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Pineda R, Vesoulis Z, El Ters N, Mathur A. aEEG in the first 3 days after extremely preterm delivery relates to neurodevelopmental outcomes. J Perinatol 2024; 44:857-864. [PMID: 38553599 PMCID: PMC11161402 DOI: 10.1038/s41372-024-01945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Investigate relationships between aEEG in the first 72 h in extremely preterm infants with 1) infant, medical, and environmental factors, and 2) infant feeding and neurobehavioral outcomes at term and school-age. METHODS Sixty-four preterm infants (≤28 weeks gestation) were enrolled within the first 24-hours of life and had two-channel aEEG until 72 h of life. Standardized neurobehavioral and feeding assessments were conducted at term, and parent-reported outcomes were documented at 5-7 years. RESULTS Lower aEEG Burdjalov scores (adjusted for gestational age) were related to vaginal delivery (p = 0.04), cerebral injury (p = 0.01), Black race (p < 0.01) and having unmarried parents (p = 0.02). Lower Burdjalov scores related to less NICU Network Neurobehavioral Scale arousal (p = 0.002) at term and poorer BRIEF global executive function (p = 0.004), inhibition (p = 0.007), working memory (p = 0.02), material organization (p = 0.0008), metacognition (p = 0.01), and behavioral regulation (p = 0.02) at 5-7 years. We did not observe relationships of early aEEG to feeding outcomes or sensory processing measures. CONCLUSION Early aEEG within the first 72 h of life was related to medical and sociodemographic factors as well as cognitive outcome at 5-7 years.
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Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
- Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, USA.
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA.
- Program in Occupational Therapy, Washington University St. Louis, St. Louis, MO, USA.
| | - Zachary Vesoulis
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Nathalie El Ters
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Amit Mathur
- Department of Pediatrics, St. Louis University, St. Louis, MO, USA
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Martens A, Phillips H, Hines M, Zimmerman E. An examination of the association between infant non-nutritive suck and developmental outcomes at 12 months. PLoS One 2024; 19:e0298016. [PMID: 38315689 PMCID: PMC10843074 DOI: 10.1371/journal.pone.0298016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To determine the association between infant non-nutritive suck (NNS) dynamics at 3 months and developmental outcomes at 12 months of age in full-term infants. We hypothesized that infants with more mature NNS at 3 months, as evidence by shorter burst duration, fewer cycles per burst, cycles per minute, higher amplitude, and more bursts, would have higher (better) scores on the developmental outcomes at 12 months. METHODS This was a prospective study that utilized objective and self-report measures. A five-minute NNS sample was collected from 67 infants (54% male) at 3 months of age (average age 2.99 (0.27) months). At 12 months (average age 11.91 (0.26) months), the Development Profile-3 was administered through caregiver interview. RESULTS Infant NNS burst duration, cycles per burst, and cycles per minute were significantly negatively associated with the Development Profile-3 cognitive domain and general scores at 12 months. This is consistent with our hypothesis that infants who have more efficient NNS (fewer bursts and cycles) at 3 months would have higher (better) scores on the Development Profile-3 at 12 months. CONCLUSIONS Findings from this work complement emerging research linking infant NNS with subsequent neurodevelopmental outcomes. This is the first time that these associations have been examined using a quantitative and physiologic-based measure of NNS. These results seem to indicate that specific NNS metrics, which demonstrate maturation of this complex skill, may be useful predictors of neurodevelopment later in life.
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Affiliation(s)
- Alaina Martens
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States of America
| | - Hannah Phillips
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States of America
| | - Morgan Hines
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States of America
| | - Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States of America
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Alonso-Fernández S, de Liria CRG, Lluch-Canut T, Poch-Pla L, Perapoch-López J, Juvé-Udina ME, Martínez-Momblan MA, Hurtado-Pardos B, Roldán-Merino JF. Psychometric properties of the oral feeding assessment in premature infants scale. Sci Rep 2022; 12:7836. [PMID: 35551222 PMCID: PMC9098432 DOI: 10.1038/s41598-022-11521-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Professionals that work in neonatal units need to identify the strengths and weaknesses of the premature infant who is in the transition process from feeding through a gastric tube to oral feeding. The main aim of this study was to validate the Oral FEeding Assessment in premaTure INfants (OFEATINg) instrument. A psychometric validity and reliability study was conducted in Neonatal Intensive Care Units of two public, metropolitan, university hospitals. The study population were premature infants at a postconceptional age of 31-35 weeks. The study included evaluation of the reliability, convergent, discriminant and construct validity, sensitivity and specificity of the OFEATINg instrument. A total of 621 feedings of 56 preterm infants were evaluated. Confirmatory factor analysis identified 3 factors and 13 indicators with a good fit to the model. Cronbach's alpha coefficient was 0.78. The instrument showed high indices of inter-rater reliability (Pearson 0.9 and intraclass correlation coefficient 0.95). The OFEATINg scale is a valid and reliable instrument for evaluating the readiness for oral feeding of preterm infants. It may enable clinicians to evaluate the physiological and behavioral abilities involved in the oral feeding process and help them make decisions related to the transition to full oral feeding.Clinical trial registration: This study was prospectively registered at the two Institutional review boards.
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Affiliation(s)
- Sergio Alonso-Fernández
- Faculty of Nursing, Rovira i Virgili University, Avinguda Catalunya, 35, 43002, Tarragona, Spain.
- Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Ctra de Canyet s/n, 08916, Badalona, Spain.
- IDIBELL, Bellvitge Biomedical Research Institute, Avinguda de la Granvia, 199, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.
| | - Carlos Rodrigo Gonzalo de Liria
- Department of Pediatrics, Germans Trias i Pujol University Hospital, Ctra de Canyet s/n, 08916, Badalona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona, Ctra Can Ruti-Camí Escoles, s/n, 08916, Badalona, Spain
| | - Teresa Lluch-Canut
- Department of Psychosocial and Mental Health Nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Laura Poch-Pla
- Neonatal and Paediatric Intensive Care Unit, Doctor Josep Trueta University Hospital, 17007, Girona, Spain
| | - Josep Perapoch-López
- Neonatal and Paediatric Intensive Care Unit, Doctor Josep Trueta University Hospital, 17007, Girona, Spain
| | - Maria-Eulàlia Juvé-Udina
- Nursing Research Group (GRIN), IDIBELL Bellvitge Biomedical Research Institute, Avinguda de La Granvia, 199, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Maria-Antonia Martínez-Momblan
- Fundamental Care and Medical-Surgical Nursing Department, School of Nursing, University of Barcelona, Pavelló de Govern, 3° pl, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Biomedical Research Networking Centre of Rare Diseases (CIBER-ER), Unit 747 ISCIII, Madrid, Spain
| | - Bárbara Hurtado-Pardos
- IDIBELL, Bellvitge Biomedical Research Institute, Avinguda de la Granvia, 199, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Campus Docent Sant Joan de Déu, School of Nursing, University of Barcelona, Carrer Miret i Sans 10-16, 08034, Barcelona, Spain
| | - Juan-Francisco Roldán-Merino
- Campus Docent Sant Joan de Déu, School of Nursing, University of Barcelona, Carrer Miret i Sans 10-16, 08034, Barcelona, Spain
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The Effect of Training on Neonatal Nurses' Knowledge about Transitioning Preterm Infants to Oral Feeding. J Pediatr Nurs 2021; 61:185-190. [PMID: 34111838 DOI: 10.1016/j.pedn.2021.05.019] [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] [Received: 02/25/2021] [Revised: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neonatal nurses require knowledge of evidence-based interventions that can be utilized for supporting oral feeding skills in preterm infants. Little is known about the impact of education/training programs on neonatal nurses' knowledge of this topic. PURPOSE This study was conducted to determine the effect of a training program about evidence-based interventions for the transition to and support of oral feeding in preterm infants on the knowledge levels of neonatal nurses. METHODS We conducted a pretest-posttest studywith 73 neonatal nurses in a research and training hospital. Participants completed a demographic information form and their knowledge about oral feeding in preterm infants was assessed before and after a 240-min training about the transition to oral feeding and evidence-based therapeutic interventions to promote preterm infants' oral feeding skills. RESULTS Posttest scores evaluated at 1 week (81.6 ± 6.8) and 1 month (79.5 ± 6.5) after the training were significantly higher than pre-test scores (66.8 ± 6.9) (p < 0.001). CONCLUSION Neonatal nurses showed higher levels of knowledge about evidence-based interventions for supporting oral feeding skills in preterm infants at 1 week and 1 month after the training program compared to their knowledge before training. IMPLICATIONS FOR PRACTICE Providing training to neonatal intensive care nurses on the transition to oral feeding in preterm infants will increase their level of knowledge and ensure that oral feeding interventions for preterm infants can be implemented using evidence-based therapeutic methods.
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Pados BF, Hill RR, Yamasaki JT, Litt JS, Lee CS. Prevalence of problematic feeding in young children born prematurely: a meta-analysis. BMC Pediatr 2021; 21:110. [PMID: 33676453 PMCID: PMC7936467 DOI: 10.1186/s12887-021-02574-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/24/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Difficulties related to eating are often reported in children born preterm. The objective of this study was to quantitatively synthesize available data on the prevalence of problematic feeding in children under 4 years of age who were born preterm. METHODS Literature was identified from PubMed, CINAHL, and PsycInfo. The search was limited to English language and publication years 2000-2020. To be included in the meta-analysis, the article had to report the prevalence of problematic oral feeding within a population of children born prematurely (< 37 weeks' gestation), and the child age at the time of study had to be between full-term corrected age and 48 months. For studies meeting inclusion criteria, the following data were extracted: sample size and subsamples by gestational age and/or child age at time of study; definition of problematic feeding; measures used for assessment of feeding; gestational age at time of birth of sample; child age at time of study; exclusion criteria for the study; and prevalence of problematic feeding. Random-effects meta-analyses were performed to estimate the prevalence of problematic feeding across all studies, by gestational age at birth, and by child age at time of study. RESULTS There were 22 studies that met inclusion criteria. Overall prevalence of problematic feeding (N = 4381) was 42% (95% CI 33-51%). Prevalence was neither significantly different across categories of gestational age nor by child age at the time of study. Few studies used psychometrically-sound assessments of feeding. CONCLUSION Problematic feeding is highly prevalent in prematurely-born children in the first 4 years of life regardless of degree of prematurity. Healthcare providers of children born preterm should consider screening for problematic feeding throughout early childhood as a potential complication of preterm birth. SYSTEMATIC REVIEW REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Britt Frisk Pados
- Boston College William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 268, Chestnut Hill, MA, 02467, USA.
| | - Rebecca R Hill
- Boston College William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 268, Chestnut Hill, MA, 02467, USA
| | - Joy T Yamasaki
- CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
| | - Jonathan S Litt
- Beth Israel Deaconess Medical Center, Boston Children's Hospital, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 268, Chestnut Hill, MA, 02467, USA
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Shandley S, Capilouto G, Tamilia E, Riley DM, Johnson YR, Papadelis C. Abnormal Nutritive Sucking as an Indicator of Neonatal Brain Injury. Front Pediatr 2021; 8:599633. [PMID: 33511093 PMCID: PMC7835320 DOI: 10.3389/fped.2020.599633] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/24/2020] [Indexed: 12/27/2022] Open
Abstract
A term neonate is born with the ability to suck; this neuronal network is already formed and functional by 28 weeks gestational age and continues to evolve into adulthood. Because of the necessity of acquiring nutrition, the complexity of the neuronal network needed to suck, and neuroplasticity in infancy, the skill of sucking has the unique ability to give insight into areas of the brain that may be damaged either during or before birth. Interpretation of the behaviors during sucking shows promise in guiding therapies and how to potentially repair the damage early in life, when neuroplasticity is high. Sucking requires coordinated suck-swallow-breathe actions and is classified into two basic types, nutritive and non-nutritive. Each type of suck has particular characteristics that can be measured and used to learn about the infant's neuronal circuitry. Basic sucking and swallowing are present in embryos and further develop to incorporate breathing ex utero. Due to the rhythmic nature of the suck-swallow-breathe process, these motor functions are controlled by central pattern generators. The coordination of swallowing, breathing, and sucking is an enormously complex sensorimotor process. Because of this complexity, brain injury before birth can have an effect on these sucking patterns. Clinical assessments allow evaluators to score the oral-motor pattern, however, they remain ultimately subjective. Thus, clinicians are in need of objective measures to identify the specific area of deficit in the sucking pattern of each infant to tailor therapies to their specific needs. Therapeutic approaches involve pacifiers, cheek/chin support, tactile, oral kinesthetic, auditory, vestibular, and/or visual sensorimotor inputs. These therapies are performed to train the infant to suck appropriately using these subjective assessments along with the experience of the therapist (usually a speech therapist), but newer, more objective measures are coming along. Recent studies have correlated pathological sucking patterns with neuroimaging data to get a map of the affected brain regions to better inform therapies. The purpose of this review is to provide a broad scope synopsis of the research field of infant nutritive and non-nutritive feeding, their underlying neurophysiology, and relationship of abnormal activity with brain injury in preterm and term infants.
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Affiliation(s)
- Sabrina Shandley
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Gilson Capilouto
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington, KY, United States
- NFANT Labs, LLC, Marietta, GA, United States
| | - Eleonora Tamilia
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - David M. Riley
- Neonatal Intensive Care Unit, Cook Children's Health Care System, Fort Worth, TX, United States
- School of Medicine, Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Yvette R. Johnson
- Neonatal Intensive Care Unit, Cook Children's Health Care System, Fort Worth, TX, United States
- School of Medicine, Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX, United States
- Neonatal Intensive Care Unit Early Support and Transition (NEST), Developmental Follow-Up Center, Neonatology Department, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Christos Papadelis
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, United States
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
- School of Medicine, Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX, United States
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States
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Neonatal feeding performance is related to feeding outcomes in childhood. Early Hum Dev 2020; 151:105202. [PMID: 33161344 PMCID: PMC7732130 DOI: 10.1016/j.earlhumdev.2020.105202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/18/2020] [Accepted: 09/23/2020] [Indexed: 11/21/2022]
Abstract
AIM Define relationships of early feeding performance with feeding outcomes in childhood, while assessing the predictive validity of the Neonatal Eating Outcome Assessment. STUDY DESIGN Ninety-one infants (44 preterm infants born ≤32 weeks at term-equivalent age and 47 full-term infants within 4 days of life) had feeding evaluated using the Neonatal Eating Outcome Assessment and the Neonatal Oral Motor Assessment Scale (NOMAS). At 4 years of age, 39 of these infants (22 preterm infants and 17 full-term infants; 43% follow-up rate) had parent-report measures of feeding conducted using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and Pediatric Eating Assessment Tool (PediEAT). RESULTS Lower Neonatal Eating Outcome Assessment scores were related to higher PediEAT scores (p = 0.01; r = -0.44), but were not related to BPFAS scores (p = 0.17; r = -0.23). Relationships were not detected between the NOMAS and BPFAS (p = 0.35; r = 0.17), and relationships between the NOMAS and PediEAT failed to reach significance (p = 0.06; r = 0.34). There was a relationship between the BPFAS and PediEAT scores at 4 years (p < 0.001; r = 0.66). Preterm infants performed poorer than full-term infants on the Neonatal Eating Outcome Assessment (p < 0.001) and NOMAS (p < 0.001), but no differences were detected in preterm compared to full-term performance on the BPFAS (p = 0.87) and PediEAT scores (p = 0.27). DISCUSSION Neonatal feeding performance is an important predictor of feeding outcomes at 4 years of age. The Neonatal Eating Outcome Assessment has predictive validity, and the Pediatric Eating Assessment Tool has concurrent validity with relationships to another childhood feeding tool.
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Turkish Neonatal Nurses' Knowledge and Practices Regarding the Transition to Oral Feeding in Preterm Infants: A Descriptive, Cross-sectional Study. J Pediatr Nurs 2020; 53:e179-e185. [PMID: 32321668 DOI: 10.1016/j.pedn.2020.03.017] [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] [Received: 01/21/2020] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE Neonatal nurses play an important role in preterm infants' safe and successful transition to oral feeding. Little is known about neonatal nurses' knowledge and practices regarding the transition to oral feeding in preterm infants. The aim of this study was to determine neonatal nurses' knowledge levels and clinical practices related to the process of transitioning preterm infants to oral feeding. DESIGN AND METHOD This descriptive cross-sectional study was conducted with 275 neonatal nurses working in the neonatal intensive care units of 9 different hospitals in Istanbul, Turkey. Data were collected using a participant demographic form and a questionnaire about the neonatal nurses' knowledge and practices regarding oral feeding. RESULTS The mean knowledge score of the nurses in this study was 64.7 out of 100 (SD = ±8.7; range = 40-87.5). Rates of correct responses were particularly low for items related to cue-based feeding, interventions to promote oral-motor development, non-nutritive sucking, and infant positioning for oral feeding. All of the NICU nurses participating in the study did not use the protocols developed for transitioning preterm infants to oral feeding. CONCLUSIONS Nurses need knowledge and practical training on evidence-based therapeutic interventions that promote oral feeding skills in preterm infants during the transition to oral feeding. The use of protocols developed for transitioning preterm infants to oral feeding is limited in NICUs. PRACTICE IMPLICATIONS In order to facilitate safe and successful feeding, nurses should improve their knowledge and practical skills regarding the transition to oral feeding and evidence-based therapeutic interventions for preterm infants.
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Azuma D, Maron JL. Individualizing Oral Feeding Assessment and Therapies in the Newborn . RESEARCH AND REPORTS IN NEONATOLOGY 2020. [DOI: 10.2147/rrn.s223472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Pineda R, Liszka L, Kwon J, Wallendorf M. Interrater Reliability and Concurrent Validity of the Neonatal Eating Outcome Assessment. Am J Occup Ther 2020; 74:7402205050p1-7402205050p11. [PMID: 32204783 DOI: 10.5014/ajot.2020.039578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Few neonatal feeding assessments are currently available, and the Neonatal Eating Outcome Assessment is the only one that identifies feeding impairment while considering the developmental changes that occur from preterm birth to term-equivalent age. OBJECTIVE To determine the interrater reliability and concurrent validity of the Neonatal Eating Outcome Assessment. DESIGN Prospective, observational study. SETTING Level 4 neonatal intensive care unit. PARTICIPANTS A convenience sample of 7 neonatal therapists participated in reliability testing. For concurrent validity, a prospective cohort of 52 preterm infants born ≤32 wk gestation had feeding assessed at term-equivalent age. OUTCOMES AND MEASURES Intraclass correlations (ICCs) and Fleiss's κ statistics were used to define reliability across therapists, who independently scored five videos of preterm infants orally feeding using the Neonatal Eating Outcome Assessment. Concurrent validity was determined by evaluating relationships between the Neonatal Oral Motor Assessment Scale (NOMAS) and the Neonatal Eating Outcome Assessment using an independent-samples t test and χ² analysis. RESULTS The ICC for the Neonatal Eating Outcome Assessment total score was 0.90 (confidence interval [CI] [0.70, 0.99]). Fleiss's κ scores for the 19 scorable items on the Neonatal Eating Outcome Assessment had predominately moderate, fair, and slight agreement, with 3 items having poor agreement. Dysfunctional NOMAS scores were related to lower Neonatal Eating Outcome Assessment scores (t[49.4] = 3.72, mean difference = 12.2, 95% CI [5.60, 18.75], p = .001). CONCLUSIONS AND RELEVANCE The Neonatal Eating Outcome Assessment has excellent reliability. Concurrent validity was established. WHAT THIS ARTICLE ADDS This article reports that the final version of the Neonatal Eating Outcome Assessment (Version 5.7) has excellent interrater and concurrent validity and is an important tool to assess the occupation of infant feeding in clinical practice.
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Affiliation(s)
- Roberta Pineda
- Roberta Pineda, PhD, OTR/L, is Assistant Professor, Program in Occupational Therapy and Department of Pediatrics, Washington University School of Medicine, St. Louis, MO;
| | - Lara Liszka
- Lara Liszka, OTD/S, is Doctor of Occupational Therapy Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Jenny Kwon
- Jenny Kwon, OTD/S, is Doctor of Occupational Therapy Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Michael Wallendorf
- Michael Wallendorf, PhD, is Research Statistician, Division of Biostatics, Washington University School of Medicine, St. Louis, MO
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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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12
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Abstract
OBJECTIVE To identify the progression of non-nutritive sucking (NNS) across postmenstrual age (PMA) and to investigate the relationship of NNS with medical and social factors and oral feeding. STUDY DESIGN Fifty preterm infants born at ≤32 weeks gestation had NNS assessed weekly starting at 32 weeks PMA with the NTrainer System. Oral feeding was assessed at 38 weeks PMA. RESULTS There were increases in NNS bursts per minute (p = 0.005), NNS per minute (p < 0.0001), NNS per burst (p < 0.001), and peak pressure (p = 0.0003) with advancing PMA. Level of immaturity and medical complications were related to NNS measures (p < 0.05). NNS measures were not related to Neonatal Oral Motor Assessment Scale scores. Smaller weekly change in NNS peak pressure (p = 0.03; β = -1.4) was related to feeding success at 38 weeks PMA. CONCLUSION Infants demonstrated NNS early in gestation. Variability in NNS scores could reflect medical complications and immaturity. More stable sucking pressure across time was related to feeding success at 38 weeks PMA.
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Affiliation(s)
- Roberta Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri,Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Kelsey Dewey
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Amy Jacobsen
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children’s Hospital, St. Louis, Missouri
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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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Bickell M, Barton C, Dow K, Fucile S. A systematic review of clinical and psychometric properties of infant oral motor feeding assessments. Dev Neurorehabil 2018; 21:351-361. [PMID: 28272918 DOI: 10.1080/17518423.2017.1289272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe the clinical properties and psychometric soundness of infant oral motor feeding assessments available for practice. METHODS A systematic review was conducted using six databases (PubMed, Ovid [Medline], CINHAL, EMBASE, psycINFO, and COCHRANE) to retrieve articles. Assessments were analyzed for their clinical characteristics and psychometric robustness. RESULTS Ten assessment tools were identified to meet the inclusion/exclusion criteria. Clinical properties of the tools varied from assessments which assessed oral feeding readiness, oral motor function, and pre-feeding skills for breast and/or bottle feeding. Psychometric evidence was found for seven assessment tools. The Neonatal Oral Motor Assessment Scale was found to be the most widely tested for psychometric soundness. The overall psychometric evidence was inconsistent and/or inadequate for the evaluative tools. CONCLUSIONS Findings from this systematic review demonstrate clinical usefulness of the tools based on their assessment properties, however additional studies are needed to further establish their psychometric soundness.
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Affiliation(s)
- Michelle Bickell
- a School of Rehabilitation Therapy, Queen's University , Kingston , Canada
| | - Courtney Barton
- a School of Rehabilitation Therapy, Queen's University , Kingston , Canada
| | - Kim Dow
- b Department of Paediatrics/Neonatology , Queen's University , Kingston , Canada
| | - Sandra Fucile
- a School of Rehabilitation Therapy, Queen's University , Kingston , Canada.,b Department of Paediatrics/Neonatology , Queen's University , Kingston , Canada
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Predictors and outcomes of the Neonatal Oral Motor Assessment Scale (NOMAS) performance: a systematic review. Eur J Pediatr 2018; 177:665-673. [PMID: 29564628 DOI: 10.1007/s00431-018-3130-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
UNLABELLED The NOMAS is by far the most used tool to screen early oral-motor skills in newborns. Here we provide an updated review of scientific literature on the use of the Neonatal Oral Motor Assessment Scale (NOMAS) to screen early oral-motor skills in newborns. An integrative review has been carried out consistent with PRISMA guidelines and standardized qualitative appraisal. Data abstracting and synthesis were executed by two independent co-authors who solved disagreement in conference. Twenty records have been included and reviewed. The efficacy of the NOMAS in screening and identifying precocious oral-motor skills received inconsistent support. Moderate validity and low reliability emerged. Moreover, despite the NOMAS' adequately screen efficient and inefficient feeders, limited evidence emerged for predictive value of NOMAS score on feeding and psychomotor developmental trajectories during the first 2 years of age. CONCLUSION The present review highlights benefits and limitations of the NOMAS. Future research is needed to develop observational and clinically-relevant tools to better identify newborns which are at lower- and higher-risk of developing less-than-optimal feeding behaviors and to guide with greater precision the diagnostic and therapeutic journey of these newborns. What is Known: • The assessment of oral-motor skills in newborns and infants is critical for early intervention • The NOMAS is the most adopted tool to assess oral-motor skills in newborns and infants What is New: • The ability of the NOMAS to target newborn at risk for feeding disorders is confirmed • Nonetheless, the capacity to predict long-term developmental outcomes is limited.
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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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Pineda R, Harris R, Foci F, Roussin J, Wallendorf M. Neonatal Eating Outcome Assessment: tool development and inter-rater reliability. Acta Paediatr 2018; 107:414-424. [PMID: 29059481 DOI: 10.1111/apa.14128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 09/29/2017] [Accepted: 10/18/2017] [Indexed: 11/30/2022]
Abstract
AIM To define the process of tool development and revision for the Neonatal Eating Outcome (NEO) Assessment and to report preliminary inter-rater reliability. METHODS Tool development consisted of a review of the literature and observations of feeding performance among 178 preterm infants born ≤32 weeks gestation. 11 neonatal therapy feeding experts provided structured feedback to establish content validity and define the scoring matrix. The tool was then used to evaluate feeding in 50 preterm infants born ≤32 weeks of gestation and 50 full-term infants. Multiple revisions occurred at each stage of development. Finally, six neonatal occupational therapists participated in reliability testing by independently scoring five videos of oral feeding of preterm infants using version 4 of the tool. RESULTS The intraclass correlation for the 'prefeeding' score was 0.71 (0.37-0.96), and the intraclass correlation for the 'total' score was 0.83 (0.56-0.98). CONCLUSION The 'total' score had good to excellent reliability. Fleiss' Kappa scores for all 18 scorable items ranged from slight agreement to moderate agreement. Items with the lowest Kappa scores were revised, and additional feedback from therapists engaged in reliability testing was incorporated, resulting in final version 5.
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Affiliation(s)
- Roberta Pineda
- Program in Occupational Therapy; Washington University School of Medicine; St. Louis MO USA
- Department of Pediatrics; Washington University School of Medicine; St. Louis MO USA
| | - Rachel Harris
- Program in Occupational Therapy; Washington University School of Medicine; St. Louis MO USA
| | - Felicia Foci
- Program in Occupational Therapy; Washington University School of Medicine; St. Louis MO USA
| | - Jessica Roussin
- Program in Occupational Therapy; Washington University School of Medicine; St. Louis MO USA
| | - Michael Wallendorf
- Division of Biostatistics; Washington University School of Medicine; St. Louis MO USA
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18
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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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Zhang X, Zhou M, Yin H, Dai Y, Li Y. The predictive value of early oral motor assessments for neurodevelopmental outcomes of moderately and late preterm infants. Medicine (Baltimore) 2017; 96:e9207. [PMID: 29390342 PMCID: PMC5815754 DOI: 10.1097/md.0000000000009207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Oral motor assessment is used to identify abnormal sucking patterns which may reflect neurodevelopmental problems in preterm infants, but few studies have focused on moderately and late preterm infants. We enrolled 118 moderately and late preterm infants (mean gestational age, 35.04 weeks; mean birth weight, 2347.59 g) and analyzed the relationship between the Neonatal Oral-Motor Assessment Scale scores of these infants and the Chinese revision of Bayley Scales of Infant Development outcomes at 6 months corrected age. And the infants with abnormal sucking pattern had significantly lower Mental Development Index and Psychomotor Development Index and showed a higher rate of below average scores than control group (P = .003, P = .029, P = .022). The incoordination of suck-swallow-respiration was a risk factor for adverse neurodevelopment (RR = 3.67, 95% CI: 1.42-9.45). These indicate that abnormal sucking patterns in moderately and late preterm infants might provide some predictive value for short-term neurodevelopmental outcomes, but the clinical predictive value for developmental delay need to be determined in a longer term follow-up. This finding may offer a basis for early intervention.
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Affiliation(s)
| | | | - Huaying Yin
- Department of Primary Healthcare, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders
| | - Ying Dai
- Department of Primary Healthcare, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders
| | - Yuwei Li
- Department of Primary Healthcare, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders
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20
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Speyer R, Cordier R, Parsons L, Denman D, Kim JH. Psychometric Characteristics of Non-instrumental Swallowing and Feeding Assessments in Pediatrics: A Systematic Review Using COSMIN. Dysphagia 2017; 33:1-14. [PMID: 28819914 DOI: 10.1007/s00455-017-9835-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 08/07/2017] [Indexed: 11/28/2022]
Abstract
As early diagnosis of swallowing and feeding difficulties in infants and children is of utmost importance, there is a need to evaluate the quality of the psychometric properties of pediatric assessments of swallowing and feeding. A systematic review was performed summarizing the psychometric properties of non-instrumental assessments for swallowing and feeding difficulties in pediatrics; no data were identified for the remaining twelve assessments. The COSMIN taxonomy and checklist were used to evaluate the methodological quality of 23 publications on psychometric properties. For each assessment, an overall quality score for each measurement property was determined. As psychometric data proved incomplete, conflicting or indeterminate for all assessments, only preliminary conclusions could be drawn; the most robust assessment based on current data is the dysphagia disorder survey (DDS). However, further research is needed to provide additional information on all psychometric properties for all assessments.
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Affiliation(s)
- Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, 4811, Australia. .,Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands. .,School of Occupational Therapy and Social Work, Curtin University, Perth, WESTERN, Australia.
| | - Reinie Cordier
- School of Occupational Therapy and Social Work, Curtin University, Perth, WESTERN, Australia
| | - Lauren Parsons
- School of Occupational Therapy and Social Work, Curtin University, Perth, WESTERN, Australia
| | - Deborah Denman
- College of Healthcare Sciences, James Cook University, Townsville, QLD, 4811, Australia
| | - Jae-Hyun Kim
- College of Healthcare Sciences, James Cook University, Townsville, QLD, 4811, Australia
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21
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Wolthuis-Stigter MI, Da Costa SP, Bos AF, Krijnen WP, Van Der Schans CP, Luinge MR. Sucking behaviour in infants born preterm and developmental outcomes at primary school age. Dev Med Child Neurol 2017; 59:871-877. [PMID: 28432690 DOI: 10.1111/dmcn.13438] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 11/29/2022]
Abstract
AIM To determine the association between sucking in infants born preterm and developmental outcomes at 5 years. METHOD Thirty-four infants were included (mean gestational age 30wks 4d, mean birthweight 1407g). The Neonatal Oral-Motor Assessment Scale was used longitudinally from 37 to 50 weeks postmenstrual age. At 5 years, we assessed motor skills, intelligence, language, verbal memory, and behavioural problems. Linear regression analyses were performed to test whether aspects of sucking behaviour predicted these developmental outcomes. Where linear regression was not appropriate, Spearman's correlation coefficients were calculated between sucking and developmental outcomes. RESULTS Sucking was associated with total motor skills (B [unstandardized correlation coefficient for normally distributed data]=22.66, 95% confidence interval [CI] 6.61 to 38.71), balance (Spearman's ρ=0.64, p<0.001), total intelligence (B=-1.16, 95% CI -1.89 to -0.44, B=10.48, 95% CI 0.39 to 20.71, B=-2.22, 95% CI -3.42 to -1.02), verbal intelligence (B=-0.95; 95% CI -1.83 to -0.07, B=-2.02; 95% CI -3.55 to -0.49), performance intelligence (B=-1.34, 95% CI -2.13 to -0.54, B=12.36, 95% CI 1.13 to 23.60, B=-2.37, 95% CI -3.75 to -0.96), and language (B=-1.78, 95% CI -3.36 to -0.19). All associations were in the same direction: the better the sucking, the higher the test scores. Verbal memory and behavioural problems were not associated with sucking. INTERPRETATION Abnormal sucking between 42 weeks and 50 weeks postmenstrual age may reflect abnormal neurological functioning in children born preterm.
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Affiliation(s)
- Mechteld I Wolthuis-Stigter
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Saakje P Da Costa
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Arend F Bos
- Department of Pediatrics, Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Wim P Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Cees P Van Der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands.,Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Margreet R Luinge
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
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Cavallini A, Provenzi L, Sacchi D, Longoni L, Borgatti R. The Functional Evaluation of Eating Difficulties Scale: Study Protocol and Validation in Infants with Neurodevelopmental Impairments and Disabilities. Front Pediatr 2017; 5:273. [PMID: 29326911 PMCID: PMC5741606 DOI: 10.3389/fped.2017.00273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/04/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION A reliable and accurate evaluation of oral-motor skills in newborns at risk for swallowing and feeding disorders is key to set the goals of effective early interventions. Although many tools are available to assess oral-motor skills in newborns, limited evidence exists for what pertains their reliability and their effectivity in predicting short- and long-term developmental outcomes in at-risk infants. The aim of the present study is to develop and provide a preliminary validation of a new clinically grounded tool [i.e., the Functional Evaluation of Eating Difficulties Scale (FEEDS)] specifically designed to be used with at-risk newborns and infants. The paper describes the steps of tool development and information on the reliability of the tool are provided. METHODS/ANALYSIS The FEEDS has been developed according to clinical evidence and expertise by a multidisciplinary team of professionals dealing with feeding problems in at-risk infants diagnosed with neurodevelopmental impairments and disabilities. The steps of FEEDS development are reported, together with a detailed description of items, scoring procedure, and clinical cutoff. The FEEDS has been applied to a relatively large sample of 0- to 12-month-old infants (N = 136) with neurodevelopmental disability, enrolled consecutively between 2004 and 2016 at the Scientific Institute IRCCS Eugenio Medea (Bosisio Parini, Italy), which is the main rehabilitation hospital for children with neurodevelopmental disabilities in Italy. Internal consistency (Cronbach's alpha) and reliability (inter-rater agreement) have been assessed. ETHICS AND DISSEMINATION All the procedures are consistent with the World Medical Association Declaration of Helsinki (2013) and the FEEDS has been approved by the clinical committee of the Scientific Institute IRCCS Eugenio Medea. Further psychometric characteristics and evidence of the predictive validity of the FEEDS will be obtained on a larger sample and they will be reported in future publications from this group.
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Affiliation(s)
- Anna Cavallini
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Livio Provenzi
- 0-3 Center for the At-Risk Infant, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Daniela Sacchi
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Laura Longoni
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Renato Borgatti
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
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23
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Abstract
BACKGROUND Feeding difficulty is common in infants younger than 6 months. Identification of infants in need of specialized treatment is critical to ensure appropriate nutrition and feeding skill development. Valid and reliable assessment tools help clinicians objectively evaluate feeding. PURPOSE To identify and evaluate assessment tools available for clinical assessment of bottle- and breastfeeding in infants younger than 6 months. METHODS/SEARCH STRATEGY CINAHL, HaPI, PubMed, and Web of Science were searched for "infant feeding" and "assessment tool." The literature (n = 237) was reviewed for relevant assessment tools. A secondary search was conducted in CINAHL and PubMed for additional literature on identified tools. FINDINGS/RESULTS Eighteen assessment tools met inclusion criteria. Of these, 7 were excluded because of limited available literature or because they were intended for use with a specific diagnosis or in research only. There are 11 assessment tools available for clinical practice. Only 2 of these were intended for bottle-feeding. All 11 indicated that they were appropriate for use with breastfeeding. None of the available tools have adequate psychometric development and testing. IMPLICATIONS FOR PRACTICE All of the tools should be used with caution. The Early Feeding Skills Assessment and Bristol Breastfeeding Assessment Tool had the most supportive psychometric development and testing. IMPLICATIONS FOR RESEARCH Feeding assessment tools need to be developed and tested to guide optimal clinical care of infants from birth through 6 months. A tool that assesses both bottle- and breastfeeding would allow for consistent assessment across feeding methods.
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Crapnell TL, Rogers CE, Neil JJ, Inder TE, Woodward LJ, Pineda RG. Factors associated with feeding difficulties in the very preterm infant. Acta Paediatr 2013; 102:e539-45. [PMID: 23952198 DOI: 10.1111/apa.12393] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 08/12/2013] [Indexed: 12/01/2022]
Abstract
AIM To investigate early medical and family factors associated with later feeding risk in preterm infants. METHODS For this longitudinal study, 136 infants born ≤30 weeks gestation were enrolled. Medical and social background factors were assessed at term equivalent age. Infants underwent magnetic resonance imaging, neurobehavioral evaluation and feeding assessment. Parent involvement in the neonatal intensive care unit was tracked, and maternal mental health was assessed at neonatal intensive care unit discharge. At age 2 years, feeding outcome was assessed using the Eating Subscale of the Infant-Toddler Social Emotional Assessment (n = 80). Associations between feeding problems at age 2 years and (i) early medical factors, (ii) neurobehavioral functioning and feeding at term equivalent age, (iii) cerebral structure and (iv) maternal mental health were investigated using regression. RESULTS Eighteen (23%) children had feeding problems at age 2 years. Feeding problems were associated with early hypotonia (p = 0.03; β = 0.29) and lower socio-economic status (p = 0.046; β = -0.22). No associations were observed between early medical factors, early feeding performance, cerebral structure alterations or maternal well-being and feeding outcome. CONCLUSION Early hypotonia may disrupt the development of oral-motor skills. Hypotonia and poor feeding also may share a common aetiology. Associations with lower socio-economic status highlight the potential influence of family background factors in feeding problems in the preterm infant.
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Affiliation(s)
- TL Crapnell
- Program in Occupational Therapy; Washington University School of Medicine; St. Louis MO USA
| | - CE Rogers
- Department of Psychiatry; Washington University School of Medicine; St. Louis MO USA
- Department of Pediatrics; Washington University School of Medicine; St. Louis MO USA
| | - JJ Neil
- Department of Pediatrics; Washington University School of Medicine; St. Louis MO USA
- Department of Neurology; Washington University School of Medicine; St. Louis MO USA
- Department of Radiology; Washington University School of Medicine; St. Louis MO USA
| | - TE Inder
- Department of Pediatrics; Washington University School of Medicine; St. Louis MO USA
- Department of Neurology; Washington University School of Medicine; St. Louis MO USA
- Department of Radiology; Washington University School of Medicine; St. Louis MO USA
| | - LJ Woodward
- Department of Pediatrics; Washington University School of Medicine; St. Louis MO USA
- Department of Psychology; Washington University School of Medicine; St. Louis MO USA
| | - RG Pineda
- Program in Occupational Therapy; Washington University School of Medicine; St. Louis MO USA
- Department of Pediatrics; Washington University School of Medicine; St. Louis MO USA
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