The use of haemostatic agents can provide life‐saving treatment for patients who suffer from massive bleeding in both prehospital and intraoperative conditions. However, there are still urgent demands for novel haemostatic materials that exhibit better haemostatic activity, biocompatibility, and biodegradability than existing products. In the present study, we aim to evaluate the feasibility of new wound dressing, RapidClot, for treating uncontrolled haemorrhage through a series of in vitro assessments to determine the swelling ratio, clotting time, enzymatic degradation, haemolytic activity, cytotoxicity, cell proliferation, and migration. The results indicated that the RapidClot revealed better water adsorption capacity and shorter blood clotting time (132.7 seconds) than two commercially available haemostatic agents Celox (378.7 seconds) and WoundSeal (705.3 seconds). Additionally, the RapidClot dressing exhibited a similar level of degradability in the presence of hyaluronidase and lysozyme as that of Celox, whereas negligible degradation of WoundSeal was obtained. Although both Celox and RapidClot revealed a similar level in cell viability (above than 90%) against NIH/3 T3 fibroblasts, improved cell proliferation and migration could be obtained in RapidClot. Taking together, our results demonstrated that RapidClot could possess a great potential for serving as an efficient healing dressing with haemorrhage control ability.
Autologous breast reconstructions using deep inferior epigastric perforator (DIEP) flaps create a large incision, presenting an opportunity for surgical site complications. In this pilot study, we aimed to examine outcomes in DIEP donor site incisions managed with standard dressings (control; n = 5) or closed incision negative pressure therapy (ciNPT; n = 5). We observed no significant differences between group age, body mass index, and past medical history. Both treatment groups had a similar duration of hospital stay, the number of blood transfusions, and pain scores on postoperative day 2 (P > .05). There was a trend of higher drainage (P = .251) and shorter time to incision healing (P = .067) in the ciNPT group than the control though the difference was not statistically significant. We did observe a significant improvement in scar pigmentation, vascularity, and pliability at 3, 6, and 12 months post‐surgery in the ciNPT group compared with control (P < .05). No surgical site complications were reported in the ciNPT group within the follow‐up period. In the control group, one patient developed wound edge fat necrosis requiring reoperation. In conclusion, we report that ciNPT is a useful incision management system for DIEP flap donor site incisions and it facilitated improved scar quality over standard dressings in this small pilot study. Further clinical studies are required to assess the full advantages provided by ciNPT.
Geriatric population is increasing rapidly worldwide, and fragility fracture and complication following orthopaedic surgery in elderly people have now become major challenges for surgeons. Further studies are required to identify potentially modifiable factors associated with surgical site infection (SSI) in geriatric patients. This retrospective, multicenter study was conducted at four level I hospitals in China. During the 31‐month study period, a total of 2341 patients (65 years or older) underwent orthopaedic surgery and complete data were recorded from September 2015 to April 2018. Demographics information, medications and additional comorbidities, surgery‐related variables, and laboratory indexes were extracted and analysed. Receiver‐operating characteristic analysis was performed to detect the optimum threshold of continuous variables. Independent risk factors of SSI were identified by univariate and multivariate analyses. Finally, 63 patients suffered from wound infection within the follow‐up period, indicating a 2.7% incidence rate of SSI. Statistical results showed that open injury (odds ratio [OR], 9.5; 95% confidence interval [CI], 5.4‐16.7), American Society of Anesthesiologists classified III‐IV score (OR, 2.2; 95% CI, 1.3‐3.8), surgical duration of >132 minutes (OR, 2.9; 95% CI, 1.1‐5.0), serum albumin (ALB) of <36.4 mg/L (OR, 2.0; 95% CI, 1.6‐3.4), and blood glucose (GLU) of >118 mg/dL (OR, 3.1; 95% CI, 1.1‐5.3) were independent risk factors of postoperative SSI. With the application of sensitive and modifiable variables such as surgical duration and the levels of ALB and GLU, more geriatric patients with sub‐high risk of postoperative SSI could be identified.
Bacterial infection is a common wound complication that can significantly delay healing. Classical local therapies for infected wounds are expensive and are frequently ineffective. One alternative therapy is photodynamic therapy (PDT). We conducted a systematic review to clarify whether PDT is useful for bacteria‐infected wounds in animal models. PubMed and Medline were searched for articles on PDT in infected skin wounds in animals. The language was limited to English. Nineteen articles met the inclusion criteria. The overall study methodological quality was moderate, with a low‐moderate risk of bias. The animal models were mice and rats. The wounds were excisional, burn, and abrasion wounds. Wound size ranged from 6 mm in diameter to 1.5 × 1.5 cm2. Most studies inoculated the wounds with Pseudomonas aeruginosa or methicillin‐resistant Staphylococcus aureus. Eleven and 17 studies showed that the PDT of infected wounds significantly decreased wound size and bacterial counts, respectively. Six, four, and two studies examined the effect of PDT on infected wound‐cytokine levels, wound‐healing time, and body weight, respectively. Most indicated that PDT had beneficial effects on these variables. PDT accelerated bacteria‐infected wound healing in animals by promoting wound closure and killing bacteria.
We performed a meta‐analysis to evaluate the effect of home exercise programmes on body function after hip fractures. A computerised literature search was performed for published trials in PubMed, EMBASE, CENTRAL, and Cochrane Database of Systematic Reviews. Randomised trials were selected investigating home‐based exercise programmes vs usual care without home‐based exercise in hip fracture patients. Physical health (measured by Short Form 36), normal gait speed, fast gait speed, balance, instrumental activities of daily living (IADL), activities of daily living (ADL), lower extremity strength, leg strength in fractured leg, leg strength in non‐fractured leg, and Six‐Minute Walk Test (6MWT) per randomised patient were measured as outcomes. Eleven randomised controlled trials of 1068 subjects were included, 533 in the home‐based exercise group and 535 in the control group. The results of this meta‐analysis showed that the home‐based exercise programmes were not significantly associated with physical health, normal gait speed, fast gait speed, balance, IADL, ADL, and lower extremity strength but were significantly associated with leg strength in the fractured leg, leg strength in the non‐fractured leg, and 6MWT. The home‐based exercise programme had a positive, although not significant, effect on physical function after hip fracture. Low‐intensity training and poor patient compliance are unavoidable problems in home‐based exercise rehabilitation. A more task‐oriented rehabilitation programme might possibly yield more benefits for disability outcomes.
by Fiona G. Kouyoumdjian, Ji Yun Lee, Aaron M. Orkin, Stephanie Y. Cheng, Kinwah Fung, Tim O’Shea, Gordon GuyattWe aimed to compare 30-day readmission after medical-surgical hospitalization for people who experience imprisonment and matched people in the general population in Ontario, Canada. We used linked population-based correctional and health administrative data. Of people released from Ontario prisons in 2010, we identified those with at least one medical or surgical hospitalization between 2005 and 2015 while they were in prison or within 6 months after release. For those with multiple eligible hospitalizations, we randomly selected one hospitalization. We stratified people by whether they were in prison or recently released from prison at the time of hospital discharge. We matched each person with a person in the general population based on age, sex, hospitalization case mix group, and hospital discharge year. Our primary outcome was 30-day hospital readmission. We included 262 hospitalizations for people in prison and 1,268 hospitalizations for people recently released from prison. Readmission rates were 7.7% (95%CI 4.4–10.9) for people in prison and 6.9% (95%CI 5.5–8.3) for people recently released from prison. Compared with matched people in the general population, the unadjusted HR was 0.72 (95%CI 0.41–1.27) for people in prison and 0.78 (95%CI 0.60–1.02) for people recently released from prison. Adjusted for baseline morbidity and social status, hospitalization characteristics, and post-discharge health care use, the HR for 30-day readmission was 0.74 (95%CI 0.40–1.37) for people in prison and 0.48 (95%CI 0.36–0.63) for people recently released from prison. In conclusion, people recently released from prison had relatively low rates of readmission. Research is needed to elucidate reasons for lower readmission to ensure care quality and access.
by Nen-Chung Chang, Patrick Hu, Tien-Hsing Chen, Chun-Tai Mao, Ming-Jui Hung, Chi-Tai Yeh, Ming-Yow HungBackground
Acute myocardial infarction (AMI) complicates the clinical management of atrial fibrillation (AF) because coronary stenting may influence subsequent antithrombotic therapy. We investigated the use of a bare-metal stent (BMS) or a drug-eluting stent (DES) and associated outcomes in patients with pre-existing AF and first AMI undergoing percutaneous coronary intervention.Methods and results
Patient records in this population-based study were retrospectively collected from the Taiwan National Health Insurance Research Database. Using propensity score matching (PSM), we used 1:2 ratio stratification into a DES group of 436 and a BMS group of 785 patients from 2007 to 2011. The mean follow-up of matched cohorts was 1.7 years. After PSM, DESs were associated with lower rates of cardiovascular death (7.8%, hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.39–0.86 and 10.1%, HR 0.64, 95% CI 0.45–0.90) and primary composite outcome (35.1%, HR 0.76, 95% CI 0.63–0.92 and 48.2%, HR 0.81, 95% CI 0.69–0.96) than BMSs within the first year and at the end of follow-up. Although the greatest benefit from DESs, irrespective of the first- and second- generation DESs, implantation was observed within the first year only, this benefit was not observed in patients with diabetes, chronic kidney disease, or dialysis.Conclusions
Use of DESs in AMI patients with pre-existing AF is associated with significantly lower rates of cardiovascular death and primary composite outcome within the first year follow-up. However, the effect is not apparent in patients with diabetes, chronic kidney disease or dialysis.
To investigate workplace violence and nurse outcomes by comparing gender differences.
A secondary analysis of cross‐sectional survey data.
Workplace violence was measured by four items from the International Hospital Outcome Study. Nurse outcomes were measured by tools including burnout, job satisfaction and intention to stay. We used propensity score matching to generate a sociodemographic balanced dataset of 108 male and 288 female nurses. A hypothetical relationship model was derived from the affective events theory. Comparative statistics and multi‐group structural equation modelling were conducted to analyze gender differences. Data were collected in China from December 2013 – August 2014.
Male nurses reported more workplace violence from staff and less intention to stay than females. Besides finding the mediation of burnout sharing with female nurses consistent with the affective events theory, workplace violence was directly linked to less intention to stay in male nurses.
Male nurses experience more workplace violence by staff than female nurses. Besides responding emotionally to workplace violence like female nurses, male nurses also respond behaviourally.
What problem did the study address? Gender differences in workplace violence and its relationship to nurse outcomes. What were the main findings? Male nurses experienced more workplace violence than female nurses, linked directly to less intention to stay. Workplace violence linked to less job satisfaction and intention to stay in nurses was mediated by burnout. Where and on whom will the research have impact? Gender‐based prevention of and coping with workplace violence should be included in nursing training.
To explore the child‐rearing experiences of immigrant mothers and their concerns about children's home environments in the contexts of transnational marriage families and non‐native culture.
Immigrant mothers are often disadvantaged by a relative lack of information on and access to children's healthcare, but little research exists on the experiences of mothers in transnational marriage families as they attempt to provide a secure home environment while navigate an unfamiliar culture.
A descriptive phenomenological research design based on intuition was employed to explore immigrant mothers’ unique lived reality through their subjective experiences and perceptions.
Semi‐structured interviews with 15 immigrant mothers from 15 transnational marriage families were conducted between May 2016–February 2017. Narratives were analyzed using the descriptive phenomenological method because it permits systematic discovery of the lived experiences from the perspective of the study's participants.
Three major themes were identified: (a) striving to maintain a secure home for children; (b) suffering and struggling with difficulties; and (c) trying to overcome difficulties and build an adequate family environment. The essential, prevailing concept of immigrant mothers’ experience in child‐rearing was identified as ‘Where my child is, is home.’
Immigrant mothers bond emotionally and physically to their new land via their children. Their child‐raising experiences are interwoven with their roles in their new familial and cultural homes.
Immigrant brides often become mothers soon after marrying to continue their husbands’ family line. Understanding their unique child‐rearing experiences and challenges in providing a secure home in a non‐native culture will help nurses provide effective care. Study results will benefit paediatric/family nurses in any setting where care for transnational marriage families is provided, those families themselves, public policymakers and future researchers.
To determine whether the virtual reality as a distracting intervention could reduce pain and fear in school‐age children receiving intravenous injections at an emergency department.
An intravenous injection is the most common invasive procedure that paediatric patients encounter in emergency department. School‐age children seldom show their fear or discomfort during the procedure which may be ignored.
A randomised controlled trial was conducted from December 2017–May 2018 and performed according to the CONSORT guidelines.
One hundred and thirty‐six children aged 7–12 years were randomly allocated to receive either a routine intravenous injection procedure or one with an immersive virtual reality experience. Children were asked to rate their pain and fear along with their caregivers and nurses on the Wong–Baker FACES Pain Rating Scale and Children's Fear Scale, respectively. The time required for successful intravenous insertion was also assessed in the emergency department. Clinical trial registration was done (ClinicalTrials.gov.: NCT04081935).
Pain and fear scores were significantly lower in the virtual reality group, as were the children's ratings as perceived by their caregivers and nurses. The children's ratings of pain and fear were positively correlated with the caregivers’ ratings and the nurses' ratings as well. The time required for successful intravenous insertion was significantly lower in the virtual reality group.
Visual reality intervention can effectively reduce the pain and fear during intravenous procedure in school‐age children in emergency department.
The results of this study indicate the feasible clinical value of virtual reality interventions during the administration of intravenous injections in school‐age children in emergency departments.
To examine the dissimilarity between Chinese myocardial infarction (MI) patients’ and spouses’ illness perceptions (IPs), and to explore the relationship between patients’ IP, differences in couples’ IP and patients’ lifestyle after discharge.
An individual's IP is affected and moderated by several factors, including the social context. One of the most influential members of the social network of patients is the spouse.
From April 2016–April 2017, 111 MI patients and their spouses were recruited. Before discharge from hospital, revised Illness Perception Questionnaire was administered to MI patients and their spouses separately. Two months after discharge, patients’ lifestyle was assessed using Health Promoting Lifestyle Profile II. The manuscript was organised according to STROBE guidelines.
Spouses were more likely to believe that the illness would last for a long time, and patients perceived MI as being more controllable than their spouses did. The patient–spouse dissimilarity in the perception of consequences was negatively correlated with both nutrition and stress control behaviours. Patients in couples with more dissimilar perception of environmental factors as a cause were more likely to choose a healthy diet, while patients in couples with more dissimilar perceived treatment control were more able to control stress.
There are both similarities and dissimilarities between MI patients’ and spouses’ IP, and these dissimilarities contributed the majority of the explained variance in patients’ lifestyle after discharge.
We should consider both couples when examining how a patient copes with a chronic illness.
The PRISMA for Abstracts (PRISMA‐A) was developed to guide authors to present a structured abstract. However, the adherence of abstracts to these guidelines in some areas was of concern.
To determine whether the publication of PRISMA‐A resulted in an improvement in the abstracts reported with nursing systematic reviews (SRs).
This was a cross‐sectional study. We searched PubMed for randomized controlled trials–based SRs published in top‐tier nursing journals. A PRISMA‐A checklist was used to assess abstracts in the SR included. Total score on checklists, comparison of total scores between two periods, and effect factors were analyzed.
Overall, abstract reporting compliance with PRISMA‐A has not improved significantly with the time span. Of the 81 SRs, 74.1% were structured. About half reported eligibility criteria, information sources, and description of the effect as recommended. Registration status was reported only in 4.9%. The reporting quality was significantly higher for journals with higher impact factors (p < .001).
Although not inclusive of all SRs in the nursing field, our sample reflects the general trend that there was no significant improvement in the compliance of SR abstracts reported in nursing with the release of PRISMA‐A. There is room for improvement, as most items have not been fully reported.
The aim of this study was to investigate factors related to self‐management and predictors of self‐management in older adult patients with type 2 diabetic nephropathy.
Diabetic patients suffer many comorbidities during their lifetime, and the process of self‐management is complex. Self‐management and an integrated care experience are extremely important for older adults with diabetic nephropathy.
A cross‐sectional correlation design was adopted.
A total of 123 older patients were enrolled in the study from June 2016 to November 2017. Data collection involved a demographic questionnaire, the Patients’ Experience of Integrated Care Questionnaire, and the Partners in Health Scale to measure the integrated care experience and self‐management. Data analysis included descriptive statistics, independent t‐tests, Pearson product moment correlation, and multiple linear regression. The methods are consistent with the STROBE criteria (Supplementary File 1).
The results showed that the majority of the sample was female (56.9%). The average age was 77 years old. Stepwise regression analysis showed that re‐admission during the past year (p < .001), physical function (p < .001), and integrated care experience (p < .001) are predictors of self‐management in older adult patients with type 2 diabetic nephropathy and explained 42.8% of the variation in self‐management behaviour.
The results can be used to enhance the awareness of clinicians of the importance of an integrated care experience and self‐management among older patients with type 2 diabetic nephropathy. Clinicians also should pay attention to physical function and the integrated care experience to promote self‐management.
Studies on the integrated care experience and self‐management of diabetic neuropathy in older adults are limited in Taiwan. The results of this study provide valuable information to support the importance of integrated care among this specific population.
To examine female youth's intentions for safe sex with the relationship partners based on the extended theory of planned behaviour (TPB) model and explore the direct and indirect impact of parent–child communication about sex, peer interaction related to sexual issues, and exposure to sexually explicit materials on female youth's safe sexual behaviour intentions.
A non‐experimental, cross‐sectional research design.
A convenience sampling was employed for data collection and 731 female youth aged 15–24 years old were recruited in 2013–2014. An anonymous, self‐report structured questionnaire was used as a research instrument to collect participants' basic information and measure the internal and additional variables in the extended TPB model.
The extended TPB model explained 42–45% of the total variance. Perceived behavioural control (PBC) and subjective norms had a positive effect on female youth's intentions for contraceptive use, condom use, and dual use with relationship partner; PBC was found to have the greatest influence. Among the additional variables in the extended TPB model, more parent–child communication about sex was found to lead to more positive dual use intentions. More peer interaction related to sexual issues was found to lead to less dual use intentions.
To improve female youth's sexual health, the priorities are to reinforce their PBC and subjective norms and enhance parent–child communication about sex. Future efforts should strengthen sex education in families and schools and shape a social environment that facilitates safe sex.
The extended TPB model can successfully predict female youth's safe sexual behaviour intentions. Empowering female youth to establish a sense of subjectivity and awareness of being a mature individual with physical autonomy, is importance for their sexual health.
Traditional Chinese medicine (TCM) has a history of thousands of years in China and is officially sanctioned by the government as a treatment option for Chinese citizens alongside, what we will refer to here as western medicine, which is also very well developed in China. In the west, TCM is becoming increasingly popular with some people who become worried about the efficacy and side‐effects of western medicine.
The aim of this study was to develop a valid and reliable instrument to assess the nurse‐child interaction during medical or nursing interventions.
Communication is an important competency for the professional practice of nurses and physicians. The nurse‐patient relationship is fundamental for high‐quality care. It has been suggested that if nurses have more skills to interact with children, care will be less distressing and less painful for the children.
A qualitative observational psychometric study; the GRRAS checklist was used.
In‐depth video‐analyses, taxonomy development (19 videos) and testing it's psychometric properties (10 videos). Three observers micro‐analysed video recordings of experienced nurses changing children's wound dressing in a specialized Burn Centre.
The nurse‐child interaction taxonomy (NCIT) was developed to observe and score the interactional behavior between nurse and child. The taxonomy has three main patterns: being considerate, attuning oneself, and procedural interventions, subdivided in 8 dimensions. These dimensions contain 16 elements that can be observed and scored on a 7‐point scale. Intrarater‐, interrater‐reliability and agreement were good.
This study shows that interaction between nurses and children can be assessed reliably with the NCIT by an experienced observer or alternatively, scoring by two observers is recommended.
The development of the taxonomy is an important step to find evidence for the best way for nurses to interact with children during nursing interventions or medical events and as such, ultimately, contributes to providing the best care possible.
To determine factors associated with nurses' spiritual care competencies.
Holistic nursing care includes biopsychosocial and spiritual care. However, nurses are limited by a lack of knowledge, time constraints and apprehension of assessing spiritual issues, which leaves them unable to assess and meet patients' spiritual needs. Thus, when patients experience spiritual distress, clinical nurses lose the opportunity to support spiritual growth and self‐actualization. In Taiwan, spiritual care, religion, and culture are unique compared to those in other countries. Overall, factors associated with Taiwanese nurses' spiritual care competencies lack comprehensive exploration.
This study adopted a descriptive correlational design using cross‐sectional survey (see Supplementary File 1). Cluster sampling was used to select clinical nurses from fourteen units of a medical center and a regional hospital. Data were collected from January to June 2018 with a 97.03% response rate. Clinical nurses completed a background questionnaire, spiritual care practice questionnaire, spirituality and spiritual care related scales. Data were analyzed using descriptive and linear regression. This report followed the STROBE checklist.
Spiritual care competence ranged from 44‐123 (mean 84.67±12.88; range 27‐135) . The majority of clinical nurses rated their spiritual care competence as moderate (64‐98). The significant factors associated with nurses' spiritual care competence were education, religion, interest in spiritual care, having role models, past life events, barriers to providing spiritual care of the spiritual care practice score, and spiritual attitude and involvement score. The overall model was significant (p<.001) and accounted for 55.0% of variance (adjusted R 2=.488).
Most clinical nurses have moderate spiritual care competence. Objective factors identified affect clinical nurses' spiritual care competencies.
To improve nurses' spiritual care competencies, objective factors that affect clinical nurses' spiritual care competencies must be emphasized. Multiple strategies for enhancing nurses' own spiritual well‐being can be provided via employee health promotion projects and activities, and promoting nurses' spirituality and spiritual care competencies can be explored in clinical settings through bedside teaching, situational simulation, objective structured clinical examinations, and self‐reflection.
To evaluate the impact of the specially designed medical dressing screen during wound dressing changes for children aged 1–3 who experienced a burn on their hand or foot.
Randomized controlled trial.
The study was performed, between January 2019 ‐ April 2019, at a Burn Outpatient Ward. A total of 52 outpatient children who had suffered burns were included in the clinical trial. The burn area of these participants accounted for 1–5% of the total body surface area. The children were randomly divided into two equal‐sized groups, each receiving a different treatment. In the medical screen group (N = 26), a medical screen was used for children during the dressing changes. In the control group (N = 26), the children received only regular dressing changes. Pain level of the children during dressing change was the primary outcome, the satisfaction of children's parents and wound therapist were used as second outcomes. The Bonferroni method was used to perform pairwise comparisons of repeatedly measured data at different measurement times in two groups.
The results showed that the medical screen group had better outcomes with respect to pain management during dressing changes; in addition, the satisfaction score of the wound therapist and children's parents presented also better outcomes compared with the control group.
This study demonstrated application of the medical screen for burns can relieve the pain of 1 ‐ 3‐year old children experienced a burn during dressing changes. In addition, the application of the medical screen also increased the satisfaction of the child's parents and wound therapist.
Registration NO: 1,900,020,953.
Compared with conventional dressing methods, the medical screen can be used as a novel way to decrease the negative experience of burn patients ages 1–3 who require dressing changes.
Tele‐coaching has been used by nurses as one of the accessible and sustainable interventions for individuals with type 2 diabetes mellitus. However, evidence has been lacking to demonstrate its effectiveness in mitigating the related cardiovascular risk factors.
To systematically evaluate the effectiveness of nurse‐led tele‐coaching on the modifiable cardiovascular risk factors (glycated hemoglobin, blood pressure, & lipid levels) among individuals with type 2 diabetes mellitus.
A systematic search of eight databases (Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, PsycINFO, Web of Science, & ProQuest Dissertations and Theses) was conducted for randomized controlled trials of nurse‐led tele‐coaching for individuals with type 2 diabetes mellitus published in English up to October 30, 2018. A meta‐analysis was conducted for the primary outcomes of the studies.
Twelve randomized controlled trials were selected that included 3,030 participants. Results from the meta‐analysis revealed statistically significant reductions for not only glycated hemoglobin (pooled mean difference = −1.23, 95% CI: −1.63 to −0.8, I 2 = 0%, p < .00) but also systolic blood pressure (SBP; pooled mean difference = −2.22, 95% CI: −3.95 to −0.49, I 2 = 0%, p < .01); such findings are supportive of the use of nurse‐led tele‐coaching on the primary outcome.
Results from the meta‐analyses have shown that nurse‐led tele‐coaching is an effective and accessible intervention that could improve the glycemic control and SBP among individuals with type 2 diabetes mellitus.
The role of donated breast milk and formula feeding in very low birth weight infants (VLBWIs) remains unclear.
The objective for this study was to evaluate the efficacy and safety of breast milk and formula for feeding VLBWIs.
A comprehensive search of PubMed databases was conducted on November 30, 2018, to identify related randomized controlled trials (RCTs). Pooled odds ratio (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using either a fixed or random‐effects model.
Seven RCTs with a total of 876 infants were included. The formula showed more advantages in increasing infant weight (MD = −6.58, 95% CI: −11.19 to −1.98) and length (MD = −0.30, 95% CI: −0.41 to −0.20) than donated breast milk, but formula could also significantly increase the risks of necrotizing enterocolitis (OR = 0.33, 95% CI: 0.18 to 0.59) and length of hospital stay (MD = −3.78, 95% CI: −6.84 to −0.72) when compared with donated breast milk. No significant differences on the head circumference gain (MD = −0.16, 95% CI: −0.33 to 0.01), sepsis (OR = 1.21, 95% CI: 0.84 to 1.75), retinopathy of prematurity (OR = 1.22, 95% CI: 0.73 to 2.05) and mortality (OR = 0.84, 95% CI: 0.47 to 1.52) were found.
The donated breast milk shows more advantages in reducing the incidence of NEC and length of hospital stay, but also more disadvantages in increasing the weight and length of VLBWIs and ELBWIs when compared with preterm formula feeding. Currently, there is no solid evidence demonstrating a significant advantage of donated breast milk over formula in the feeding of VLBWIs. Larger‐scale RCTs with rigorous designs are needed to elucidate the feeding plans of VLBWIs.