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Updated: Dec 25, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Interrater Reliability and Concurrent Validity of the Neonatal Eating Outcome Assessment
Roberta Pineda1, Lara Liszka2, Jenny Kwon3
1Roberta Pineda, PhD, OTR/L, is Assistant Professor, Program in Occupational Therapy and Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; pineda_r@kids.wustl.edu.
Insights
The Neonatal Eating Outcome Assessment demonstrates excellent reliability and concurrent validity for evaluating infant feeding. This tool is crucial for assessing feeding impairments in preterm infants, supporting their developmental needs.
Area of Science:
- Neonatal care
- Pediatric feeding disorders
- Occupational therapy
Background:
- Limited neonatal feeding assessments exist.
- The Neonatal Eating Outcome Assessment (NEOATM) uniquely addresses developmental changes from preterm birth to term-equivalent age.
- It identifies feeding impairment in neonates.
Purpose of the Study:
- To determine the interrater reliability of the NEOATM.
- To establish the concurrent validity of the NEOATM.
Main Methods:
- Prospective, observational study in a Level 4 NICU.
- 7 neonatal therapists assessed feeding videos using the NEOATM for reliability.
- 52 preterm infants (≤32 wk gestation) were assessed for concurrent validity at term-equivalent age.
- Intraclass correlations (ICCs) and Fleiss's κ statistics were used for reliability.
- Neonatal Oral Motor Assessment Scale (NOMAS) was used for concurrent validity.
Main Results:
- The NEOATM total score showed excellent interrater reliability (ICC = 0.90).
- Most individual items demonstrated moderate to slight agreement among therapists.
- Lower NEOATM scores correlated significantly with dysfunctional NOMAS scores (p = .001).
Conclusions:
- The NEOATM exhibits excellent interrater reliability.
- Concurrent validity of the NEOATM is established.
- The NEOATM is a valuable clinical tool for assessing infant feeding occupation.
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.
