Abstract
The Neonatal Oral–Motor Assessment Scale is a clinical tool commonly used to evaluate the oral–motor skills of neonates. This study is to examine its predictability in feeding performance using newly organized items. The results showed that in addition to the adjusted age and weight at observed feed, jaw depression and jaw initiation were the significant predictors for successful bottle feed. Discuss implications of findings and the need for standardized assessment in neonates' feeding.
Primary Author and Speaker: Tsu-Hsin Howe
Additional Authors and Speakers: Christine L. Kroll
Compared to full-term infants, a higher percentage of preterm infants experience feeding problems (Jadcherla, 2017). The development of instruments to assess feeding behaviors is essential not only to evaluate an infant's ability to achieve good nutritional and growth status but also to allow clinicians to observe infants’ neurobehavioral maturation indirectly. The Neonatal Oral–Motor Assessment Scale (NOMAS) is a clinical tool commonly used to evaluate the oral–motor skills of neonates who demonstrate reflexive sucking. Compared to other neonatal clinical feeding assessment tools, the NOMAS appeared to have been examined more thoroughly psychometrically than others despite its own limitations (Howe, Lin, Fu, Su, & Hsieh, 2008). The validation of the psychometric properties of the NOMAS remains inconclusive (Longoni et al., 2018), and overlapping items found in the NOMAS created problems of redundancy in the test construct (Howe, Sheu, Hsieh, & Hsieh, 2007). The purpose of this study was, therefore, to re-organize the items of NOMAS by deleting or combining redundant items listed in the assessment, and to examine the predictability of the newly structured items of NOMAS on infants' feeding performance. A retrospective study was conducted to collect records of NOMAS of a sample of preterm infants during their stays in the neonatal intensive care unit. Longitudinal data of 686 preterm infants with adjusted age ranged 29.43 to 54.43 weeks (M ± SD = 35.95 ± 2.72 weeks), weight at observed feed ranged from 1,125 g to 4,090 g (M ± SD = 2030 ± 463.95 g), over the course of one to 13 visits were collected. The 28 items of the NOMAS were re-organized and re-structured into 15 items with 7 items in the jaw category and 8 items in the tongue category. A random-effects regression, generalized linear mixed-effect model trees, and IRT partial credit model were used to analyze the longitudinal data. The results showed that in addition to the adjusted age and weight at observed feed, jaw depression and jaw initiation were the significant predictors for successful bottle feed. Despite the NOMAS is a valuable checklist for clinical use, most of the items listed in the NOMAS did not show significant predictability of feeding performance under the rigorous psychometric testing. The findings of this study have implications for researchers that more work is warranted to establish the eligibility of the NOMAS as a true outcome measure. As an occupational therapy practitioner, one should caution the application of the NOMAS as a means only to describe observed oral-motor skills but not to measure the neurodevelopmental outcomes.
Howe, T.-H., Lin, K.-C., Fu, C.-P., Su, C.-T., & Hsieh, C.-L. (2008). A review of psychometric properties of feeding assessment tools used in neonates. Journal of Obstetric, Gynecologic & Neonatal Nursing, 37(3), 338-349. https://doi.org/10.1111/j.1552-6909.2008.00240.x
Jadcherla, S. R. (2017). Advances with neonatal aerodigestive science in the pursuit of safe swallowing in infants: invited review. Dysphagia, 32(1), 15-26. https://doi.org/10.1007/s00455-016-9773-z
Longoni, L., Provenzi, L., Cavallini, A., Sacchi, D., Scotto, d. M. G., & Borgatti, R. (2018). Predictors and outcomes of the Neonatal Oral Motor Assessment Scale (NOMAS) performance: a systematic review. European journal of pediatrics. https://doi.org/10.1007/s00431-018-3130-1.