Gayacan, Jesst Godwin V.

July
10, 2010
BSN116

EVIDENCE BASED NURSING

I. Clinical Question

Does soy milk increase stool frequency in young children who

have chronic constipation and are being given cows' milk?

II. Citation

Soy milk decreased chronic constipation in young children

III. Study Characteristics

1. Patients Included

65 children

2. Interventions Compared

Children who were less than 15 months old were given formula
(based on cows' milk or soy milk) and older children were given whole
cows' milk or soy milk. In the first stage, 33 children were allocated to
cows' milk and 32 children were allocated to soy milk for 2 weeks.
After a 1 week wash out period, during which use of soy or cows' milk
derivatives was unrestricted, children were given the alternate milk for
another 2 weeks. Parents were asked to withhold foods that contained
milk during the study. Children with a positive response to soy milk
took it for an additional month and then were re-randomized to cows'
milk or soy milk for a 2 week period (challenge test).

3. Outcomes Monitored

A positive response defined as greater than or equal to 8

bowel movements during the 2 week study period. Fecal score
was also calculated (1 for mushy or liquid stools, 2 for soft
feces, and 3 for hard stools and difficulty and pain on passing
stools).
 4. Does the study focus on a significant problem in
clinical practice?

Yes

IV. Methodology/Design

1.Methodology Used

Challenge Test

2. Design

Randomized, Controlled, Double Blind and Crossover Trial.

3. Setting

A pediatric Gastroenterology clinic at a university hospital in

Italy.

4. Data Sources

(1998) N Engl J Med 339, 1100; Iacono G, Cavataio F,

Montalto G,. Et al. . . . Intolerance of cow's milk
and chronic constipation in children... Oct 15; –
4...

5. Subject Selection

A. Inclusion Criteria

65 children less than 6 years of age who were referred for

chronic constipation (chronic fecal retention of 1 bowel
movement every 3–15 days often associated with abdominal
symptoms)

B. Exclusion Criteria

Exclusion criteria were anatomical causes of constipation,

constipation caused by another disorder, previous anal
surgery, and use of medications associated with constipation.
All children were being fed cows' milk, dairy products, or
commercial formulas derived from cows' milk. All had
 unsuccessful treatment with laxatives. Follow up was
complete.

6. Has the original study been replicated?

Yes

7. What were the risks and benefits of the nursing

action/intervention tested in the study?

For the risk, even if soy milk can reduce constipation, it may
lead also to milk intolerance and also mucosal inflammation to
infants due to undeveloped immune system. For benefits soy
milk is a good source of alternative milk for children as for it is
not that so expensive and yet nutritious enough for the needs
of the body of the children.

V. Results of the Study

44 of the 65 children (68%) had a response while receiving soy

milk and none of the children had a response while receiving cows'
milk. Children who received cows' milk had a mean of 4 bowel
movements during the 2 study weeks and children who received soy
milk had a mean of 10 bowel movements. Children who received soy
milk had better fecal scores than children who received cows' milk. Of
the 44 children in the challenge test, all children who received cows'
milk had constipation compared with none of the children who received
soy milk. At baseline, children who responded to soy milk had more
anal fissures with erythema or edema, symptoms of intolerance to
cows' milk, and positive results for immunological tests.

VI. Authors Conclusions/Recommendations

1. What contribution to client health status does the

nursing action/intervention make?

In young children, constipation was associated with cows' milk; soy

milk reduced the constipation.

2. What overall contribution to nursing knowledge does

the study make?

The results of this research should be of interest to nurses who deal

with children suffering from chronic constipation.
 VII. Applicability

1. Does the study provide a direct enough answer to your

clinical question in terms of type of patients, intervention
and outcome?

Yes

2. Is it feasible to carry out the nursing action in the real

word?\

Yes

VIII. Reviewers Conclusion/Commentary

A nurse knows that foreign object enters in an

infants body is a treat to its body physiologically, and may lead to
allergies, complications or may be lead to death. For me as a nurse a
good intervention for this study is for the patient to undergo test to
verify if the patient is applicable to the milk (Skin test). It is obvious
that soy milk is cheaper and a convenient way to reduce expenses in
terms of feeding the baby, but we must also not forget that it is not in
the value of the product is important, but its nutrition and need it gives
to the consumer.