Part 4A: Critical Appraisal of Research
Skin Contact and Success of Breastfeeding Essay Paper
| Full APA formatted citation of selected article. | Article #1 | Article #2 | Article #3 | Article #4 |
| Cleveland, L., Hill, C.M., Pulse, W.S., DiCioccio, H.C., Field, T., & White-Traut, R. (2017). Systematic review of skin-to-skin care for full-term, healthy newborns. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 46(6), 857-869. https://doi.org/10.1016/j.jogn.2017.08.005 | Ghojazadeh, M., Hajebrahimi, S., Pournaghi –Azar, F., Mohseni, M., Derakhshani, N., & Azami-Aghdash, S. (2019). Effect of Kangaroo Mother Care on successful breastfeeding: A systematic review and meta-analysis of randomised controlled trials. Reviews on Recent Clinical Trials, 14(1), 31-40. https://doi.org/10.2174/1574887113666180924165844 | Karimi, F.Z., Miri, H.H., Khadivzadeh, T., & Maleki-Saghooni, N. (2020). The effect of mother-infant skin-to-skin contact immediately after birth on exclusive breastfeeding: A systematic review and meta-analysis. Turkish-German Gynecological Association, 21(1), 46-56. https://doi.org/10.4274/jtgga.galenos.2019.2018.0138
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Karimi, F.Z., Sadeghi, R., Maleki-Saghooni, N., & Khadivzadeh, T. (2019). The effect of mother-infant skin to skin contact on success and duration of first breastfeeding: A systematic review and meta-analysis. Taiwanese Journal of Obstetrics and Gynecology, 58(1), 1-9. https://doi.org/10.1016/j.tjog.2018.11.002
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| Evidence Level *
(I, II, or III) |
Level I (systematic review) | Level I (systematic review and meta-analysis) | Level I (systematic review and meta-analysis) | Level I (systematic review and meta-analysis) |
| Conceptual Framework
Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).
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The conceptual framework of the study is not explicitly stated but implied. It is that there is a beneficial bond that develops between mammalian offspring and their mothers in infancy if the two maintain close skin-to-skin contact from birth. | The conceptual framework is implied. The bond between mother and child that develops as a result of skin-to-skin contact influences the pituitary to produce more prolactin for lactation. | The conceptual framework in this study too is implied. It is also that the pituitary neuro-hormonal pathway responsible for prolactin production and lactation is activated more when a close bond created by skin-to-skin contact develops. | The implied conceptual framework is that Kangaroo care helps in stimulating the mother psychologically to produce more milk that then helps with uneventful breastfeeding as the baby has enough milk. |
| Design/Method
Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). |
This was a systematic review of studies about skin-to-skin care of term babies and its benefits. The inclusion criteria were that studies needed to have the terms ‘kangaroo care,’ ‘skin-to-skin contact,’ and ‘full term newborns.’ The exclusion criterion was published status in a language other than English. Skin Contact and Success of Breastfeeding Essay Paper | A systematic review and meta-analysis of randomized controlled trials. For inclusion studies needed to have the search terms “kangaroo mother care,” “skin-to-skin,” and “breastfeeding.” | A systematic review and meta-analysis of RCTs.
Inclusion criteria: RCTs, mother-infant skin-to skin contact, breastfeeding. |
A systematic review and meta-analysis of RCTs.
Inclusion criteria: RCTs, publication in Persian and English. Exclusion criterion: Publication in any other language apart from Persian and English. |
| Sample/Setting
The number and characteristics of patients, attrition rate, etc. |
The setting was the research databases CINAHL, PubMed, & Scopus.
The sample of studies was n=90. All these studies met the inclusion criteria set. |
The setting was the library and specifically the databases Embase, PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Google Scholar.
Sample of studies reviewed: n=20 Sample of subjects in total (neonates): n=2,842 |
Setting is the library in research databases.
Sample of studies: n=12 5 studies done in Iran, 3 studies in India, and the remaining 4 studies in Italy, Spain, the USA, and Pakistan. |
The setting is research databases in the library.
Sample of studies included: n=9 Sample of participants total: n=1,150 (597 intervention and 553 control) Studies must have been published between the year 2000 and 2017. |
| Major Variables Studied
List and define dependent and independent variables |
Independent variable: Skin-to-skin care
Dependent variable: successful breastfeeding |
Independent variable: Skin-to-skin care
Dependent variable: successful breastfeeding |
Independent variable: Skin-to-skin care
Dependent variable: successful breastfeeding |
Independent variable: Skin-to-skin care
Dependent variable: successful breastfeeding |
| Measurement
Identify primary statistics used to answer clinical questions (You need to list the actual tests done). |
Systematic review and feasibility reporting.
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· Mean scores
· Infant Breast-Feeding Assessment Tool (IBFAT) |
· Egger’s & Begg’s tests
· I2 · PRISMA checklist |
· Mean differences
· Odds ratios · Comprehensive meta-analysis (CMA) |
| Data Analysis Statistical or
Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data). |
· 33 articles on skin-to-skin holding only
· 7 articles on infant massage · Rest on a mixture of kangaroo and other methods |
· Mean scores of IBFAT statistically significant (p<0.05)
· Inter-groups difference statistically significant (p<0.05) |
· Heterogeneity of factor of effects 16.2% (p<0.303)
· P values for Egger’s and Begg’s tests 0.168 and 0.386 respectively |
· Mother-infant SSC has positive effect on first breastfeeding (p=0.00)
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| Findings and Recommendations
General findings and recommendations of the research |
Skin-to-skin care (kangaroo care) is beneficial and recommended for all term babies. | Kangaroo mother care (KMC) is superior with regard to breastfeeding success. | Mother-infant skin-to-skin contact (SSC) is associated with a higher rate of exclusive breastfeeding. | Mother-infant SSC is beneficial and increases the rate of successful breastfeeding. It is therefore recommended. |
| Appraisal and Study Quality
Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research?
What is the feasibility of use in your practice? |
This study is important for improving postnatal care of mother and child.
The strength of this study is that it is a level I study with the best evidence. Its limitation is that it might have left out some pertinent evidence. There are no foreseeable risks associated with the implementation of the study recommendations. The study findings are feasible as the only thing needed is skin-to-skin contact. |
The study improves EBP.
Its strength is in its level I status. Its limitation is that it is a filtered study and not original research. There are no risks associated with implementing the findings. The findings are feasible in practice. |
The study is important for EBP.
Its strength is that it is a level I evidence study. The limitation is that it is not primary research. There are no risks associated with applying the findings in practice. It is feasible to apply the findings to clinical practice. |
The study adds to the knowledge needed for evidence-based practice.
The strength is that it provides the highest level of evidence. The limitation is that it is not primary research. There is no foreseeable risk in applying the findings to practice. Application of the findings seems very feasible as nothing really is needed except for the mother to put the baby in contact with her skin. |
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Key findings |
Skin-to-skin care or kangaroo care is beneficial for the infant including in breastfeeding. | Kangaroo mother care (KMC) is superior with regard to breastfeeding success. | Mother-infant skin-to-skin contact (SSC) is associated with a higher rate of exclusive breastfeeding. | Mother-infant SSC is beneficial and increases the rate of successful breastfeeding. The positive correlation is statistically significant. |
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Outcomes
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Better bonding between mother and child.
Improved lactation. Lower likelihood of postpartum depression. |
Better nutritional status of the neonate.
Production of more milk. |
Improvement in lactation
Higher quantities of milk A healthier child Better protection of the infant against childhood diseases. |
Faster growth and development
Fewer incidents of infant morbidity Greater love and affection for the child |
| General Notes/Comments | The study adds to evidence-based practice (EBP) knowledge. | This study helps in building up EBP knowledge. | This study builds EBP knowledge. | This study increases EBP knowledge used in clinical practice. |
References
Cleveland, L., Hill, C.M., Pulse, W.S., DiCioccio, H.C., Field, T., & White-Traut, R. (2017). Systematic review of skin-to-skin care for full-term, healthy newborns. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 46(6), 857-869. https://doi.org/10.1016/j.jogn.2017.08.005
Ghojazadeh, M., Hajebrahimi, S., Pournaghi –Azar, F., Mohseni, M., Derakhshani, N., & Azami-Aghdash, S. (2019). Effect of Kangaroo Mother Care on successful breastfeeding: A systematic review and meta-analysis of randomised controlled trials. Reviews on Recent Clinical Trials, 14(1), 31-40. https://doi.org/10.2174/1574887113666180924165844
Karimi, F.Z., Miri, H.H., Khadivzadeh, T., & Maleki-Saghooni, N. (2020). The effect of mother-infant skin-to-skin contact immediately after birth on exclusive breastfeeding: A systematic review and meta-analysis. Turkish-German Gynecological Association, 21(1), 46-56. https://doi.org/10.4274/jtgga.galenos.2019.2018.0138
Karimi, F.Z., Sadeghi, R., Maleki-Saghooni, N., & Khadivzadeh, T. (2019). The effect of mother-infant skin to skin contact on success and duration of first breastfeeding: A systematic review and meta-analysis. Taiwanese Journal of Obstetrics and Gynecology, 58(1), 1-9. https://doi.org/10.1016/j.tjog.2018.11.002 Skin Contact and Success of Breastfeeding Essay Paper