Quality Indicators for Evaluation of Neonatal Basic Care in Nutrition and Feeding: A Scoping Review and Modified...

Background/Objectives: Despite the clinical relevance of nutrition and feeding in neonatal intensive care, no consensus-based set of quality indicators currently exists to systematically evaluate basic nutritional care in hospitalised neonates. This study aimed to identify, agree through expert consensus and prioritise a structured set of nursing-sensitive quality indicators for this domain. Methods: A two-phase methodological study combined a Scoping Review (Joanna Briggs Institute methodology; prospectively registered on OSF; reported per PRISMA-ScR) and a two-round modified Delphi study based on the RAND/UCLA Appropriateness Method. Four databases (PubMed, Embase, Scopus, and Cochrane Library; 2020-2025) were searched, complemented by snowball and the grey literature. Twenty-seven candidate indicators synthesised inductively into eight domains were rated by 23 expert nurses across three dimensions (appropriateness, clinical validity, and feasibility) on a nine-point Likert scale. Results: Retention from Round 1 to Round 2 was 87% (n = 20). Twenty-two indicators (81.5%) were classified as appropriate and five (18.5%) as uncertain, in all cases because of feasibility. The overall median for appropriateness and clinical validity was 9.0 in both rounds. Feasibility showed greater variability, with an 18% mean IQR reduction after Round 2. Indicators reaching consensus were distributed across structure (n = 3, 13.6%), process (n = 16, 72.7%) and outcome (n = 3, 13.6%) dimensions. An exploratory post-hoc prioritisation analysis identified four implementation tiers; the five Tier 1 indicators ranked in the top five under every weighting scheme tested. Conclusions: This consensus-based set provides a structured basis for monitoring neonatal nutritional care quality and for reducing clinical variability. Validation by a broader interdisciplinary panel including families, and prospective testing in routine practice, are required before its use in clinical dashboards or benchmarking.