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Psychometric properties of the SMART tool for infant oral feeding skill assessment
Ravi Mishra1, Anne Albi2, Cynthia Lira-Crame2
1Advocate Illinois Masonic Medical Center, Chicago, IL, 60657, USA. ravi.mishra@aah.org.
Insights
The novel SMART tool effectively assesses infant oral feeding skills in premature and medically complex infants. This reliable and valid tool addresses limitations of existing assessments, improving care and reducing hospital stays.
Area of Science:
- Pediatrics
- Neonatology
- Clinical Assessment
Background:
- Premature and medically complex infants often experience feeding problems, delaying oral feeding development.
- These feeding delays lead to extended hospital stays, increased healthcare costs, malnutrition, developmental issues, and family stress.
- Existing oral feeding assessment tools have limitations in psychometric properties, feasibility, and cost-effectiveness.
Purpose of the Study:
- To establish the psychometric properties of the novel Sequential Micro-Assessment of Readiness for Transition (SMART) tool.
- To evaluate the validity and reliability of the SMART tool for assessing infant oral feeding skills.
Main Methods:
- Prospective, observational, multicenter trial involving 76 infants across four level-3 Neonatal Intensive Care Units.
- 136 complete feeding observations were analyzed.
- Criterion validity was established by comparing the SMART tool to the Neonatal Eating Outcome Assessment (NEOA) tool.
Main Results:
- The SMART tool demonstrated strong criterion validity when compared to the NEOA tool, with a correlation of r = 0.7 (p < 0.001).
- Sensitivity was 0.76 (95% CI 0.63-0.89) and specificity was 0.82 (95% CI 0.72-0.93).
- Inter-rater reliability for post-feed scores showed 100% agreement, indicating high consistency.
Conclusions:
- The SMART tool is a valid, reliable, and feasible instrument for assessing infant oral feeding skills.
- This novel tool addresses the limitations of current assessments, offering a more effective solution for evaluating feeding readiness in vulnerable infants.
Abstract:
Premature and medically complex infants are at risk of feeding problems, specifically the delay in the development of independent oral feedings, which leads to prolonged hospital stays, higher costs, malnutrition, developmental delays, and family stress. Available oral feeding skill assessment tools lack strong psychometrics, feasibility, and cost-effectiveness. We developed a novel tool, the SMART tool, to address these barriers. The objective of this study was to establish the psychometric properties of the SMART tool for assessing infant oral feeding skills. The study design was a prospective, observational, multicenter trial. To establish criterion validity, we hypothesized that the performance of the SMART tool would be similar to that of a comparator tool, the Neonatal Eating Outcome Assessment (NEOA) tool. A convenience sample of 76 infants across four level-3 Neonatal Intensive Care Units were enrolled, and 136 complete feeding observations were included. Compared to NEOA, the SMART tool had a sensitivity of 0.76 (95% CI 0.63-0.89) and a specificity of 0.82 (95% CI 0.72-0.93), with a strong correlation (r = 0.7, p < 0.001). Inter-rater reliability of post-feed scores was 100% agreement. The SMART tool is valid, reliable, and feasible for assessing infant oral feeding skills.
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