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Kinoshita M, White MJ, Doolan A. Clinical assessment of breastfeeding in preterm infants. Eur J Clin Nutr 2024:10.1038/s41430-024-01471-3. [PMID: 38982131 DOI: 10.1038/s41430-024-01471-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 06/22/2024] [Accepted: 07/01/2024] [Indexed: 07/11/2024]
Abstract
Breastmilk confers empirical benefits for preterm infants, however direct breastfeeding rates in this population remain low. For preterm infants, it may be useful to assess the volume of breastmilk transferred from mother to baby when breastfeeding, particularly during transition to oral feeding when breastfeeding attrition is high. Establishing breastfeeding in preterm infants is complex and without knowledge of milk intake during breastfeeds there is risk of inaccurate feed supplementation with subsequent effects on growth and nutrition. Here we review the evidence for clinical assessments of breastfeeding in preterm infants including test weighing, use of isotope labelled water and clinical observation tools designed to estimate adequacy of breastfeeds. Test weighing is a validated measurement, however requires rigorous protocols and further investigation in small infants. Use of isotope labelled water is a validated technique but, due to sampling requirements, reflects intake over days and weeks instead of individual feeds. Clinical observation tools assessed in preterm infants, have not been shown to reflect volumes of breastmilk intake. While current methods have limitations, the goal is to identify measurement tools to be used as temporary aids to facilitate transition to direct breastfeeding while minimising risk of inaccurate supplementation.
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Affiliation(s)
- Meredith Kinoshita
- The Coombe Hospital, Dublin, Ireland.
- Royal College of Surgeons Ireland, Dublin, Ireland.
| | - Martin J White
- The Coombe Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Anne Doolan
- The Coombe Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
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Pados BF, Hill RR. Development, Psychometric Testing, and Reference Values of the Infant Eating Assessment Tool (InfantEAT). Adv Neonatal Care 2024; 24:E2-E10. [PMID: 38181670 DOI: 10.1097/anc.0000000000001132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND Problematic feeding is common in infancy, particularly in infants with a history of premature birth or medical complexity. A concise, valid, and reliable measure of feeding that can be used across feeding methods is needed for clinical practice and research. PURPOSE The purpose of this study was to create an assessment tool to evaluate symptoms of problematic feeding in infants that can be used across all feeding methods (breastfeeding, bottle-feeding, and mixed feeding), then test its psychometric properties and establish reference values. METHODS Item response theory (IRT) was used to identify the most important items on the Neonatal Eating Assessment Tool (NeoEAT) related to symptoms of problematic feeding in infants (N = 1054) to create the Infant Eating Assessment Tool (InfantEAT). Reliability of the InfantEAT was tested using Cronbach's α and interitem correlations. Reference values of the InfantEAT were determined from a sample of healthy, full-term infants (n = 561). Percent agreement in identifying problematic feeding between the NeoEAT and the InfantEAT was calculated. RESULTS The InfantEAT is comprised of 31 items in 9 subscales. The InfantEAT has evidence of acceptable reliability (α = 0.88). There was 74% agreement between the NeoEAT and the InfantEAT, with the InfantEAT being more sensitive to identifying problematic feeding. References values are presented for infants 0 to 2, 2 to 4, 4 to 6, and 6 to 7 months. IMPLICATIONS PRACTICE AND RESEARCH The InfantEAT is a reliable and sensitive tool to evaluate symptoms of problematic feeding across feeding methods for infants younger than 7 months in both practice and research.
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Affiliation(s)
- Britt F Pados
- Infant Feeding Care, Wellesley, Massachusetts (Dr Pados); and MGH Institute of Health Professions School of Nursing, Charlestown, Massachusetts (Dr Hill)
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Pujos M, Käppeli BM, Beckmann S. The German version of the Bristol breastfeeding assessment tool: A validation study. Midwifery 2023; 127:103843. [PMID: 37931458 DOI: 10.1016/j.midw.2023.103843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/31/2023] [Accepted: 10/10/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES This study aimed, first, to validate the Bristol Still [Breastfeeding] Assessment Tool (BSAT) through determining inter-rater reliability, construct and criterion and second, to assess if healthcare professionals viewed the tool as appropriate for use on a maternity ward. DESIGN AND SETTING A validation study was performed at the maternity ward of a university hospital in the German-speaking region of Switzerland. PARTICIPANTS We included 44 mother-newborns dyads in the validation study, and 15 healthcare professionals assessed its appropriateness for use on a maternity ward. MEASUREMENTS AND FINDINGS Inter-rater reliability was determined by observing 82 breastfeeding sessions, which were independently assessed by two assessors based on the criteria of the BSAT. Convergent validity was determined using the Breastfeeding Self-Efficacy Scale Short Form. Predictive validity was determined by breastfeeding status at hospital discharge. A self-developed 5-item questionnaire assessed the appropriateness of the tool for use on a maternity ward. Inter-rater reliability was good at the item level (six out of eight intraclass-correlation coefficient values were greater than 0.75 and p < 0.00). The convergent validity demonstrated a moderate positive correlation with breastfeeding self-efficacy, with a Pearson's correlation coefficient of 0.69 (Confidence Interval = 0.46-0.83, p < 0.00). The predictive validity with breastfeeding status at hospital discharge was not statistically significant with χ2(22, n = 44) = 26.98, p = 0.21). Healthcare professionals confirmed that the tool was appropriate for using in daily practice on the maternity ward. KEY CONCLUSION The BSAT had an overall good inter-rater reliability and a moderate construct validity with the mother's breastfeeding self-efficacy level and has comparable psychometrics properties as the original. IMPLICATIONS FOR PRACTICE We recommend assessing breastfeeding with the BSAT and scoring it at the item level and not with a total score. Using the BSAT on maternity wards could help monitor and objectify breastfeeding practices.
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Affiliation(s)
- Magali Pujos
- Institute for Nursing Sciences, Department of Public Health (DPH), Faculty of medicine, University Basel, Bernoullistrasse 28, Basel 4056, Switzerland; Center for Clinical Nursing Research, University Hospital Zurich, Rämistrasse 100, Zürich 8091, Switzerland.
| | - Barbara Meier Käppeli
- Department of Obstetrics and Gynecology, University Hospital Zurich, Frauenklinikstrasse, 10, Zurich 8090, Switzerland
| | - Sonja Beckmann
- Institute for Nursing Sciences, Department of Public Health (DPH), Faculty of medicine, University Basel, Bernoullistrasse 28, Basel 4056, Switzerland; Center for Clinical Nursing Research, University Hospital Zurich, Rämistrasse 100, Zürich 8091, Switzerland
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Kaiza R, Joho AA. The effect of low-fidelity simulation training on breastfeeding knowledge, practice, and self-efficacy among young lactating mothers in Tanzania: A quasi-experimental study. PLoS One 2023; 18:e0285392. [PMID: 38015978 PMCID: PMC10684063 DOI: 10.1371/journal.pone.0285392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/18/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Exclusive breastfeeding (EBF) is of paramount importance for the survival, growth, and development of neonates. Lack of EBF puts mothers and their babies at high risk of many complications. Mothers may end up having breast engorgement, cracked nipple, mastitis, breast pain, and backache. Babies may acquire postnatal HIV transmission, reduce weight, stunting, poor cognitive and motor development, and increase the risk of diarrhea disease and respiratory infection. Breastfeeding training has been provided immediately after a women's birth. However, young mothers are still staggering with breastfeeding. RESEARCH AIM We aim to assess the effect of low-fidelity simulation training on breastfeeding knowledge, practice, and self-efficacy among young lactating mothers and we will also assess the impact of simulation on infants' weight in Tanzania. METHODS The study will be a health facility-based quasi-experimental design. The study will have four phases: baseline survey, intervention, immediate assessment, and two-month end-line follow-up. The assessment will focus on participants' breastfeeding knowledge, practice, and self-efficacy. Furthermore, infant weight will also be assessed during baseline and end-line. A total of 261 young lactating mothers who have first baby with their infants aged 0 to 2 months will be included, whereby 87 young lactating mothers will be in an interventional group and 174 will be in the control group. The intervention will have four packages: 1) group lecture education and interactive on the importance of breastfeeding 2) videos, 3) pictures, and 4) simulation in the umbrella LVPS using the wearable Lactation Simulation Model (LSM) and newborn manikins (Global Health Media and Laerdal baby). At the end of the study, all groups will be given education brochures which will be in the Swahili language for easy understanding. Data will be analyzed using SPSS version 23. An independent T-test and repeated measures ANOVA will be used in this study to compare the difference between the mean of the 2 groups. DISCUSSION This study aims to generate evidence of the effect of simulation on improving breastfeeding knowledge, practice, and self-efficacy. We expect the study findings to inform the stakeholders and policymakers on formulating breastfeeding education and simulation training that will improve women's breastfeeding knowledge, practice, and self-efficacy and improve infant health.
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Affiliation(s)
- Rogers Kaiza
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Angelina A. Joho
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
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El-Kassas O, Amer A, Abdel-Hady H, Abou-Elsaad T. Developing the Mansoura Early Feeding Skills Assessment Scale for Preterm Infants. Pediatr Gastroenterol Hepatol Nutr 2023; 26:320-337. [PMID: 38025492 PMCID: PMC10651360 DOI: 10.5223/pghn.2023.26.6.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose This study aimed to develop a new bedside scoring system scale that assesses preterm infants' oral feeding skills (OFS) in the neonatal intensive care unit (NICU). Methods A literature review and critical appraisal of available oral feeding assessment tools/scores were performed. Subsequently, we developed the "Mansoura Early Feeding Skills Assessment" (MEFSA) scale, an 85-item observational measure of oral feeding skills with three main sections. Forty-one preterm infants who did not receive oral feeding but were clinically stable enough to initiate oral feeding were included in the study. Next, we applied and interpreted the MEFSA to describe and score their feeding skills. Results Applying the MEFSA resulted in a smooth feeding transition, early start of oral feeding, full oral feeding, and discharge with a shorter period of tube feeding in preterm infants. Conclusion The MEFSA is a successful bedside scoring system that assesses the OFS of preterm infants in the NICU.
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Affiliation(s)
- Omnia El-Kassas
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ayman Amer
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hesham Abdel-Hady
- Department of Pediatric, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Tamer Abou-Elsaad
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Lee KJ, Shin YB, Park HE, Choi S, de Oliveira JG, Hong D, Kim S, Yoon JA. Quantitative non-nutritive sucking measurement as a predictor of oral feeding readiness in newborns. Front Pediatr 2023; 11:1143416. [PMID: 37635795 PMCID: PMC10450951 DOI: 10.3389/fped.2023.1143416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Background and purpose The purpose of this study is to examine the relationship between the parameters of a silver nanowire-based flexible pressure sensor developed to measure the non-nutritive sucking (NNS) performance and predict the nutritive sucking status in preterm infants. Methods Preterm infants who were referred for feeding difficulty during the transition period from tubal feeding to oral feeding were enrolled in our study. A flexible pressure sensor was used to measure the non-nutritive sucking parameters of neonates. The evaluator stimulated the infants' lips and tongue with a pacifier integrated with a sucking pressure sensor, to check whether non-nutritive sucking had occurred. When the sucking reflex was induced, it was measured. The infants' sucking characteristics were subdivided into classifications according to the NOMAS criteria and full oral feeding (FOF) status. Quantitative NNS measurement according to the feeding state was compared between groups. Results When comparing the quantitative NNS measurement by feeding characteristics, the average sucking pressure was significantly higher in infants in the FOF capable group than those in the incomplete FOF group. In addition, the maximum and average sucking pressure was significantly higher in infants with a normal sucking pattern compared to those with a disorganized sucking pattern. The average NNS pressure was divided over the range of 0-3 kPa and the same weight was assigned to each item. When the optimal cut-off value for the sensitivity and specificity of the average NNS pressure to estimate the FOF was set, a pressure of 1.5 kPa yielded the highest sensitivity (84.62%) and specificity (67.65%) on the receiver operating characteristic (ROC) curve. The area under the curve (AUC) was 0.786, and this result was statistically significant. Conclusions This study presents a quantitative parameter for non-nutritive sucking in preterm infants with the use of a flexible pressure sensor. Results show possible quantitative indicators that can aid in predicting when preterm infants can transition to oral feeding and their prognosis. This will serve as a basis for future research on determining the feeding transition period of newborns with health conditions that affect oral feeding.
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Affiliation(s)
- Kyeong Jae Lee
- Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, Republic of Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Ho Eun Park
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Suro Choi
- School of Undergraduate Studies, DGIST, Daegu, Republic of Korea
| | - Jean G. de Oliveira
- Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, Republic of Korea
| | - Daun Hong
- Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, Republic of Korea
| | - Sohee Kim
- Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, Republic of Korea
| | - Jin A Yoon
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Tomita A, Tahara-Sasagawa E, Yonezawa K, Usui Y, Haruna M. Reliability and validity of the Japanese Version of the Infant Breastfeeding Assessment Tool. Midwifery 2023; 121:103670. [PMID: 37019001 DOI: 10.1016/j.midw.2023.103670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 03/28/2023]
Abstract
OBJECTIVE To translate the Infant Breastfeeding Assessment Tool (IBFAT) into Japanese and confirm the reliability and validity of the Japanese version of IBFAT. DESIGN The methodological study examining the reliability and validity of the Japanese version of the IBFAT. SETTING A maternity hospital in Tokyo. PARTICIPANTS Ten mother-newborn pairs were recruited for the reliability analysis. 101 mother-newborn pairs were recruited for the validity analysis. MEASUREMENTS AND FINDINGS Reliability was verified by video recording and direct observation. The observers are one researcher, and 11 evaluators consisting of midwives and nurses. Amongst the 11 evaluators, six evaluators directly observed breastfeeding behaviours and five evaluators observed breastfeeding behaviours through video viewing. Regarding the inter-rater agreement, the intraclass correlation (ICC) between the researcher and six direct evaluators was 0.985 (95% confidence interval [CI]: 0.941-0.996) and that amongst five video viewing evaluators was 0.827 (95% CI: 0.647-0.945). In the intra-rater agreement, the lowest ICC amongst all those investigating IBFAT scores was 0.810 (95% CI: 0.433-0.948). In concurrent validity, the correlation coefficients between the IBFAT and Breastfeeding behaviour Assessment (BBA) scores on the first day after birth and the fourth or fifth day after birth (at discharge) were 0.66 (p < 0.001) and 0.40 (p < 0.001), respectively. In predictive validity, the medians and interquartile ranges (IQRs) of IBFAT scores at discharge were 11.0 (IQR: 11.0-12.0) and 11.0 (IQR: 11.0-12.0) for the breast and mixed milk groups at one-month check-up, respectively. While both median values were the same, the Mann-Whitney U test showed a significant difference. KEY CONCLUSIONS The Japanese version of the IBFAT is valid and reliable for measuring feeding behaviour amongst newborns in the first week of life. IMPLICATIONS FOR PRACTICE The Japanese version of the IBFAT can be available both in a clinical setting and in research to help support breastfeeding.
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Affiliation(s)
- Aya Tomita
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Emi Tahara-Sasagawa
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kaori Yonezawa
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yuriko Usui
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Megumi Haruna
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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Desai H, Jones CE, Fogel JL, Negrin KA, Slater NL, Morris K, Doody LR, Engstler K, Torzone A, Smith J, Butler SC. Assessment and management of feeding difficulties for infants with complex CHD. Cardiol Young 2022; 33:1-10. [PMID: 36562257 DOI: 10.1017/s1047951122004024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Early surgical intervention in infants with complex CHD results in significant disruptions to their respiratory, gastrointestinal, and nervous systems, which are all instrumental to the development of safe and efficient oral feeding skills. Standardised assessments or treatment protocols are not currently available for this unique population, requiring the clinician to rely on knowledge based on neonatal literature. Clinicians need to be skilled at evaluating and analysing these systems to develop an appropriate treatment plan to improve oral feeding skill and safety, while considering post-operative recovery in the infant with complex CHD. Supporting the family to re-establish their parental role during the hospitalisation and upon discharge is critical to reducing parental stress and oral feeding success.
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Affiliation(s)
- Hema Desai
- Department of Rehabilitation Services, Children's Hospital of Orange County, Orange, CA, USA
| | - Courtney E Jones
- Acute Care Therapy Services, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Jennifer L Fogel
- Department of Pediatric Rehabilitation, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Karli A Negrin
- Department of Therapy and Rehabilitative Services, Nemours Children's Health, Wilmington, DE, USA
| | - Nancy L Slater
- Physical Medicine and Rehabilitation Services, Children's Minnesota, Minneapolis, MN, USA
| | - Kimberly Morris
- Department of Speech-Language Pathology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Lisa R Doody
- Pediatric Rehabilitation and Development, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Katherine Engstler
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Andrea Torzone
- Heart Center, Cardiac Intensive Care Unit, Children's Medical Center Dallas, Dallas, TX, USA
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Jayapradha G, Venkatesh L, Amboiram P, Sudalaimani P, Balasubramanium RK, Pados BF. Cross-Cultural Adaptation and Psychometric Evaluation of the Neonatal Eating Assessment Tool-Breastfeeding Into Tamil. J Obstet Gynecol Neonatal Nurs 2022; 51:450-460. [PMID: 35568097 DOI: 10.1016/j.jogn.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To adapt the Neonatal Eating Assessment Tool-Breastfeeding (NeoEAT-Breastfeeding) into Tamil, a language spoken in several South Asian countries, to identify the tool's factor structure, and to assess its psychometric properties. DESIGN Cross-sectional. SETTING Tertiary care hospital in South India. PARTICIPANTS A cohort of 323 mothers of infants ages 1 week to 7 months, including infants with and without feeding difficulties. METHOD To adapt the English tool to Tamil, we followed standard procedures specified by the tool developers and international guidelines for tool translation and adaptation, including pilot testing and personal interviews with participants who had infants younger than 7 months. Participants completed the NeoEAT-Breastfeeding (Tamil) after assessment of breastfeeding by professionals. The 62-item tool involves rating each item on a 6-point scale, and higher scores indicate increased feeding difficulties. RESULTS After exploratory factor analysis, we divided the tool into five subscales in the Tamil version compared to the seven subscales in the original English version. The Tamil version demonstrated high internal consistency reliability (Cronbach's α = 0.97) and test-retest reliability (intraclass correlation = 0.99) for the total scores. Infants with feeding concerns demonstrated significantly higher total and subscale scores on the NeoEAT-Breastfeeding (Tamil) than infants without feeding concerns (p = .000; construct validity). CONCLUSION The NeoEAT-Breastfeeding (Tamil) holds promise as a culturally appropriate, clinically useful parent-report tool with evidence for initial reliability and validity for identifying feeding-related concerns among infants younger than 7 months in the Tamil-speaking population.
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Singhala K, Mills AC, Wong-Anuchit C. Bristol Breastfeeding Assessment Tool-Thai Version: Translation, Validity, and Reliability. J Hum Lact 2022; 38:227-235. [PMID: 35259996 DOI: 10.1177/08903344221079348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In 2019, 14.0% of infants in Thailand were exclusively breastfed up to 6 months of age. To increase exclusive breastfeeding, an objective assessment measure would be useful to maternity care providers for appraising the problems encountered by new mothers' experiences with breastfeeding. RESEARCH AIMS To translate the Bristol Breastfeeding Assessment Tool from English into Thai; to assess the reliability and validity of the Thai Bristol Breastfeeding Assessment Tool; and to explore the relationship of a mother's self-efficacy to successful breastfeeding. METHODS Using a methodological design, we purposively sampled 302 new mothers from two tertiary hospitals in Thailand who had given birth to a single baby with an uncomplicated vaginal birth. The Thai Bristol Breastfeeding Assessment Tool's structure was examined using confirmatory factor analysis. Concurrent and convergent validity were assessed using the Thai LATCH instrument and Thai Breastfeeding Self-Efficacy Scale, respectively. RESULTS The inter-item Thai Bristol Breastfeeding Assessment Tool correlation coefficients were positive and strong. The correlation between scores of the Thai Bristol Breastfeeding Assessment Tool and Thai LATCH instrument were positive and strong and had acceptable concurrent validity. The confirmatory factor analysis model fit the Thai Bristol Breastfeeding Assessment Tool data perfectly and the Cronbach's alpha coefficient had acceptable internal reliability. CONCLUSIONS The Thai Bristol Breastfeeding Assessment Tool is a cross-culturally translated instrument equivalent to its English version and demonstrated acceptable validity and reliability. The instrument provides a mechanism for an objective assessment and monitoring system of optimal breastfeeding practices in Thai mothers with newborns.
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Affiliation(s)
| | - Andrew C Mills
- Faculty of Nursing, Mahasarakham University, Mahasarakham, Thailand.,School of Nursing, Saint Louis University, St. Louis, Missouri, USA
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Balaguer-Martínez JV, Esquivel-Ojeda JN, Valcarce-Pérez I, Ciriza-Barea E, García-Sotro C, López-Santiveri A, Hernández-Gil A. Translation to Spanish and validation of a scale for the observation of breastfeeding: The Bristol Breastfeeding Assessment Tool. An Pediatr (Barc) 2022; 96:286-293. [DOI: 10.1016/j.anpede.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/23/2021] [Indexed: 10/18/2022] Open
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Agudelo SI, Molina CF, Gamboa OA, Acuña E. Comparison of the Effects of Different Skin-to-Skin Contact Onset Times on Breastfeeding Behavior. Breastfeed Med 2021; 16:971-977. [PMID: 34494889 DOI: 10.1089/bfm.2021.0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: Skin-to-skin contact (SSC) between mother and child improves the rates of exclusive breastfeeding (EBF) in the neonatal period. This study evaluated the effects of two SSC onset times on breastfeeding behavior in the neonatal period. Materials and Methods: A multicenter clinical trial was conducted, with random allocation of participants to two different SSC onset times: immediate (at birth) and early (at 60 minutes of life). Low-risk neonates at birth were included. The researchers responsible for analyzing the data were blinded. The outcomes evaluated were early breastfeeding; EBF in the hospital, in the first week of life, and in the first month; and breastfeeding effectiveness in the neonatal period. Bivariate analyses were performed to evaluate the effect of the onset of SSC on breastfeeding indicators. The relative risk (RR) was reported as an effect measure. Results: A total of 297 neonates were included (immediate SSC, n = 148; and early SSC, n = 149). No differences were found in early breastfeeding (93.6% versus 90.6%; RR 1.6, 95% confidence interval 0.07-3.82), breastfeeding effectiveness, or EBF in the neonatal period. There was an earlier initiation of breastfeeding in the immediate SSC group (22 versus 27 minutes, p < 0.001). Conclusions: No differences in breastfeeding indicators in the neonatal period were observed between groups with different onset times of SSC (immediate versus early) in the neonatal sensitive period among low-risk neonates at birth. Clinical Trial Registration Number: NCT02687685.
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Affiliation(s)
- Sergio I Agudelo
- Ciencias de La Salud, Escuela de Graduados, Universidad CES, Medellín, Colombia.,Pediatrics Department, Universidad de La Sabana, Chía, Colombia
| | | | - Oscar A Gamboa
- Departamento de Investigación, Universidad de La Sabana, Chía, Colombia
| | - Eduardo Acuña
- Pediatrics Department, Hospital Regional de Zipaquirá, Hospital Universitario de La Samaritana, Zipaquirá, Colombia
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Dosso YS, Greenwood K, Harrold J, Green JR. Bottle-Feeding Intervention Detection in the NICU. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1814-1819. [PMID: 34891639 DOI: 10.1109/embc46164.2021.9631105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Video-based monitoring of patients in the neonatal intensive care unit (NICU) has great potential for improving patient care. Video-based detection of clinical events, such as bottle feeding, would represent a step towards semi-automated charting of clinical events. Recording such events contemporaneously would address the limitations associated with retrospective charting. Such a system could also support oral feeding assessment tools, as the patient's feeding skills and nutrition are pivotal in monitoring their growth. We therefore leverage transfer learning using a pretrained VGG-16 model to classify images obtained during an intervention, to determine if a bottle-feeding event is occurring. Additionally, we explore a data expansion technique by extracting similar-feature images from publicly available sources to supplement our dataset of real NICU patients to address data scarcity. This work also visualizes and quantifies the gap between the source domain (ImageNet data subset) and target domain (NICU dataset), thereby illustrating the impact of expanding our training set for knowledge transfer proficiency. Results show an increase of over 18% in sensitivity after data expansion. Analysis of network activation maps indicates that data expansion is able to reduce the distance between the source and target domains.
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Evaluating the Use of Telepractice for Bottle-Feeding Assessments. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8110989. [PMID: 34828701 PMCID: PMC8625576 DOI: 10.3390/children8110989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
There is currently limited evidence supporting the use of telepractice to conduct bottle-feeding assessments. This study aimed to investigate the inter-rater reliability of bottle-feeding assessments conducted via synchronous telepractice (real-time videoconferencing). Secondary aims were to investigate parent and clinician satisfaction. Bottle-feeding skills of 30 children (aged 1 month-2 years) were simultaneously assessed by a telepractice SP (T-SP) at a remote location and an in-person SP (IP-SP) at the family home. A purpose-designed assessment form was used to evaluate: (1) developmental level (screen only), (2) state, color, and respiration, (3) oral motor skills, (4), infant oral reflexes, (5) tongue tie (screen only), (6) non-nutritive suck, (7) bottle-feeding, (8) overall feeding skills and (9) recommendations. Results of the T-SP and IP-SP assessments were compared using agreement statistics. Parents reported perceptions of telepractice pre and post session, and also rated post-session satisfaction. The telepractice SP completed a satisfaction questionnaire post-appointment. The majority of assessment components (45/53, 85%) met the agreement criteria (≥80% exact agreement). Difficulties were noted for the assessment of palate integrity, gagging during non-nutritive suck assessment, and 6 components of the tongue tie screen. Parent and clinician satisfaction was high; SPs reported that they would offer telepractice services to 93% of families again in the future. Overall, the results demonstrated that most components of a bottle-feeding assessment could be reliably completed via synchronous telepractice in family homes. However, further research is required to improve the reliability of some intra-oral assessment components.
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Balest AL, Mahoney AS, Shaffer AD, White KE, Theiss R, Dohar J. Infant aspiration and associated signs on clinical feeding evaluation. Int J Pediatr Otorhinolaryngol 2021; 149:110856. [PMID: 34358815 DOI: 10.1016/j.ijporl.2021.110856] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/14/2021] [Accepted: 07/27/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Few studies have examined clinical signs of aspiration in infants <51 weeks post-menstrual age (PMA) for whom the laryngeal cough reflex is not fully developed. This retrospective study explored 1) the association between signs of aspiration on a clinical feeding evaluation (CFE) and/or comorbid conditions with aspiration (silent or overt) on a modified barium swallow study (MBS) for infants in this age range, 2) the association between lower respiratory infection (LRI) and aspiration on MBS, and 3) the sensitivity and specificity of detecting aspiration according to signs on CFE and the evaluating speech-language pathologist's (SLP) years of experience. METHODS A retrospective review of charts of patients with MBS completed January 1, 2012-December 31, 2014 was performed. Patients were included if they were <51-weeks PMA at the time of MBS and had a CFE conducted no more than seven days prior to the MBS. Patient age, comorbidities, and MBS and CFE details were collected. The impact of CFE findings, patient age, comorbid syndromes/associations, and aerodigestive diagnoses on the odds of demonstrating silent aspiration (SA) or overt aspiration during MBS with thin liquids was determined using logistic regression, and the sensitivity and specificity of CFE for identifying SA was calculated. RESULTS Results from 114 patients indicated that 46 (40 %) of the infants had SA and nine (8 %) had overt aspiration on MBS. Notable signs on CFEs were cough (36 %), oxygen desaturations (33 %), and chest congestion (32 %). On multiple regression analysis there was increased odds of SA on MBS with at least one clinical sign on CFE (OR: 24.3, p = 0.02), chronic lung disease, (OR: 18.2, p = 0.01), and airway abnormalities (OR: 2.94, p = 0.01). Cough on CFE was associated with increased odds of overt aspiration on MBS (OR: 5.69, p = 0.04). Neither SA nor overt aspiration were significantly associated with LRI. Sensitivity and specificity of CFE for correctly identifying the presence of SA were 98 % and 15 %, respectively; experience of the SLP was not a contributing factor. CONCLUSION Further study is required to determine if specific signs on CFE are predictive of aspiration.
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Affiliation(s)
- Arcangela L Balest
- UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, Division of Neonatology, USA.
| | - Amanda S Mahoney
- University of Pittsburgh Communication Science and Disorders, 3600 Atwood Street, Forbes Tower, Pittsburgh, PA, 15260, USA
| | - Amber D Shaffer
- UPMC Children's Hospital of Pittsburgh, Department of Otolaryngology, USA
| | - Katherine E White
- UPMC Children's Hospital of Pittsburgh, Department of Audiology and Communication Disorders, USA
| | - Robert Theiss
- University of Pittsburgh, School of Medicine, Present Address Allegheny General Hospital, Pittsburgh, PA, USA
| | - Joseph Dohar
- University of Pittsburgh Communication Science and Disorders, 3600 Atwood Street, Forbes Tower, Pittsburgh, PA, 15260, USA; UPMC Children's Hospital of Pittsburgh, Department of Otolaryngology, USA
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Matarazzo Zinoni M, Campos Herrero L, González Lamuño D, de las Cuevas Terán I. Traducción y estudio de propiedades métricas de la herramienta Early Feeding Skills Assessment en el nacido prematuro. An Pediatr (Barc) 2021. [DOI: 10.1016/j.anpedi.2020.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Chen D, Yang Z, Chen C, Wang P. Effect of Oral Motor Intervention on Oral Feeding in Preterm Infants: A Systematic Review and Meta-Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2318-2328. [PMID: 34314255 DOI: 10.1044/2021_ajslp-20-00322] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective This review article aimed to explore the effect of oral motor intervention on oral feeding in preterm infants through a meta-analysis. Method Eligible studies were retrieved from four databases (PubMed, Embase, Cochrane Library, and Web of Science) up to July 2020 and screened based on established selection criteria. Thereafter, relevant data were extracted and heterogeneity tests were conducted to select appropriate effect models according to the chi-square test and I 2 statistics. Assessment of risk of bias was performed among the included studies. Finally, a meta-analysis was carried out to evaluate the effect of oral motor intervention in preterm infants according to four clinical indicators: transition time for oral feeding, length of hospital stay, feeding efficiency, and weight gain. Results Eighteen randomized controlled trials with 848 participants were selected to evaluate the effect of oral motor intervention on preterm infants. The meta-analysis results revealed that oral motor intervention could effectively reduce the transition time to full oral feeds and the length of hospital stay as well as increase feeding efficiency and weight gain. Conclusions Oral motor intervention was an effective way to improve oral feeding in preterm infants. It is worthy to be used widely in hospitals to improve the clinical outcomes of preterm infants and reduce the economic burdens of families and society. Future studies should seek to identify detailed intervention processes and intervention durations for clinical application.
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Affiliation(s)
- Danna Chen
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zhen Yang
- Histology and Imaging Platform, Core Facility of West China Hospital, Sichuan University, Chengdu, China
| | - Chujie Chen
- Department of Urology, Kidney and Urology Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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Balaguer-Martínez JV, Esquivel-Ojeda JN, Valcarce-Pérez I, Ciriza-Barea E, García-Sotro C, López-Santiveri A, Hernández-Gil A. [Translation to Spanish and validation of a scale for the observation of breastfeeding: The Bristol Breastfeeding Assessment Tool]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00181-8. [PMID: 34301524 DOI: 10.1016/j.anpedi.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION The observation of a feeding by a professional is important to strengthen breastfeeding. The Bristol Breastfeeding Assessment Tool (BBAT) was translated into Spanish and validated. MATERIAL AND METHODS Translation and back-translation of the original scale was done. Six pediatricians and six pediatric nurses collaborated. At the newborn's first visit, a feeding was observed and the pediatrician and nurse scored the BBAT scale independently. The nurse also scored the LATCH Breastfeeding Assessment (LATCH) and each mother filled out the Breastfeeding Self-Efficacy Scale (BSES-SF). Mothers were appointed a week later and the nurse re-scored the BBAT. RESULTS A total of 62 mothers participated. There was good internal consistency for the BBAT (Cronbach's alpha = 0.83 in the assessment made by the nurses and Cronbach's alpha = 0.79 in the assessment made by the pediatricians). Inter-rater consistency showed an intra-class correlation coefficient of 0.91, while for the test-retest was 0.67. Concurrent validity with the BSES-SF scale was good and with the LATCH scale very good. The factor analysis showed the one-dimensional character of the scale and a good homogeneity of the 4 items (positioning = 0.771, attachment = 0.852, sucking = 0.856 and swallowing = 0.679). CONCLUSIONS The scale obtained in Spanish shows good reliability and validity. The BBAT is an easy-to-use tool that allows breastfeeding assessment and determines the aspects that need to be improved.
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Affiliation(s)
| | | | | | | | | | - Amalia López-Santiveri
- Centro de Atención Primaria (CAP) Sant Ildefons, Cornellá de Llobregat, Barcelona, España
| | - Alícia Hernández-Gil
- Centro de Atención Primaria (CAP) Sant Ildefons, Cornellá de Llobregat, Barcelona, España
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Matarazzo Zinoni M, Campos Herrero L, González Lamuño D, de Las Cuevas Terána I. Translation and study of the measurement properties of the Early Feeding Skills Assessment tool in premature newborn. An Pediatr (Barc) 2021; 95:72-77. [PMID: 34246623 DOI: 10.1016/j.anpede.2020.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/07/2020] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION With the aim of improving the care of the premature newborn during their hospital stay, and their well-being in the transition from enteral to independent feeding, it is proposed to incorporate an assessment system within a Spanish Neonatal Unit. The translation of the Early Feeding Skills Assessment (EFSA) tool is presented, along with a study of its measurement properties. PATIENTS AND METHOD A total of 104 assessments were made on premature babies of less than 34 + 6 weeks of gestational age, admitted to the neonatal unit with total or partial feeding, including a normal neurological examination for their age and with physiological stability. RESULTS The EFSA 2010 tool achieved an acceptable value (0.76) as regards its internal consistency. The EFSA 2018 tool maintained an acceptable internal consistency value (0.751). As regards the reliability between two observers, the results showed a satisfactory and excellent reliability in 57.69% of the items in the EFSA 2010 tool, a property that improved in the EFSA 2018 tool (73.68%). CONCLUSIONS The Spanish version of the EFSA tool is consistent and reliable for use as a tool for the assessment of oral abilities for feeding premature babies admitted into a Spanish Neonatal Unit.
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Affiliation(s)
- Milagros Matarazzo Zinoni
- Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, Spain.
| | - Laura Campos Herrero
- Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, Spain
| | - Domingo González Lamuño
- Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, Spain
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Randomized clinical trial of the effect of the onset time of skin-to-skin contact at birth, immediate compared to early, on the duration of breastfeeding in full term newborns. Int Breastfeed J 2021; 16:33. [PMID: 33849584 PMCID: PMC8043060 DOI: 10.1186/s13006-021-00379-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background Skin-to-skin contact (SSC) compared to separation at birth has a positive effect on breastfeeding. However, separation at birth is common with negative impact on breastfeeding. The aim was to determine the effect of immediate SSC compared to early SSC on the duration of exclusive breastfeeding. Methods A randomized multicentre parallel clinical trial was conducted in two hospitals in Cundinamarca (Colombia) between November 2018 and January 2020. Low-risk full term newborns at birth were included. Neonates were assigned to immediate (in the first minute after birth) or early onset (start exactly at 60 min of life) skin to skin contact. Monthly follow-up was performed until 6 months of age. The primary outcome was the percentage of exclusively breastfed infants at 6 months (time in months with human milk as the only source of food). Secondary outcomes were the percentage of infants with exclusive breastfeeding at 3 months, duration in months of exclusive breastfeeding, neonate’s breastfeeding ability, percentage of weight change between birth and the first week of life and hospitalization in the neonatal unit in the first week. A bivariate analysis was performed to determine the variables associated with exclusive breastfeeding at 6 months. A survival analysis was performed to evaluate the effect of the onset of SSC on exclusive breastfeeding duration. Results A total of 297 newborns were included: 49.8% (n = 148) in the immediate SSC group, and 50.2% (n = 149) in the early SSC group. The mean duration of exclusive breastfeeding in both groups was 5 months. There were no differences between the groups in the percentage of exclusive breastfeeding at 6 months (relative risk [RR] 1.06, 95% CI 0.72, 1.58) or in the duration of exclusive breastfeeding (hazard ratio [HR] 0.98, 95% CI 0.74, 1.28). Conclusions The percentage of infants and the duration of exclusive breastfeeding in the first 6 months of age were the same between the two groups of SSC interventions. Given the current barriers to its implementation, the results of this study could positively impact the use of SSC at birth and standardize the intervention and improve breastfeeding indicators. Trial registration ClinicalTrials.gov NCT02687685.
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Schwerla F, Daake B, Moeckel E, Resch KL. Osteopathic Treatment of Infants in Their First Year of Life: A Prospective Multicenter Observational Study (OSTINF Study). Complement Med Res 2021; 28:395-406. [PMID: 33601373 DOI: 10.1159/000514413] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In Germany in recent years, a growing number of parents are seeking help from osteopaths for the perceived health complaints of their infants and children. However, reliable evidence for the effectiveness of osteopathic interventions for this group of patients is largely lacking. OBJECTIVE To observe and document changes in the symptoms of certain health disturbances, as perceived by parents, during the course of an osteopathic treatment of their baby, and associated side effects. METHODS A single-arm, prospective, multicenter, observational study was chosen as the study design. Parents who contacted an osteopathic practice with any of the following 5 health disturbances were invited to include their baby into the study: idiopathic infant asymmetry (IA), deformational plagiocephaly (DP), feeding disorders (FD), excessive crying (EC), and sleep disorders (SD). Osteopaths performed osteopathic treatment as usual for these conditions, and the parents were asked to rate the perceived severity of symptoms on standardized forms including numerical rating scales (NRS 0-10). In DP, the head circumference of the child's skull was measured with a craniometer, and the cranial vault index (CVAI) was calculated. RESULTS 230 osteopaths agreed to participate, 151 osteopaths returned parental ratings. 1,136 infants were treated 2.8 ± 1.1 times (mean ± SD). IA was the most prevalent disturbance (48%), followed by EC (18%), FD (15%), DP (14%), and SD (4%). In IA, perceived asymmetry as rated on the NRS improved from 6.1 to 1.1, a mean improvement of 82%. In DP, the CVAI improved from 8.0 to 4.0%, a mean improvement of 51%. FD improved by 77%, EC by 70% (from 7.7 to 2.3 on the NRS) and SD by 56%. Adverse reactions with a timely association with osteopathic treatments were reported in 3.5% of all treatments, probably reflecting typical day-to-day variations in symptoms. In a total of 3,212 treatments, there was not a single serious adverse reaction affecting infant health. CONCLUSIONS This is one of the largest studies worldwide to date on the osteopathic treatment of infants. Osteopathic treatment was associated with major positive changes in the severity of perceived health complaints as assessed by parents, which in most cases were resolved as a matter of concern, and was proved to be a safe treatment modality among a large number of therapists. Based on these results, confirmatory intervention studies can and should be planned and conducted.
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Hill RR, Pados BF. Symptoms of problematic feeding in infants under 1 year of age undergoing frenotomy: A review article. Acta Paediatr 2020; 109:2502-2514. [PMID: 32654280 DOI: 10.1111/apa.15473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022]
Abstract
AIM The aims of this systematic review were to first identify and summarise original research that compared symptoms of problematic feeding in infants with tongue tie before and after frenotomy and then evaluate the quality of measures used to assess problematic feeding. METHODS CINAHL and PubMed were searched for ((tongue-tie) or (ankyloglossia)) and ((feeding) or (breastfeeding) or (bottle-feeding)) and ((frenotomy) or (frenectomy) or (frenulectomy) or (frenulotomy)). Original research reporting on feeding before and after frenotomy in infants under 1 year old was included. RESULTS Maternal nipple pain, breastfeeding self-efficacy and LATCH scores improved after frenotomy. Few data are available on the effect of frenotomy on infant feeding. The measures used to assess infant feeding were not comprehensive and did not possess strong psychometric properties. CONCLUSION Literature suggests that maternal nipple pain, self-efficacy and LATCH scores improve in breastfeeding mother-infant dyads after frenotomy. However, current literature does not provide adequate data regarding the effect of frenotomy on the infant's ability to feed or which infants benefit from the procedure. Future research should utilise comprehensive, psychometrically sound measures to assess infants for tongue tie and to evaluate infant feeding to provide stronger evidence for the effect of frenotomy on feeding in infants with tongue tie.
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Affiliation(s)
- Rebecca R. Hill
- MGH Institute of Health Professions School of Nursing Boston MA USA
| | - Britt F. Pados
- Boston College William F. Connell School of Nursing Chestnut Hill MA USA
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Brugaletta C, Le Roch K, Saxton J, Bizouerne C, McGrath M, Kerac M. Breastfeeding assessment tools for at-risk and malnourished infants aged under 6 months old: a systematic review. F1000Res 2020; 9:1310. [PMID: 33628437 PMCID: PMC7898355 DOI: 10.12688/f1000research.24516.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Many small and malnourished infants under 6 months of age have problems with breastfeeding and restoring effective exclusive breastfeeding is a common treatment goal. Assessment is a critical first step of case management, but most malnutrition guidelines do not specify how best to do this. We aimed to identify breastfeeding assessment tools for use in assessing at-risk and malnourished infants in resource-poor settings. Methods: We systematically searched: Medline and Embase; Web of Knowledge; Cochrane Reviews; Eldis and Google Scholar databases. Also the World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), CAse REport guidelines, Emergency Nutrition Network, and Field Exchange websites. Assessment tool content was analysed using a framework describing breastfeeding 'domains' (baby's behaviour; mother's behaviour; position; latching; effective feeding; breast health; baby's health; mother's view of feed; number, timing and length of feeds). Results: We identified 29 breastfeeding assessment tools and 45 validation studies. Eight tools had not been validated. Evidence underpinning most tools was low quality and mainly from high-income countries and hospital settings. The most comprehensive tools were the Breastfeeding, Evaluation and Education Tool, UNICEF Baby-Friendly Hospital Initiative tools and CARE training package. The tool with the strongest evidence was the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form. Conclusions: Despite many possible tools, there is currently no one gold standard. For assessing malnourished infants in resource-poor settings, UNICEF Baby-Friendly Hospital Initiative tools, Module IFE and the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form are the best available tools but could be improved by adding questions from other tools. Allowing for context, one tool for rapid community-based assessment plus a more detailed one for clinic/hospital assessment might help optimally identify breastfeeding problems and the support required. Further research is important to refine existing tools and develop new ones. Rigorous testing, especially against outcomes such as breastfeeding status and growth, is key.
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Affiliation(s)
- Concetta Brugaletta
- Gastrointestinal Physiology Unit, University College London Hospitals NHS Trust, London, England, NW12BW, UK
| | - Karine Le Roch
- Mental Health and Care Practices Department, Action Contre la Faim, 75017 Paris, France
| | | | - Cécile Bizouerne
- Mental Health and Care Practices Department, Action Contre la Faim, 75017 Paris, France
| | - Marie McGrath
- Emergency Nutrition Network, Kidlington, England, OX5 2DN, UK
| | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, England, WC1E 7HT, UK
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Brugaletta C, Le Roch K, Saxton J, Bizouerne C, McGrath M, Kerac M. Breastfeeding assessment tools for at-risk and malnourished infants aged under 6 months old: a systematic review. F1000Res 2020; 9:1310. [PMID: 33628437 PMCID: PMC7898355 DOI: 10.12688/f1000research.24516.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 11/08/2023] Open
Abstract
Background: Many small and malnourished infants under 6 months of age have problems with breastfeeding and restoring effective exclusive breastfeeding is a common treatment goal. Assessment is a critical first step of case management, but most malnutrition guidelines do not specify how best to do this. We aimed to identify breastfeeding assessment tools for use in assessing at-risk and malnourished infants in resource-poor settings. Methods: We systematically searched: Medline and Embase; Web of Knowledge; Cochrane Reviews; Eldis and Google Scholar databases. Also the World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), CAse REport guidelines, Emergency Nutrition Network, and Field Exchange websites. Assessment tool content was analysed using a framework describing breastfeeding 'domains' (baby's behaviour; mother's behaviour; position; latching; effective feeding; breast health; baby's health; mother's view of feed; number, timing and length of feeds). Results: We identified 29 breastfeeding assessment tools and 45 validation studies. Eight tools had not been validated. Evidence underpinning most tools was low quality and mainly from high-income countries and hospital settings. The most comprehensive tools were the Breastfeeding, Evaluation and Education Tool, UNICEF Baby-Friendly Hospital Initiative tools and CARE training package. The tool with the strongest evidence was the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form. Conclusions: Despite many possible tools, there is currently no one gold standard. For assessing malnourished infants in resource-poor settings, UNICEF Baby-Friendly Hospital Initiative tools, Module IFE and the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form are the best available tools but could be improved by adding questions from other tools. Allowing for context, one tool for rapid community-based assessment plus a more detailed one for clinic/hospital assessment might help optimally identify breastfeeding problems and the support required. Further research is important to refine existing tools and develop new ones. Rigorous testing, especially against outcomes such as breastfeeding status and growth, is key.
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Affiliation(s)
- Concetta Brugaletta
- Gastrointestinal Physiology Unit, University College London Hospitals NHS Trust, London, England, NW12BW, UK
| | - Karine Le Roch
- Mental Health and Care Practices Department, Action Contre la Faim, 75017 Paris, France
| | | | - Cécile Bizouerne
- Mental Health and Care Practices Department, Action Contre la Faim, 75017 Paris, France
| | - Marie McGrath
- Emergency Nutrition Network, Kidlington, England, OX5 2DN, UK
| | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, England, WC1E 7HT, UK
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Estimates of Preterm Infants' Breastfeeding Transfer Volumes Are Not Reliably Accurate. Adv Neonatal Care 2020; 20:E93-E99. [PMID: 32868595 DOI: 10.1097/anc.0000000000000721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adequate human milk nutrition is critical for infant growth and neurodevelopment; however, low milk transfer volumes are common when establishing preterm breastfeeding. Despite clinical assessments of milk transfer volumes at the breast being inaccurate, measurement of feed volume via test weighing is rarely carried out either routinely or in cases where infant weight gain is inadequate. PURPOSE To assess the accuracy of the Preterm Breastfeeding Assessment Tool (PBAT) in determining transfer volumes and examine factors associated with PBAT accuracy. METHODS Pre/postfeed weights were performed using electronic scales and PBAT scores recorded for 1186 breastfeeds in 60 preterm infants born less than 33/40 and 33 to 39/40 postmenstrual age. Measured milk intake volumes were converted to percent prescribed feed volume and compared with PBAT estimates of milk transfer. RESULTS The PBAT is accurate in identifying when no milk is transferred at the breast but not in estimating transfer of half or the full prescribed volume (accuracy 26% and 47%, respectively). Wide ranges of transfer volumes (11-75 mL) were observed within and between infants, and for 20% of breastfeeds, no milk was transferred. Preterm Breastfeeding Assessment Tool accuracy decreased with each 1-week increase in birth gestation (odds ratio = 0.82; 95% confidence interval, 0.71-0.94; P = .004). IMPLICATIONS FOR PRACTICE When establishing breastfeeding, test weighing facilitates adequate nutrition by guiding appropriate complementary feeding. For mothers breastfeeding several times per day in preparation for discharge home, test weighing may offer a useful tool for developing maternal confidence in assessing milk transfer. Preterm Breastfeeding Assessment Tool is inaccurate in assessing preterm infants' milk transfer volumes when breastfeeding. IMPLICATIONS FOR RESEARCH While studies have typically focused on medically stable infants, test weighing offers a useful tool to examine breastfeeding efficacy and inform nutritional management of preterm infants with complications such as chronic lung and cardiac disease.
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Hill RR, Park J, Pados BF. Bottle-Feeding Challenges in Preterm-Born Infants in the First 7 Months of Life. Glob Pediatr Health 2020; 7:2333794X20952688. [PMID: 32953946 PMCID: PMC7479869 DOI: 10.1177/2333794x20952688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/03/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022] Open
Abstract
Preterm infants frequently experience oral feeding challenges while in the
neonatal intensive care unit, with research focusing on infant feeding during
this hospital stay. There is little data on symptoms of problematic feeding in
preterm-born infants in the months after discharge. The purpose of this study
was to describe symptoms of problematic bottle-feeding in the first 7 months of
life in infants born preterm, compared to full-term infants. Parents of infants
less than 7 months old completed an online survey that included the Neonatal
Eating Assessment Tool—Bottle-feeding and questions about the infant’s medical
and feeding history. General linear models were used to evaluate differences in
NeoEAT—Bottle-feeding total score and subscale scores by preterm category,
considering other significant factors. Very preterm infants had more symptoms of
problematic bottle-feeding than other infants. Current age, presence of
gastroesophageal reflux, and anomalies of the face/mouth were associated with
problematic bottle-feeding.
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Affiliation(s)
- Rebecca R. Hill
- MGH Institute of Health Professions,
Boston, MA, USA
- Rebecca R. Hill, DNP, FNP-C, MGH Institute
of Health Professions, 36 First Avenue, Boston, MA 02129, USA.
| | - Jinhee Park
- William F. Connell School of Nursing,
Boston College, Chestnut Hill, MA, USA
| | - Britt F. Pados
- William F. Connell School of Nursing,
Boston College, Chestnut Hill, MA, USA
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Suiter DM, Daniels SK, Barkmeier-Kraemer JM, Silverman AH. Swallowing Screening: Purposefully Different From an Assessment Sensitivity and Specificity Related to Clinical Yield, Interprofessional Roles, and Patient Selection. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:979-991. [PMID: 32650661 DOI: 10.1044/2020_ajslp-19-00140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this clinical focus article is to summarize the goal and process by which identification of individuals at risk for having feeding problems or dysphagia is clinically screened across the life span by speech-language pathologists (SLPs). The topic of this clinical focus article was presented at the Charleston Swallowing Conference in Chicago, Illinois, in July 2018. The contents of this clinical focus article offer an expanded summary of information discussed at this meeting with focus on critical considerations to guide clinical decisions by SLPs regarding the optimal feeding and dysphagia screening approach and process. Conclusion Screening is a critical first step in the identification of individuals at risk for feeding problems and dysphagia across the life span. Understanding the difference between screening and assessment objectives as well as having the knowledge, skills, and clinical competency to implement psychometrically sound screening approaches is a recommended clinical practice standard for SLPs working with these clinical populations. This clinical focus article summarizes critical considerations for identifying individuals at risk for feeding problems and dysphagia across the life span to guide clinicians working with dysphagia populations.
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Affiliation(s)
- Debra M Suiter
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Stephanie K Daniels
- Department of Communication Sciences and Disorders, University of Houston, TX
| | | | - Alan H Silverman
- Section of Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee
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Garand KLF, McCullough G, Crary M, Arvedson JC, Dodrill P. Assessment Across the Life Span: The Clinical Swallow Evaluation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:919-933. [PMID: 32650662 DOI: 10.1044/2020_ajslp-19-00063] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose This clinical focus article considers the roles of the clinical swallow examination (CSE) as a clinically meaningful assessment method used in both adult and pediatric populations. Method This clinical focus article explores the utility of the CSE across the life span. Specifically, components, reliability, standardized assessments, and limitations of the CSE within the adult and pediatric populations are highlighted. Conclusions The CSE remains a crucial assessment tool for the speech-language pathologist. The experienced clinician can make important judgments regarding patient safety and function. If the CSE is conducted mindfully and methodically, findings can help chart the course of care for individuals needing additional assessment and possibly intervention.
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Affiliation(s)
| | - Gary McCullough
- Department of Communication Sciences and Disorders, Appalachian State University, Boone, NC
| | - Michael Crary
- School of Communication Sciences and Disorders, University of Central Florida, Orlando
| | - Joan C Arvedson
- Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin-Milwaukee
| | - Pamela Dodrill
- Department of Otolaryngology, Boston Children's Hospital Boston, MA
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Pados BF, Park J, Thoyre SM. Neonatal Eating Assessment Tool-Breastfeeding: Reference Values for Infants Less Than 7 Months old. J Hum Lact 2020; 36:236-244. [PMID: 31465698 DOI: 10.1177/0890334419869598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Neonatal Eating Assessment Tool-Breastfeeding is a valid and reliable 62-item parent-report assessment of symptoms of problematic breastfeeding behavior intended for infants less than 7 months old. RESEARCH AIM The aim of this study was to describe the Neonatal Eating Assessment Tool-Breastfeeding total score and subscale scores within a sample of full-term, healthy, typically-developing infants under 7 months old. METHODS Parents of healthy, full-term breastfeeding infants (N = 475) less than 7 months old completed the Neonatal Eating Assessment Tool - Breastfeeding through an online survey. Descriptive statistics were calculated for the total score and seven subscale scores within each age group: 0-2, 2-4, 4-6, and 6-7 months. RESULTS Neonatal Eating Assessment Tool-Breastfeeding total scores were highest (i.e., more problematic symptoms) at 0-2 months and decreased in older infant age groups. All subscale scores also had a downward trajectory in symptoms of problematic breastfeeding except the subscale Compelling Symptoms of Problematic Feeding, which was very low across age groups. Scores on the Infant Regulation subscale remained elevated for the first 6 months of life, then declined markedly in the 6-7 month age group. CONCLUSION The Neonatal Eating Assessment Tool-Breastfeeding now has reference values to facilitate interpretation of scores and guide decision-making, personalization of interventions, and assessment of response to interventions. For research, the Neonatal Eating Assessment Tool-Breastfeeding can be used to follow longitudinal development of breastfeeding as well as to test efficacy of breastfeeding interventions.
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Affiliation(s)
- Britt Frisk Pados
- 6019 Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Jinhee Park
- 6019 Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Suzanne M Thoyre
- 2331 University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
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Pados BF, Thoyre SM, Galer K. Neonatal Eating Assessment Tool - Mixed Breastfeeding and Bottle-Feeding (NeoEAT - Mixed Feeding): factor analysis and psychometric properties. Matern Health Neonatol Perinatol 2019; 5:12. [PMID: 31384477 PMCID: PMC6668191 DOI: 10.1186/s40748-019-0107-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/04/2019] [Indexed: 01/11/2023] Open
Abstract
Background Early identification of feeding difficulty in infancy is critical to supporting breastfeeding and ensuring optimal nutrition for brain development. The Neonatal Eating Assessment Tool (NeoEAT) is a parent-report assessment that currently has two versions: NeoEAT – Breastfeeding and NeoEAT – Bottle-feeding for use in breast and bottle-fed infants, respectively. There are currently no valid and reliable parent-report measures to assess feeding through a combination of both breast and bottle delivery. The purpose of this study was to conduct a factor analysis and test the psychometric properties of a new measure, the NeoEAT – Mixed Breastfeeding and Bottle-Feeding (NeoEAT – Mixed Feeding), including internal consistency reliability, test-retest reliability, construct validity and known-groups validity. Methods Parents of infants younger than 7 months who had fed by both bottle and breast in the previous 7 days were invited to participate. Internal consistency reliability was tested using Cronbach’s α. Test-retest reliability was tested between scores on the NeoEAT – Mixed Feeding completed 2 weeks apart. Construct validity was tested using correlations between the NeoEAT – Mixed-Feeding, the Infant Gastroesophageal Reflux Questionnaire - Revised (I-GERQ-R), and the Infant Gastrointestinal Symptoms Questionnaire (IGSQ). Known-groups validation was tested between healthy infants and infants with feeding problems. Results A total of 608 parents participated. Exploratory factor analysis revealed a 68-item scale with 5 sub-scales. Internal consistency reliability (Cronbach’s α = .88) and test-retest reliability (r = 0.91; p < .001) were both acceptable. Construct validity was demonstrated through correlations with the I-GERQ-R (r = 0.57; p < .001) and IGSQ (r = 0.5; p < .001). Infants with feeding problems scored significantly higher on the NeoEAT – Mixed Feeding, indicating more problematic feeding symptoms, than infants without feeding problems (p < .001), supporting known-groups validity. Conclusions The NeoEAT – Mixed Feeding is a 68-item parent-reported measure of breast- and bottle-feeding behavior for infants less than 7 months old that now has evidence of validity and reliability for use in clinical practice and research. The NeoEAT – Mixed Feeding can be used to identify infants with problematic feeding, guide referral decisions, and evaluate response to interventions.
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Affiliation(s)
- Britt Frisk Pados
- 1Boston College William F. Connell School of Nursing, Maloney 268, Chestnut Hill, MA 02467 USA
| | - Suzanne M Thoyre
- 2University of North Carolina at Chapel Hill School of Nursing, Carrington Hall, Chapel Hill, NC 27599 USA
| | - Kara Galer
- 1Boston College William F. Connell School of Nursing, Maloney 268, Chestnut Hill, MA 02467 USA
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Pados BF, Park J, Thoyre SM. Neonatal Eating Assessment Tool-Bottle-Feeding: Norm-Reference Values for Infants Less Than 7 Months Old. Clin Pediatr (Phila) 2019; 58:857-863. [PMID: 30938192 DOI: 10.1177/0009922819839234] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The Neonatal Eating Assessment Tool (NeoEAT)-Bottle-feeding is a parent-report assessment of bottle-feeding behavior in infants less than 7 months old with evidence of validity and reliability. The purpose of this study was to establish norm-reference values to guide score interpretation and clinical decision making. Parents of 478 healthy, typically developing infants completed the NeoEAT-Bottle-feeding. Descriptive statistics were calculated for the following age groups: 0 to 2, 2 to 4, 4 to 6, and 6 to 7 months. NeoEAT-Bottle-feeding total scores decreased with increasing infant age. The Infant Regulation subscale contributed the most to the total score and remained high across the first 6 months of life, then decreased dramatically in the 6- to 7-month age group. The 90th and 95th percentile values for the total score and subscale scores can be used to identify infants with problematic feeding, guide referral, tailor treatment, and assess response to treatment.
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Muelbert M, Harding JE, Bloomfield FH. Nutritional policies for late preterm and early term infants - can we do better? Semin Fetal Neonatal Med 2019; 24:43-47. [PMID: 30341037 PMCID: PMC6368456 DOI: 10.1016/j.siny.2018.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Late preterm (LP) and early term (ET) infants can be considered the "great dissemblers": they resemble healthy full-term infants in appearance, but their immaturity places them at increased risk of poor short- and long-term outcomes. Nutritional requirements are greater than for full-term babies, but there are few good data on the nutritional requirements for LP and ET babies, leading to substantial variation in practice. Recent data indicate that rapid growth may be beneficial for neurocognitive function but not for body composition and later metabolic health. Breastfeeding the LP or ET infant can be challenging, and mothers of these infants may need additional support to breastfeed successfully. Future research should investigate nutritional requirements of LP and ET infants for optimal growth, addressing both short- and long-term outcomes and the potential trade-off between neurocognitive and metabolic benefits.
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Affiliation(s)
- Mariana Muelbert
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Abstract
BACKGROUND Supporting infants as they develop feeding skills is an essential component of neonatal and pediatric care. Selecting appropriate and supportive interventions begins with a thorough assessment of the infant's skills. The Early Feeding Skills (EFS) tool is a clinician-reported instrument developed to assess the emergence of early feeding skills and identify domains in need of intervention. PURPOSE The purpose of this study was to identify the factor structure of the EFS and test its psychometric properties, including internal consistency reliability and construct validity. METHODS EFS-trained interprofessional clinicians in 3 settings scored 142 feeding observations of infants 33 to 50 weeks' postmenstrual age. Redundant and rarely endorsed items were removed. Factor analysis methods clustered items into subscales. Construct validity was examined through the association of the EFS with (1) concurrently scored Infant-Driven Feeding Scale-Quality (IDFS-Q), (2) infant birth risk (gestational age), and (3) maturity (postmenstrual age). RESULTS Principal components analysis with varimax rotation supported a 5-factor structure. The total EFS demonstrated good internal consistency reliability (Cronbach α= 0.81). The total EFS score had construct validity with the IDFS-Q (r =-0.73; P < .01), and with gestational age of a subsample of premature infants (r = 0.22; P < .05). IMPLICATIONS FOR PRACTICE As a valid and reliable tool, the EFS can assist the interprofessional feeding team to organize feeding assessment and plan care. IMPLICATIONS FOR RESEARCH The strong psychometric properties of the EFS support its use in future research.
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Pados BF, Thoyre SM, Park J. Age-based norm-reference values for the Child Oral and Motor Proficiency Scale. Acta Paediatr 2018; 107:1427-1432. [PMID: 29486068 DOI: 10.1111/apa.14299] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/18/2018] [Accepted: 02/22/2018] [Indexed: 11/29/2022]
Abstract
AIM To determine reference values for the Child Oral and Motor Proficiency Scale (ChOMPS) based on healthy, typically developing and typically eating children between six months and seven years old. METHODS Parents of children six months to seven years old (n = 1057) completed the 63-item ChOMPS. Median, range, 5th and 10th percentiles were calculated for scores on the four subscales of the ChOMPS as well as the total score in each of 11 age groups. RESULTS Age-based norm-reference values are reported. By 24 months, 95% of children could perform all skills in the Basic Movement Patterns subscale. By four years, more than 95% of children could perform all of the skills in the Fundamental Oral-Motor Skills subscale. The Oral-Motor Coordination and Complex Movement Patterns skills developed later. By five years, 90% of children could perform all Oral-Motor Coordination skills. In six to seven year olds, 95% received a score of 44 of 46 on the Complex Movement Patterns subscale, indicating that some typical children had not established all of these complex skills by seven years. CONCLUSION The ChOMPS is the first valid and reliable parent-report measure of eating, drinking and related skills that has age-based norm-reference values for use in clinical practice and research.
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Affiliation(s)
- Britt Frisk Pados
- William F. Connell School of Nursing; Boston College; Chestnut Hill MA USA
| | - Suzanne M. Thoyre
- School of Nursing; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Jinhee Park
- William F. Connell School of Nursing; Boston College; Chestnut Hill MA USA
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Factor Structure and Psychometric Properties of the Neonatal Eating Assessment Tool-Bottle-Feeding (NeoEAT-Bottle-Feeding). Adv Neonatal Care 2018; 18:232-242. [PMID: 29746271 DOI: 10.1097/anc.0000000000000494] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Feeding difficulties are common in infancy. There are currently no valid and reliable parent-report measures to assess bottle-feeding in infants younger than 7 months. The Neonatal Eating Assessment Tool (NeoEAT)-Bottle-feeding has been developed and content validated. PURPOSE To determine the factor structure and psychometric properties of the NeoEAT-Bottle-feeding. METHODS Parents of bottle-feeding infants younger than 7 months were invited to participate. Exploratory factor analysis was used to determine factor structure. Internal consistency reliability was tested using Cronbach α. Test-retest reliability was tested between scores on the NeoEAT-Bottle-feeding completed 2 weeks apart. Construct validity was tested using correlations between the NeoEAT-Bottle-feeding, the Infant Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R), and the Infant Gastrointestinal Symptoms Questionnaire (IGSQ). Known-groups validation was tested by comparing scores between healthy infants and infants with feeding problems. RESULTS A total of 441 parents participated. Exploratory factor analysis revealed a 64-item scale with 5 factors. Internal consistency reliability (α= .92) and test-retest reliability (r = 0.90; P < .001) were both excellent. The NeoEAT-Bottle-feeding had construct validity with the I-GERQ-R (r = 0.74; P < .001) and IGSQ (r = 0.64; P < .001). Healthy infants scored lower on the NeoEAT-Bottle-feeding than infants with feeding problems (P < .001), supporting known-groups validity. IMPLICATIONS FOR PRACTICE The NeoEAT-Bottle-feeding is an available assessment tool for clinical practice. IMPLICATIONS FOR RESEARCH The NeoEAT-Bottle-feeding is a valid and reliable measure that can now be used in feeding research.Video Abstract Available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.
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Pados BF, Thoyre SM, Estrem HH, Park J, McComish C. Factor Structure and Psychometric Properties of the Neonatal Eating Assessment Tool-Breastfeeding. J Obstet Gynecol Neonatal Nurs 2018; 47:396-414. [PMID: 29649419 DOI: 10.1016/j.jogn.2018.02.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study was to identify the factor structure of the Neonatal Eating Assessment Tool-Breastfeeding (NeoEAT-Breastfeeding) and to assess its psychometric properties, including internal consistency reliability, test-retest reliability, and construct validity as measured by concurrent and known-groups validity. Exploratory factor analysis conducted on responses from 402 parents of breastfeeding infants younger than 7 months old showed a 62-item measure with seven subscales and acceptable internal consistency reliability (Cronbach's α = .92). Test-retest reliability was also acceptable (r = .91). The NeoEAT-Breastfeeding has evidence of concurrent validity with the Infant Gastroesophageal Reflux Questionnaire (r = .69) and Infant Gastrointestinal Symptoms Questionnaire (r = .62). The NeoEAT-Breastfeeding total score and all subscale scores were higher in infants with feeding problems than in typically feeding infants (p < .001, known-groups validity). The NeoEAT-Breastfeeding is a parent-report assessment of breastfeeding in infants from birth to 7 months old with good initial evidence of reliability and validity.
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Yi YG, Oh BM, Shin SH, Shin JY, Kim EK, Shin HI. Stress Signals During Sucking Activity Are Associated With Longer Transition Time to Full Oral Feeding in Premature Infants. Front Pediatr 2018; 6:54. [PMID: 29594085 PMCID: PMC5857543 DOI: 10.3389/fped.2018.00054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 02/26/2018] [Indexed: 11/13/2022] Open
Abstract
Several treatments have been proposed to shorten the time to the attainment of full oral feeding (FOF) for premature infants, but there are only a few evaluation methods useful in estimating predictors of this period. We investigated whether specific items within the disorganized sucking patterns described by the Neonatal Oral-Motor Assessment Scale (NOMAS) could estimate the time to FOF in preterm infants with feeding difficulty. Preterm infants diagnosed with a disorganized sucking pattern in the NOMAS evaluation before 50 weeks of postmenstrual age were included. Video recordings of at least 2 min of oral feeding were further analyzed retrospectively by two assessors and the premature infants who exhibited disorganized sucking patterns (n = 109) were divided into three clusters (clusters 2-4). The observational items compatible with disorganization in the original NOMAS were divided into three groups: cluster 2 (disorganized: arrhythmical), cluster 3 (disorganized: arrhythmical + unable to sustain), and cluster 4 (disorganized: arrhythmical + incoordination ± unable to sustain) and further divided into incoordination-positive (cluster 4) and incoordination-negative groups (clusters 2 and 3). Premature infants in the incoordination-positive group (cluster 4, which means stress signals) showed a median transition time of 22 days (range: 4-121 days) which was longer than that in the incoordination-negative group (median 6 days; range: 1-25 days). Univariate linear regression analysis revealed that the presence of incoordination among disorganized sucking patterns (NOMAS cluster 4 vs. clusters 2 and 3), birth weight, total parenteral nutrition (TPN) duration, non-invasive positive pressure ventilation duration, the presence of moderate to severe bronchopulmonary dysplasia, pulmonary hypertension, sepsis, small for gestational age (SGA), and necrotizing enterocolitis are associated with the transition time to FOF. In a multivariate linear regression analysis, the variables revealed to be associated with the transition time were TPN duration, SGA, and the presence of stress signals (incoordination-positive group) among disorganized sucking patterns. When selecting premature infants to be treated with swallowing therapy, it is reasonable to pay more attention to the incoordination-positive group described in the NOMAS, that is, premature infants with stress signals to shorten the time to attain FOF.
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Affiliation(s)
- You Gyoung Yi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung Han Shin
- Division of Neonatology, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Jin Yong Shin
- Department of Pediatric Occupational Therapy, Seoul National University Children's Hospital, Seoul, South Korea
| | - Ee-Kyung Kim
- Division of Neonatology, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Pados BF, Estrem HH, Thoyre SM, Park J, McComish C. The Neonatal Eating Assessment Tool: Development and Content Validation. Neonatal Netw 2017; 36:359-367. [PMID: 29185947 DOI: 10.1891/0730-0832.36.6.359] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To develop and content validate the Neonatal Eating Assessment Tool (NeoEAT), a parent-report measure of infant feeding. DESIGN The NeoEAT was developed in three phases. Phase 1: Items were generated from a literature review, available assessment tools, and parents' descriptions of problematic feeding in infants.Phase 2: Professionals rated items for relevance and clarity. Content validity indices were calculated. Phase 3: Parent understanding was explored through cognitive interviews. SAMPLE Phase 1: Descriptions of infant feeding were obtained from 12 parents of children with diagnosed feeding problems and 29 parents of infants younger than seven months. Phase 2: Nine professionals rated items. Phase 3: Sixteen parents of infants younger than seven months completed the cognitive interview. MAIN OUTCOME VARIABLE Content validity of the NeoEAT. RESULTS Three versions were developed: NeoEAT Breastfeeding (72 items), NeoEAT Bottle Feeding (74 items), and NeoEAT Breastfeeding and Bottle Feeding (89 items).
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Viviers M, Kritzinger A, Vinck B, Graham M. Preliminary psychometric performance of the Neonatal Feeding Assessment Scale. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2017; 64:e1-e8. [PMID: 28155281 PMCID: PMC5843074 DOI: 10.4102/sajcd.v64i1.163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 11/11/2016] [Accepted: 09/22/2016] [Indexed: 12/01/2022] Open
Abstract
Objective The objective was to determine the preliminary psychometric performance of a new clinical feeding scale to diagnose oropharyngeal dysphagia (OPD) in neonates. Methods Twenty neonates with a median gestational age of 35 weeks were evaluated using the Neonatal Feeding Assessment Scale (NFAS) and modified barium swallow studies (MBSS). The results were compared. Results Nine of the 20 participants presented with OPD on the NFAS. Comparison of the scale’s results with instrumental MBSS indicated that all participants without OPD were correctly excluded (100% sensitivity). The specificity was 78.6%, indicating that three participants were falsely identified with OPD on the scale. Inter-rater reliability was determined on 50% (n = 10) of the sample. Substantial agreement (80%) was obtained between two raters in five of the six sections of the scale and on the diagnostic outcome. Conclusion The preliminary performance of the scale appears to be promising. A further validation study will take place.
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Affiliation(s)
- Mari Viviers
- Department of Speech-Language Pathology and Audiology, University of Pretoria.
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Viviers M, Kritzinger A, Vinck B. Development of a clinical feeding assessment scale for very young infants in South Africa. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2016; 63:e1-e11. [PMID: 27796101 PMCID: PMC5843192 DOI: 10.4102/sajcd.v63i1.148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 08/01/2016] [Accepted: 08/07/2016] [Indexed: 11/30/2022] Open
Abstract
Background There is a need for validated neonatal feeding assessment instruments in South Africa. A locally developed instrument may contribute to standardised evaluation procedures of high-risk neonates and address needs in resource constrained developing settings. Objective The aim of the study was to develop and validate the content of a clinical feeding assessment scale to diagnose oropharyngeal dysphagia (OPD) in neonates. Method The Neonatal Feeding Assessment Scale (NFAS) was developed using the Delphi method. Five international and South African speech-language therapists (SLTs) formed the expert panel, participating in two rounds of electronic questionnaires to develop and validate the content of the NFAS. Results All participants agreed on the need for the development of a valid clinical feeding assessment instrument to use with the neonatal population. The initial NFAS consisted of 240 items across 8 sections, and after the Delphi process was implemented, the final format was reduced to 211 items across 6 sections. The final format of the NFAS is scored using a binary scoring system guiding the clinician to diagnose the presence or absence of OPD. All members agreed on the format, the scoring system and the feeding constructs addressed in the revised final format of the NFAS. Conclusion The Delphi method and the diverse clinical and research experience of participants could be integrated to develop the NFAS which may be used in clinical practice in South Africa or similar developing contexts. Because of demographically different work settings marked by developed versus developing contexts, participants did not have the same expectations of a clinical dysphagia assessment. The international participants contributed to evidence-based content development. Local participants considered the contextual challenges of South African SLTs entering the field with basic competencies in neonatal dysphagia management, thereby justifying a comprehensive clinical instrument. The NFAS is aimed at clinicians working in Neonatal Intensive Care Units where they manage large caseloads of high-risk neonates. Further validation of the NFAS is recommended to determine its criterion validity in comparison with a widely accepted standard such as the modified barium swallow study.
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Affiliation(s)
- Mari Viviers
- Department of Speech-Language Pathology and Audiology, University of Pretoria.
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