruited a cohort of 38 neonates born by caesarian section. The study evaluated the immune response of the participants. The results of the study revealed that exclusive breastfeeding significantly increases proportion of T-cells and reduction in inflammatory cytokine production when compared to exclusive feeding on milk formula. The study concluded that breastfeeding drives maturation of T-cells and improves tolerance of neonates towards non-inherited maternal antigens Effects of breastfeeding as opposed to formula feeding.

Wood et al. (2021) adopts a primary research approach in which data is collected by directly engaging the participants. This approach ensures that the research is relevant, up-to-date and specific to the set objectives. Still, it has a weakness in only recruiting neonates born through caesarian section. This makes it unclear if the same results would be reported for neonates born through normal birth.

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Fourthly, Harmancıoğlu and Kabaran (2019) presents the results of a secondary research study that explores the role of breast milk in early development of immune system and long-term health of infants. The authors concede that breast milk is the best source of nutrition and energy for infants as it helps them have ideal growth and development. In addition, they note that breast milk contains bioactive compounds that protect the infant against infection and contribute to immune maturation. Besides that, the article explains that breast milk is dynamic as its composition changes over time. This is ideal as the child has different nutritional requirements at every stage of growth, and breast milk is able to meet the needs of the infant through the growth stages. The study concludes that breast milk protects infants from infection, strengthens their immune systems and provides protective effects against autoimmune and allergic diseases in later life Effects of breastfeeding as opposed to formula feeding.

Harmancıoğlu and Kabaran (2019) adopts a secondary research approach in which data is collected from other publications. This is a convenient strategy for synthesizing relevant information presented in other publications. Still, it has the weaknesses of providing broader results that are not specific to the research objectives. Another weakness is that it does not present current information. Yet another weakness is that the study on focuses on breast milk while ignoring formula milk.

Fifthly, Almeida et al. (2021) presents the results of a secondary research study that explored the bioactive compounds in infant formula and how they affect the nutrition and health of infants. The authors acknowledge that milk formulas are intended to replace or supplement human breast milk, and questions how it affects infants. The authors concede that formulas have optimized compositions intended to mimic the effects of breast milk. Still, questions remain whether the novel bioactive ingredients included in breast milk have the same effects as breast milk.

Almeida et al. (2021) adopts a secondary research approach that conducts a systematic review of relevant publications. This allows the researchers to convenient collect the relevant data/information on infant formula. Although this approach is convenient, it has the weakness of not presenting current results, and focusing on milk formula.

Finally, Goldman and Chheda (2021) presents the results of a secondary research study that explored the historical perspective on how human milk affects the immune system. The authors acknowledge that human milk contains many immunological agents that have been specifically structured and formulated to protect infants. The human milk has been through millions of years in evolution so that it is the best food for meeting the nutrition and health needs of infants as they grow. The protection that breast milk offers to infants extends to after the child has grown up and topped drinking the milk. Overall, the study concluded that breast milk improves the immune response of infants Effects of breastfeeding as opposed to formula feeding.

Goldman and Chheda (2021) adopt a secondary research approach that systematically reviews relevant publications. Still, this is a weakness as the information is not current and not matched to our objective as it does not compare breast milk performance to formula milk performance.

Synthesis of the Articles

Studies of infant feeding and effect on immune function present comparable results. Although Fonvig et al. (2021) found that breast milk is safe, well tolerated, and contains beneficial bacteria that improve the health of children, it was unclear whether these results are applicable to infants. Narayanaswamy et al. (2022) explored whether mothers transfer antibodies to infants through breast milk, noting that vaccinated mothers can pass antigens breastfeeding infants thereby causing them to have acquired passive immunity, at least for a period of time. Wood et al. (2021) was more circumspect in revealing that breast milk promotes early neonatal regulatory T-cell expansion and immune tolerance of non-inherited maternal antigens, thus making it clear that breast milk improves infant immune response. Although Harmancıoğlu and Kabaran (2019) adopted a secondary research approach that brings into question where the results are current, it agrees with the other studies that breast immune improves infant immune response as it is specifically formulated to meet the changing needs of infants. Goldman and Chheda (2021) add to this awareness in revealing that breast milk has gone through millions of years of evolution in which it was tweaked to meet the nutrition and health needs of infants as they grow. While Almeida et al. (2021) does not focus on breast milk, it reveals that formula milk mimics breast milk by presenting similar effects on infants Effects of breastfeeding as opposed to formula feeding.

A review of the six articles reveals that they are a combination of primary research studies (three level I evidence) and secondary research studies (one level III evidence and two level V evidence) that explore the use of breast milk and formula milk, particularly their health effects. All the studies reveal that breastfeeding improves neonate immune function. Also, the studies reveal that formula milk contains active compounds designed to match the health functions of breast milk thus making the two comparable. The three level I evidence present current information as they directly engaged participants to collect data. This is a weakness in the one level III and two level V evidence as they use information from other publications and this information is not current. Another weakness of the six studies is that they do not compare how breast milk and formula milk affect the health of children. This is a significant shortcoming. However, the nursing intervention uses the results of the six studies to postulate that breastfeeding would be more effective in improving in improving neonate immune function when compared to formula feeding Effects of breastfeeding as opposed to formula feeding.

Recommendation and Conclusion

The six reviewed studies are unclear about the compared performance of breastfeeding and formula feeding in improving immune function of infants. However, five significant insights can be gleaned from the studies. Firstly, breast milk contains bioactive compounds that improve neonate immune function. Secondly, breast milk has been through millions of years of evolution in which it has turned more effective in improving the health and nutrition of infants. Thirdly, breast milk allows mothers to pass on antigens to infants thereby enabling them to gain passive immunity. Fourthly, breast milk is safe for infants. Finally, formula milk is designed to mimic breast milk. Since formula milk is designed to mimic breast milk, then it can be assumed that the performance of formula milk can only approach the performance of breast milk. As such, it is recommended that breast milk should be the first choice of food for infants. Formula milk should only be used as a supplement for breast milk or when breast feeding is not possible. Given this awareness, the conclusion can be drawn that breast milk is more beneficial for meeting the nutritional needs of children and improving their health, when compared to formula milk. Another conclusion is that breast milk is more beneficial for improving neonate immune function since the milk has bioactive ingredients that confer immunity on the infant, with the transfer of antigens from the lactating mother to the infant through the breast milk helping to improve immunity. Even if formula milk is similar to breast milk, no formula can match the agents of immunity and nutrients conveyed to infants through human breastmilk Effects of breastfeeding as opposed to formula feeding.

References

Almeida, C. C., Pereira, B. F., Leandro, K. C., Costa, M. P., Spisso, B. F., & Conte-Junior, C. A. (2021). Bioactive Compounds in Infant Formula and Their Effects on Infant Nutrition and Health: A Systematic Literature Review. International Journal of Food Science, vol. 2021, Article ID 8850080. https://doi.org/10.1155/2021/8850080

DeBruyne, L. K., & Pinna, K. (2020). Nutrition for Health and Health Care (7th ed.). Cengage Learning, Inc.

Fonvig, C. E., Amundsen, I. D., Vigsnaes, L. K., Sorensen, N., Frithioff-Bojsoe, C., Christiansen, M., … & Holm, J-C. (2021). Human milk oligosaccharides modulate fecal microbiota and are safe for use in children with overweight: a randomized controlled trial. Journal of Pediatric Gastroenterology and Nutrition, 73(3), 408-414. https://doi.org/10.1097/MPG.000000000003205

Goldman, A. S., & Chheda, S. (2021). The Immune System in Human Milk: A Historic Perspective. Annals of Nutrition and Metabolism, 77, 189-196. https://doi.org/10.1159/000516995

Harmancıoğlu, B. and Kabaran, S. (2019). Breast Milk: Its Role in Early Development of the Immune System and Long-Term Health. Open Journal of Obstetrics and Gynecology, 9(4), 458-473. https://doi.org/10.4236/ojog.2019.94045

Harvey, M., & Land, L. (2017). Research Methods for Nurses and Midwives: Theory and Practice. SAGE Publications, Inc

Langley-Evans, S. (2021). Nutrition, Health and Disease: A Lifespan Approach (3rd ed.). John Wiley & Sons, Inc Effects of breastfeeding as opposed to formula feeding.

Narayanaswamy, V., Pentecost, B. T., Schoen, C. N., Alfandari, D., Schneider, S. S., Baker, R. B., & Arcaro, K. F. (2022). Neutralizing Antibodies and Cytokines in Breast Milk After Coronavirus Disease 2019 (COVID-19) mRNA Vaccination. Obstetrics & Gynecology, 139(2), 181-191. https://doi.org/10.1097/AOG.0000000000004661

Rolfes, S. R., & Pinna, K., & Whitney, E. (2021). Understanding Normal and Clinical Nutrition (12th ed.). Cengage Learning, Inc.

Sizer, F., & Whitney, E. (2022).  Nutrition: Concepts and Controversies (16th ed.). Cengage Learning, Inc.

Smolin, L. A., & Grosvenor, M. B. (2019). Nutrition: Science and Application (4th ed.). John Wiley & Sons, Inc.

Whitney, E., & Rolfes, S. R. (2019). Understanding Nutrition (15th ed.). Cengage Learning, Inc.

Wood, H., Acharjee, A., Pearce, H., Quraishi, M. N., Powell, R., Rossiter, A., … & Toldi, G. (2021).  Breastfeeding promotes early neonatal regulatory T-cell expansion and immune tolerance of non-inherited maternal antigens. Allergy, 76(8), 2447-2460. https://doi.org/10.1111/all.14736

Outcome: Each student engages in the scholarly exploration of a relevant clinical nursing concern and ultimately decides whether an evidence-based practice (EBP) change is indicated or whether more research should be undertaken Effects of breastfeeding as opposed to formula feeding.

Part 1: Identification of the Clinical Nursing Concern

Identify a nursing issue/problem that needs improvement for clinical nursing practice to improve patient outcomes. Clearly explain and provide support for the significance of this issue for patients and families, for nurses, and for healthcare in general.  In this section, include information such as: What is the condition? Who is affected by this condition/issue?  What is the prevalence/incidence of this condition?  What is the seriousness of this condition: its associated complications/morbidity and mortality? What are the costs associated with preventing/treating this condition? How is this issue relevant for nurses/the nursing profession? Present a brief discussion (a few sentences in one paragraph) of how/why the selected intervention is being proposed to test as a solution in your PICOT question.  This section of the paper concludes with a clearly written, preapproved PICOT question.  The PICOT question should be of the intervention/therapy format. You must pose a question that is testing an intervention compared to either standard care or an alternate intervention. The question for this paper must be the same question that was approved by your faculty in the beginning weeks of the course. This introduction section of the paper should be approximately 2 pages in length. This section of the paper should be written objectively.  Avoid the use of “I/we”Effects of breastfeeding as opposed to formula feeding.

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Part 2: Review of the Literature

Search the scholarly literature to ascertain evidence for best practice (i.e., what is already known) about the selected issue. Keep track of the databases and key words used.  A minimum of 4 primary articles and 1 systematic article must be included: a total of 5 articles. These articles must be published in nursing journals within the last 5 years. Most should be quantitative studies; only one can be a qualitative study and one must be a systematic review.  One article may describe research conducted outside of the United States.  Studies that examine the same intervention but in a different condition may be used with permission of faculty. Example: You are comparing a video discharge teaching method to usual written discharge teaching methods for COPD patients. You find a very good randomized controlled trial study on video discharge teaching compared to standard care written materials; however, the study is conducted on people with asthma, not COPD. You should discuss use of this article with your faculty. The search process paragraph should describe the methodology of the search process used for retrieving the articles. Include factors such as the databases searched, keywords used in search, and range of dates. Describe how you selected the articles from those you initially found when searching. This section of the paper should be written objectively.  Avoid the use of “I/we”Effects of breastfeeding as opposed to formula feeding.

  1. Present the evidence in two modes.
    1. Complete the Johns Hopkins Individual Evidence Summary Tool.
      1. To complete this Individual Evidence Summary Tool, students need to complete the Research Evidence Appraisal Tool for each of the 5 articles that will be used in the EBP paper. The 5 Research Evidence Appraisal Forms are to be uploaded with the Individual Evidence Summary Tool. Students will attach the completed Individual Evidence Summary Tool as a table to the end of the EBP paper. The original Individual Evidence Summary Tool and the 5 Research Evidence Appraisal Tools will be submitted prior to the EBP Paper. Please include the Individual Evidence Summary Tool with your EBP Paper submission.  If indicated, please provide an updated/corrected Individual Evidence Summary Tool with the EBP Paper.
  1. Write a narrative review of the literature of the articles within the body of the paper. This section of the paper should include:
    1. Discussion of each of the 5 articles in two paragraphs. This discussion should concisely, yet comprehensively, present the essential information of each article. Typically, two paragraphs are needed per article.

Paragraph 1 includes:

  • Study purpose
  • Study design
  • Level of evidence according to Johns Hopkins Hierarchy of Evidence Guide
  • Sampling essential information
  • Description of the intervention
  • Method of data collection

Paragraph 2 includes:

  • Study findings (include p values for significant findings)
  • Limitations of the study
  • Implications for practice/research/education Effects of breastfeeding as opposed to formula feeding

Part 3: Synthesis of the Articles

Write a summary section that provides a synthesis of the evidence based on the five articles.  Compare strengths and weakness of the articles. Explain what is known (similar findings, sample sizes, research designs, strength of evidence- according to the Johns Hopkins Hierarchy of Evidence Guide, conclusions) and what remains unknown (researchable due to inconsistent findings, variable research designs, small sample sizes, etc.). Reference each of the articles reviewed within the discussion to provide support for your conclusions about evidence.

Part 4: Recommendation and Conclusion

Present your recommendation for either: 1) a change that needs to be made to translate the evidence into practice (you decide there is adequate evidence); or, 2) recommend an area for more research to be conducted (you decide the evidence is not adequate for practice).  Give a brief (1 to 2 paragraphs) rationale for your decision.  You should provide 2 approaches/strategies for whatever you recommend (either more research or implement an EBP project). The strategies should be feasible and within the scope of nursing Effects of breastfeeding as opposed to formula feeding.

Part 5: Style and Format

Paper should be written using the 7th ed. of the APA Style Manual with attention to title page, headings, in-text citations, references, and other style elements.  An abstract is not required.   Students must attend to scholarly writing with attention to spelling, grammar, and sentence structure.  Example: “Its” indicates possession and it’s is the contraction form for “it is”. Be sure to proofread your paper – spell check does not pick up errors when words are correctly spelled but incorrectly used. The EBP Paper should be 10-12 pages, excluding title page, reference page, and Individual Evidence Summary Tool.

Suggested EBP Paper Format

Identification of the Clinical Nursing Concern

  • Description of the problem
  • Rationale for proposing the selected clinical nursing intervention
  • Prevalence, burden to patients, families, healthcare system;
  • Relevance of topic to NURSING
  • PICOT question

Search Process

  • Search process (databases, keywords, range of dates used in search process)
  • Rationale for how articles were chosen

Literature Review

  • Discuss each article in depth and comment on its strengths and weaknesses.
  • Utilize the above two paragraph format for each article.

Synthesis of the Articles

  • Compare strengths and weaknesses of the five articles.
  • Synthesize what was found in all of the 5 articles, e.g. similar findings, populations, conclusions, etc.
    • Comment on the strength of the evidence (according to Johns Hopkins Hierarchy of Evidence Guide) to support (or not to support) your nursing intervention.

Recommendation and Conclusion

  • Make a recommendation for a change in nursing practice or the need for more research. Provide a rationale for your decision.

References

**Please refer to the EBP paper grading rubric prior to your final submission of the EBP paper.  All final papers must be submitted by students via Canvas with Turnitin enabled via the assignment. The Turnitin Similarity Score must be 20% or less. A sample paper is provided in Modules for your reference; however, attention to the EBP Paper Guidelines, EBP Grading Rubric, and 7th edition of APA Style is paramount Effects of breastfeeding as opposed to formula feeding