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Summary: Eating is an important part of daily life; it ensures nutrition for growth and is an important activity of daily living with strong social implications. The construct of feeding/eating is especially important in preterm infants, who are born without the maturity that enables successful oral feeding, but who also have high rates of long-term feeding problems. While much emphasis has been placed on maintaining the quality of nutrition, through breast milk or formula and supplemental feeding strategies, less attention has focused on the feeding ability of preterm infants.

There are few tools available to assess feeding in neonates, and the ones that are available do not account for the significant developmental changes that occur from preterm birth until term equivalent age. To address this issue, we have developed the Neonatal Eating Outcome assessment tool, which assesses the most important clinically and research-derived factors associated with feeding skills in preterm infants. This tool can potentially improve the understanding of age appropriate feeding skills, improve early identification of feeding difficulties, and enable targeted interventions to preterm infants with problems eating. To preview the assessment, click here.

Applications: The NEO is a comprehensive, standardized assessment of feeding for preterm infants in the neonatal intensive care unit. It can be used from the time that feeding is initiated throughout the neonatal period. It is used to delineate alterations in the feeding trajectory.

Advantages:

• Feeding/eating component skills are scored based on expected performance across postmenstrual age.
• Quantitative scoring provides valid outcome measures for research as well as an objective way to track progress clinically. The NEO defines if feeding skills are age-appropriate.
• Markers in the assessment enable the clinician to understand if feeding is appropriate to initiate and if feeding should be stopped due to lack of safety with oral feeding.
• The NEO can be used for both breastfeeding and bottle feeding infants.

Stage of Development: Content validity has been conducted with neonatal feeding experts. Additional revisions were informed by reliability testing within the research team. Finally, reliability testing with neonatal therapists demonstrated good to excellent inter-rater reliability. The tool has been finalized, but additional psychometric testing is underway.

For more information, please contact Jessica Roussin at jroussin@wustl.edu.