Abstract
BackgroundThere is a need for validated neonatal feeding assessment instruments in South Africa. A locally developed instrument may contribute to standardised evaluation procedures of high-risk neonates and address needs in resource constrained developing settings.ObjectiveThe aim of the study was to develop and validate the content of a clinical feeding assessment scale to diagnose oropharyngeal dysphagia (OPD) in neonates.MethodThe Neonatal Feeding Assessment Scale (NFAS) was developed using the Delphi method. Five international and South African speech-language therapists (SLTs) formed the expert panel, participating in two rounds of electronic questionnaires to develop and validate the content of the NFAS.ResultsAll participants agreed on the need for the development of a valid clinical feeding assessment instrument to use with the neonatal population. The initial NFAS consisted of 240 items across 8 sections, and after the Delphi process was implemented, the final format was reduced to 211 items across 6 sections. The final format of the NFAS is scored using a binary scoring system guiding the clinician to diagnose the presence or absence of OPD. All members agreed on the format, the scoring system and the feeding constructs addressed in the revised final format of the NFAS.ConclusionThe Delphi method and the diverse clinical and research experience of participants could be integrated to develop the NFAS which may be used in clinical practice in South Africa or similar developing contexts. Because of demographically different work settings marked by developed versus developing contexts, participants did not have the same expectations of a clinical dysphagia assessment. The international participants contributed to evidence-based content development. Local participants considered the contextual challenges of South African SLTs entering the field with basic competencies in neonatal dysphagia management, thereby justifying a comprehensive clinical instrument. The NFAS is aimed at clinicians working in Neonatal Intensive Care Units where they manage large caseloads of high-risk neonates. Further validation of the NFAS is recommended to determine its criterion validity in comparison with a widely accepted standard such as the modified barium swallow study.
Highlights
Clinical assessment is an important part of evidence-based management of neonatal dysphagia (Thoyre, Park, Pados & Hubbard, 2013)
All members agreed on the format, the scoring system and the feeding constructs addressed in the revised final format of the Neonatal Feeding Assessment Scale (NFAS)
Infants discharged with inadequate investigation into the feeding difficulties or unresolved feeding difficulties, low birth weight (LBW) and prematurity are more at risk of developing failure-tothrive than their term counterparts with appropriate weight for age (Browne & Ross, 2011)
Summary
Clinical assessment is an important part of evidence-based management of neonatal dysphagia (Thoyre, Park, Pados & Hubbard, 2013). The purpose of clinical assessment is to establish the possible nature of the feeding problem, to explore the parent’s perception of the problem and the neonate’s readiness for oral feeding, to make a differential diagnosis and to determine the need for multi-disciplinary management (Arvedson, 2008; Rommel, 2006; Thoyre et al, 2013). A clinical instrument should support an accurate diagnosis and description of the feeding profile related to oropharyngeal dysphagia (OPD) in high-risk neonates. A locally developed instrument may contribute to standardised evaluation procedures of high-risk neonates and address needs in resource constrained developing settings
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