Neonatal Oral Motor Assessment Scale Research Articles

Oral Feeding Readiness Assessment Tools for Preterm Infants

Due to their underdeveloped physiological maturity, preterm infants often face challenges related to sucking, breathing, and swallowing coordination during initial feeding. This lack of coordination may lead to episodes of apnea and choking, resulting in unstable vital signs. Preterm infants with this issue must gradually learn oral feeding skills appropriate to their developmental stage. Registered nurses play a critical role in assessing the right time to transition from tube to oral feeding and in providing a safe and positive oral feeding experience. In this article, three validated assessment tools for feeding premature infants are introduced, accompanied by clinical research data demonstrating their use in clinical practice. These three tools include: (1) the Neonatal Oral Motor Assessment Scale, which is applied to evaluate oral motor skills using observations of nonnutritive sucking and the sucking state during the two minutes before feeding; (2) the Premature Oral Feeding Readiness Assessment Scale, which is used to assess readiness for oral feeding in preterm infants; and (3) the Early Feeding Skills assessment, which is used to evaluate the oral feeding skills of preterm infants. These tools aid nurses in helping preterm infants achieve independent oral feeding, facilitating earlier discharge and return to home. The clinical implications and effectiveness of these tools are also discussed to provide to nurses the means and confidence necessary to apply them appropriately in clinical settings.

Are sucking patterns and early spontaneous movements related to later developmental functioning outcomes? A cohort study.

Sucking patterns and early spontaneous movements have an important role in the determination of later developmental problems, but the relationship of the two together with long-term outcomes has not been investigated. The objectives of this study were to (i) examine the relationship between sucking patterns using the Neonatal Oral Motor Assessment Scale (NOMAS) and fidgety movements and other movement patterns using detailed General Movements Assessment (GMA), and (ii) investigate the relationship between these early assessment methods and developmental functioning outcomes at later ages. We analyzed the NOMAS from 34weeks' postmenstrual age up to 10weeks post-term and GMA between 9 and 20weeks post-term age, and the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) was applied for the developmental functioning outcomes to 62 infants (61%, 62/102) between 12 and 42months of age. Among 102 infants at-risk, 70 (69%) showed a normal sucking pattern, and 85 (83%) had fidgety movements. The median Motor Optimality Score-Revised (MOS-R), as determined by GMA, of all infants was 24. The NOMAS was related to the MOS-R and its subcategories (p < 0.05) in all infants at-risk. The NOMAS, MOS-R and its subcategories were also related to cognitive, language, and motor development at later ages according to Bayley-III (p < 0.05). Conclusion: This longitudinal study showed that the quality of sucking patterns, fidgety movements, and MOS-R were related to later developmental functioning, indicating that abnormal sucking patterns, aberrant fidgety movements, and lower MOS-R might predict developmental disorders. What is Known: • Sucking patterns and early spontaneous movements in which central pattern generators play an important role are related. • Sucking patterns and early spontaneous movements might be used separately to predict developmental outcomes. What is New: • Sucking patterns and early spontaneous movements, when used together, were related to later developmental functioning, including cognitive, language, and motor developmentin at-risk infants. • Predictive value of sucking patterns was lower for each developmental functioning outcome than early spontaneous movements.

EFFECT OF COMPREHENSIVE APPROACH ON FEEDING ABILITY OF INFANT WITH FACIAL NERVE PALSY &amp; MICROTIA GRADE 4: A CASE REPORT

Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. it can be congenital or acquired. The unilateral facial paralysis can be suspected when, in absence of front and nasolabial groove motility, there is also asymmetry of the face with buccal deviation when crying. The custom-made Facial splint of low-temperature thermoplastic material can support the weak muscle &amp; prevent the deviation. The infant was referred to Occupational Therapy with facial palsy grade IV. The aim of our study is evaluating the immediate functional outcome, while using the custom-made splint. The patient was assessed twice (i.e. Baseline &amp; after 6 weeks) on Neonatal Behavioral Assessment scale (NBAS), Neonatal Oral Motor Assessment Scale (NOMAS), Nonnutritive sucking scoring system, Preterm Infant Feeding Readiness Assessment Scale &amp; Parent stress scale was used to track the feeding readiness &amp; parental stress respectively during intervention. On NBAS, Level 3 to level 5. On NNSS, infant scored 2 to 6 scoring system on non-nutritive sucking &amp; on NOMAS baby scored from 19 to 22. Her ability to initiate suck was improved considerably. Improvement in scores of Preterm Infant Feeding Readiness Assessment Scale at baseline &amp; after 6 weeks. Infant scored 65 to 57 on Parent Stress Scale. In this study, Family Centered approach &amp; the need-based intervention, a custom-made facial splint of low-temperature thermoplastic material along with face strap effective to facial palsy patient, along with conventional Occupational Therapy intervention.

Predicting Bottle-Feeding Performance Using a Reorganized Neonatal Oral–Motor Assessment Scale

Abstract Date Presented 04/23/21 The Neonatal Oral–Motor Assessment Scale is a clinical tool commonly used to evaluate the oral–motor skills of neonates. This study is to examine its predictability in feeding performance using newly organized items. The results showed that in addition to the adjusted age and weight at observed feed, jaw depression and jaw initiation were the significant predictors for successful bottle feed. Discuss implications of findings and the need for standardized assessment in neonates' feeding. Primary Author and Speaker: Tsu-Hsin Howe Additional Authors and Speakers: Christine L. Kroll

Neonatal feeding performance is related to feeding outcomes in childhood

AimDefine relationships of early feeding performance with feeding outcomes in childhood, while assessing the predictive validity of the Neonatal Eating Outcome Assessment. Study designNinety-one infants (44 preterm infants born ≤32 weeks at term-equivalent age and 47 full-term infants within 4 days of life) had feeding evaluated using the Neonatal Eating Outcome Assessment and the Neonatal Oral Motor Assessment Scale (NOMAS). At 4 years of age, 39 of these infants (22 preterm infants and 17 full-term infants; 43% follow-up rate) had parent-report measures of feeding conducted using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and Pediatric Eating Assessment Tool (PediEAT). ResultsLower Neonatal Eating Outcome Assessment scores were related to higher PediEAT scores (p = 0.01; r = −0.44), but were not related to BPFAS scores (p = 0.17; r = −0.23). Relationships were not detected between the NOMAS and BPFAS (p = 0.35; r = 0.17), and relationships between the NOMAS and PediEAT failed to reach significance (p = 0.06; r = 0.34). There was a relationship between the BPFAS and PediEAT scores at 4 years (p < 0.001; r = 0.66). Preterm infants performed poorer than full-term infants on the Neonatal Eating Outcome Assessment (p < 0.001) and NOMAS (p < 0.001), but no differences were detected in preterm compared to full-term performance on the BPFAS (p = 0.87) and PediEAT scores (p = 0.27). DiscussionNeonatal feeding performance is an important predictor of feeding outcomes at 4 years of age. The Neonatal Eating Outcome Assessment has predictive validity, and the Pediatric Eating Assessment Tool has concurrent validity with relationships to another childhood feeding tool.

Interrater Reliability and Concurrent Validity of the Neonatal Eating Outcome Assessment.

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. To determine the interrater reliability and concurrent validity of the Neonatal Eating Outcome Assessment. Prospective, observational study. Level 4 neonatal intensive care unit. 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. 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. 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). The Neonatal Eating Outcome Assessment has excellent reliability. Concurrent validity was established. 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.

Sucking patterns are not predictive of further feeding development in healthy preterm infants

Preterm infants are at risk of experiencing difficulties in their feeding development. For a possible early identification of these, we examined the association between sucking patterns, assisted spoon feeding, and chewing skills in 40 healthy preterm infants, and the role of experience in the acquisition of these skills in a prospective longitudinal study. Sucking patterns were evaluated at 34, 37, and 44 weeks postmenstrual age (PMA), assisted spoon feeding was evaluated at 6, 9, and 12 months PMA, and chewing was evaluated at 9, 12, and 24 months PMA. Sucking patterns were rated using the Neonatal Oral Motor Assessment Scale, assisted spoon feeding was rated using the Observation List Spoon Feeding, and chewing was evaluated using the Mastication Observation and Evaluation Instrument.All infants showed progression in their oral motor skills during the study period, but not all demonstrated a stable progression of skills. Quality of sucking patterns was not associated with skill level achievement of assisted spoon feeding or with chewing. Length of experience in sucking was significantly associated with duration of supplemental tube feeding but not with the quality of the sucking pattern. Length of chewing experience was significantly associated with chewing abilities at 9 and 12 months PMA. No clinical characteristics were sufficiently predictive of oral motor skill development. Results show that sucking patterns are not predictive of subsequent feeding development in healthy preterm infants. The food consistency offered and the length of feeding experience influenced the acquisition and quality of oral motor skills differently.

Association of uncoordinated sucking pattern with developmental outcome in premature infants: a retrospective analysis

BackgroundStress signals during sucking activity such as nasal flaring, head turning, and extraneous movements of the body have been attributed to incoordination of sucking, swallowing, and respiration (SSR) in premature infants. However, the association of uncoordinated sucking pattern with developmental outcomes has not yet been investigated. The aim of this study was to investigate whether uncoordinated sucking pattern during bottle-feeding in premature infants is associated with the developmental outcomes at 8–12 and 18–24 months of age (corrected for prematurity).MethodsWe retrospectively reviewed the medical records and video recordings for the Neonatal Oral-Motor Assessment Scale (NOMAS) of premature infants and divided them into two groups based on the presence or absence of incoordination. The Bayley-III cognition composite scores of the incoordination-positive and incoordination-negative group were compared at 8–12 and 18–24 months of age.ResultsSeventy premature infants exhibited a disorganized sucking pattern according to the NOMAS. The average Bayley-III cognition composite scores at 8–12 months of age were 92.5 ± 15.6 and 103.0 ± 11.3 for the incoordination-positive (n = 22) and incoordination-negative groups (n = 48), respectively (p = 0.002). The average Bayley-III cognition composite scores at 18–24 months were 90.0 ± 17.9 and 100.7 ± 11.5 for the incoordination-positive (n = 21) and incoordination-negative groups (n = 46), respectively (p = 0.005). A multiple linear regression analysis indicated that the presence of uncoordinated sucking pattern, grade 3 or 4 germinal matrix hemorrhage–intraventricular hemorrhage, and moderate to severe bronchopulmonary dysplasia were independently associated with cognitive development at 18–24 months of age.ConclusionsUncoordinated sucking pattern in premature infants was independently associated with a higher risk of abnormal developmental outcome in the cognitive domain of the Bayley-III at both 8–12 and 18–24 months. There may be a need for periodic follow-up and early intervention for developmental delay when incoordination of SSR that results in stress signals on the NOMAS is observed before 40 weeks postmenstrual age.

Oral feeding readiness and premature infant outcomes

BackgroundPreterm infants develop a coordinated suck and swallow depending upon their postmenstrual age and neurological status. However, criteria to determine when to best initiate oral feeding are unclear. Yet, infant readiness for oral feeding is essential for successful transition from enteral tube to oral feeding. AimThis study aimed to (a) identify infant characteristics associated with feeding readiness assessed with the Neonatal Oral Motor Assessment Scale (NOMAS)1 and (b) examine the relationship between readiness and preterm infants’ time to reach full oral feeding and length of hospital stay. Study designThis is a secondary descriptive analysis from a randomized controlled study to determine the effect of a premature infant oral motor intervention on feeding progression and length of hospital stay. Seventy-five stable premature infants were recruited from five neonatal intensive care units in Assiut city, Assiut governorate, Egypt. Eligible infants’ gestational age ranged from 30 to 32 weeks gestational age (GA). Readiness was assessed individually for each infant during non/nutritive sucking using NOMAS. ResultPreterm infants who demonstrated greater oral feeding readiness achieved full oral feeding sooner (P < 0.0001) and were discharged earlier from the hospital (P < 0.0001) than those with less readiness. Gender, gestational age at birth, birth weight, number of intervention days were not related to infant oral feeding readiness. ConclusionReadiness for oral feeding in premature infants is related to earlier feeding progression and shorter hospital stays.

Non-Nutritive Sucking in the Preterm Infant.

To identify the progression of non-nutritive sucking (NNS) across postmenstrual age (PMA) and to investigate the relationship of NNS with medical and social factors and oral feeding. Fifty preterm infants born at ≤32 weeks gestation had NNS assessed weekly starting at 32 weeks PMA with the NTrainer System. Oral feeding was assessed at 38 weeks PMA. There were increases in NNS bursts per minute (p = 0.005), NNS per minute (p < 0.0001), NNS per burst (p < 0.001), and peak pressure (p = 0.0003) with advancing PMA. Level of immaturity and medical complications were related to NNS measures (p < 0.05). NNS measures were not related to Neonatal Oral Motor Assessment Scale scores. Smaller weekly change in NNS peak pressure (p = 0.03; β = -1.4) was related to feeding success at 38 weeks PMA. Infants demonstrated NNS early in gestation. Variability in NNS scores could reflect medical complications and immaturity. More stable sucking pressure across time was related to feeding success at 38 weeks PMA.

Incoordinated sucking pattern is associated with longer transition time to full oral feeding in premature infants

Several treatments have been proposed in order to shorten the time to the attainment of full oral feeding (FOF) for pre-term infants, but there are only a few evaluation methods useful in estimating predictors of this period. We investigated whether specific items within the disorganized sucking patterns described by the neonatal oral-motor assessment scale (NOMAS) could estimate the time to FOF in preterm infants with sucking difficulty. Video recordings of at least 2 minutes of oral feeding were analyzed by two assessors, and the premature infants observed to exhibit disorganized sucking patterns ( n = 109) were divided into three clusters (clusters 2, 3, and 4), and further divided into incoordination positive (cluster 4) and incoordination negative groups (clusters 2, 3). Premature infants in the incoordination positive group showed a median transition time of 22 days (range: 4–121 days) which was longer than that in the incoordination negative group (arrhythmic and/or unable to sustain sucking pattern, median 6 days; range: 1–25 days). Univariate analysis revealed that the presence of incoordination among disorganized sucking patterns (NOMAS cluster 4 vs. clusters 2, 3), birth weight, TPN duration, NIPPV duration, the presence of moderate to severe BPD, pulmonary hypertension, sepsis, SGA, and NEC, are associated with the transition time to FOF. When selecting premature infants to be treated with swallowing therapy, it is reasonable to perform treatment with the incoordination positive group described in the NOMAS, that is, premature infants with stress signals to shorten the time to attain full oral feeding.

Predictors and outcomes of the Neonatal Oral Motor Assessment Scale (NOMAS) performance: a systematic review.

The present review highlights benefits and limitations of the NOMAS. Future research is needed to develop observational and clinically-relevant tools to better identify newborns which are at lower- and higher-risk of developing less-than-optimal feeding behaviors and to guide with greater precision the diagnostic and therapeutic journey of these newborns. What is Known: • The assessment of oral-motor skills in newborns and infants is critical for early intervention • The NOMAS is the most adopted tool to assess oral-motor skills in newborns and infants What is New: • The ability of the NOMAS to target newborn at risk for feeding disorders is confirmed • Nonetheless, the capacity to predict long-term developmental outcomes is limited.

Stress Signals During Sucking Activity Are Associated With Longer Transition Time to Full Oral Feeding in Premature Infants.

Several treatments have been proposed to shorten the time to the attainment of full oral feeding (FOF) for premature infants, but there are only a few evaluation methods useful in estimating predictors of this period. We investigated whether specific items within the disorganized sucking patterns described by the Neonatal Oral-Motor Assessment Scale (NOMAS) could estimate the time to FOF in preterm infants with feeding difficulty. Preterm infants diagnosed with a disorganized sucking pattern in the NOMAS evaluation before 50 weeks of postmenstrual age were included. Video recordings of at least 2 min of oral feeding were further analyzed retrospectively by two assessors and the premature infants who exhibited disorganized sucking patterns (n = 109) were divided into three clusters (clusters 2–4). The observational items compatible with disorganization in the original NOMAS were divided into three groups: cluster 2 (disorganized: arrhythmical), cluster 3 (disorganized: arrhythmical + unable to sustain), and cluster 4 (disorganized: arrhythmical + incoordination ± unable to sustain) and further divided into incoordination-positive (cluster 4) and incoordination-negative groups (clusters 2 and 3). Premature infants in the incoordination-positive group (cluster 4, which means stress signals) showed a median transition time of 22 days (range: 4–121 days) which was longer than that in the incoordination-negative group (median 6 days; range: 1–25 days). Univariate linear regression analysis revealed that the presence of incoordination among disorganized sucking patterns (NOMAS cluster 4 vs. clusters 2 and 3), birth weight, total parenteral nutrition (TPN) duration, non-invasive positive pressure ventilation duration, the presence of moderate to severe bronchopulmonary dysplasia, pulmonary hypertension, sepsis, small for gestational age (SGA), and necrotizing enterocolitis are associated with the transition time to FOF. In a multivariate linear regression analysis, the variables revealed to be associated with the transition time were TPN duration, SGA, and the presence of stress signals (incoordination-positive group) among disorganized sucking patterns. When selecting premature infants to be treated with swallowing therapy, it is reasonable to pay more attention to the incoordination-positive group described in the NOMAS, that is, premature infants with stress signals to shorten the time to attain FOF.

The predictive value of early oral motor assessments for neurodevelopmental outcomes of moderately and late preterm infants.

Oral motor assessment is used to identify abnormal sucking patterns which may reflect neurodevelopmental problems in preterm infants, but few studies have focused on moderately and late preterm infants. We enrolled 118 moderately and late preterm infants (mean gestational age, 35.04 weeks; mean birth weight, 2347.59 g) and analyzed the relationship between the Neonatal Oral-Motor Assessment Scale scores of these infants and the Chinese revision of Bayley Scales of Infant Development outcomes at 6 months corrected age. And the infants with abnormal sucking pattern had significantly lower Mental Development Index and Psychomotor Development Index and showed a higher rate of below average scores than control group (P = .003, P = .029, P = .022). The incoordination of suck–swallow–respiration was a risk factor for adverse neurodevelopment (RR = 3.67, 95% CI: 1.42–9.45). These indicate that abnormal sucking patterns in moderately and late preterm infants might provide some predictive value for short-term neurodevelopmental outcomes, but the clinical predictive value for developmental delay need to be determined in a longer term follow-up. This finding may offer a basis for early intervention.

Sucking behaviour in infants born preterm and developmental outcomes at primary school age.

To determine the association between sucking in infants born preterm and developmental outcomes at 5 years. Thirty-four infants were included (mean gestational age 30wks 4d, mean birthweight 1407g). The Neonatal Oral-Motor Assessment Scale was used longitudinally from 37 to 50weeks postmenstrual age. At 5years, we assessed motor skills, intelligence, language, verbal memory, and behavioural problems. Linear regression analyses were performed to test whether aspects of sucking behaviour predicted these developmental outcomes. Where linear regression was not appropriate, Spearman's correlation coefficients were calculated between sucking and developmental outcomes. Sucking was associated with total motor skills (B [unstandardized correlation coefficient for normally distributed data]=22.66, 95% confidence interval [CI] 6.61 to 38.71), balance (Spearman's ρ=0.64, p<0.001), total intelligence (B=-1.16, 95% CI -1.89 to -0.44, B=10.48, 95% CI 0.39 to 20.71, B=-2.22, 95% CI -3.42 to -1.02), verbal intelligence (B=-0.95; 95% CI -1.83 to -0.07, B=-2.02; 95% CI -3.55 to -0.49), performance intelligence (B=-1.34, 95% CI -2.13 to -0.54, B=12.36, 95% CI 1.13 to 23.60, B=-2.37, 95% CI -3.75 to -0.96), and language (B=-1.78, 95% CI -3.36 to -0.19). All associations were in the same direction: the better the sucking, the higher the test scores. Verbal memory and behavioural problems were not associated with sucking. Abnormal sucking between 42 weeks and 50 weeks postmenstrual age may reflect abnormal neurological functioning in children born preterm.

Assessment of Oral Feeding Readiness Among Preterm Infants

Background: Being born preterm presents numerous challenges for the preterm infant including neurodevelopmental immaturity, physiologic instability, and behavioral state disorganization. In this context, there are often challenges with the initiation and achievement of full oral feedings. Recognition and support of oral feeding readiness may accelerate feeding progression period and decrease length of hospital stay (LOS), thereby reducing healthcare costs. Supporting effective cue-based oral feeding through use of rigorous assessment or evidence-based care guidelines can optimize the hospital experience for infants and caregivers. Aims: This study aimed to assess premature infant’s readiness level at the beginning of oral feeding. Identify factors that contributed to readiness in premature infants. Methods: A descriptive cross sectional design used in this study. Subjects: A convenience sample of 75 stable premature infants recruited from five neonatal intensive care units (NICUs) in Assuit city, Egypt. Infants’ gestational age ranged from 30 to ≤ 32 weeks post menstrual age (PMA). Tools: Infant’s readiness assessed directly after oral feeding was introduced by using Neonatal Oral Motor Assessment scale (NOMAS). Results: Majority of the premature infants showed feeding readiness behavior (74.7%) when they received their first oral feeding. No relationship between infants’ gestational age at birth or weight and readiness behavior was observed. Conclusion: Most of infants had high level of readiness when oral feeding was initiated, correlation between infant’s characteristics and readiness level were not significant. Recommendations: Encourage clinician to use standard measure as NOMAS to early assess readiness behavior of premature infants. And address NOMAS as a routine process in NICUs

A systematic review of clinical and psychometric properties of infant oral motor feeding assessments

ABSTRACTPurpose: To describe the clinical properties and psychometric soundness of infant oral motor feeding assessments available for practice. Methods: A systematic review was conducted using six databases (PubMed, Ovid [Medline], CINHAL, EMBASE, psycINFO, and COCHRANE) to retrieve articles. Assessments were analyzed for their clinical characteristics and psychometric robustness. Results: Ten assessment tools were identified to meet the inclusion/exclusion criteria. Clinical properties of the tools varied from assessments which assessed oral feeding readiness, oral motor function, and pre-feeding skills for breast and/or bottle feeding. Psychometric evidence was found for seven assessment tools. The Neonatal Oral Motor Assessment Scale was found to be the most widely tested for psychometric soundness. The overall psychometric evidence was inconsistent and/or inadequate for the evaluative tools. Conclusions: Findings from this systematic review demonstrate clinical usefulness of the tools based on their assessment properties, however additional studies are needed to further establish their psychometric soundness.

New scoring system improves inter-rater reliability of the Neonatal Oral-Motor Assessment Scale.

The Neonatal Oral-Motor Assessment Scale (NOMAS) is a standardised tool to assess sucking patterns in infants to 48 weeks of postmenstrual age (PMA). In the Netherlands, the interpretation of specific NOMAS items has evolved, leading to a new scoring system. Recent research using the NOMAS describes a way of clustering the most frequent items, and the aim of this study was to determine whether those changes improved the inter-rater reliability. The inter-rater reliability was tested by two NOMAS-certified therapists who scored 120 video recordings of 40 preterm infants, admitted to the University Hospital of Düsseldorf, Germany, at 34, 37 and 44 weeks PMA, for normal, disorganised and dysfunctional diagnosis. The NOMAS comprised 28 items and five clusters of items. The therapists agreed on the level of diagnoses for 116 of 120 recordings (Cohen's Κ 0.90), on an item level for 107 of 120 recordings (Cohen's Κ 0.78) and on a cluster level for 108 of 120 recordings (Cohen's K 0.90). The new scoring system improved the inter-rater reliability of the NOMAS on all levels, highlighting the importance of NOMAS user having a clear understanding on how to interpret and score each item.

The Association between Sucking Behavior in Preterm Infants and Neurodevelopmental Outcomes at 2 Years of Age

To evaluate whether a specific period after birth (in weeks postmenstrual age [PMA]) and specific elements of sucking are associated with abnormal neurodevelopmental outcomes at age 2 years using a longitudinal approach. Fifty-two preterm infants participated in this longitudinal cohort study (mean gestational age, 29.5 weeks; mean birth weight, 1197 g). We assessed the infants' sucking patterns at 37-50 weeks PMA using the Neonatal Oral-Motor Assessment Scale. At age 2 years, based on a neurologic examination and the Dutch version of the Bayley Scales of Infant and Toddler Development, Second Edition, we categorized the children as developing normally (n = 39) or abnormally (n = 13). ORs, including 95% CIs, were calculated to ascertain the risk of abnormal neurodevelopmental outcomes. The inability to sustain sucking at 46 weeks PMA (OR, 6.25; 95% CI, 1.29-30.35) and the absence of a mature sucking pattern at 44 weeks PMA (OR, 6.30; 95% CI, 1.40-28.32) significantly increased the odds of abnormal neurodevelopmental outcomes at age 2 years. The ORs of the Neonatal Oral-Motor Assessment Scale items assessing rhythmic jaw movements, rhythmic tongue movements, and coordination among sucking, swallowing, and respiration were high shortly after term, but failed to reach significance. Specific elements of sucking at 4-6 weeks postterm are associated with abnormal neurodevelopmental outcomes in preterm infants at age 2 years. This period might be a sensitive time of infant development in which sucking behavior is an early marker of abnormal developmental outcomes. This finding may offer opportunities for early intervention.

Psychometrics of the Neonatal Oral Motor Assessment Scale

To establish the psychometrics of the Neonatal Oral Motor Assessment Scale (NOMAS). In this prospective cohort study of 75 preterm infants (39 females, 36 males) born at or before 30 weeks gestation (mean gestational age 26.56 wks, SD 1.90, range 23-30 wks; mean birthweight 967.33 g, SD 288.54, range 480-2240), oral feeding was videotaped before discharge from the neonatal intensive care unit (NICU). The NOMAS was used to classify feeding as normal, disorganized, or dysfunctional. Neurobehavior was assessed at term equivalent, and infants underwent magnetic resonance imaging. Children returned for developmental testing at 2 years corrected age. Associations between NOMAS scores and (1) neurobehavior; (2) cerebral injury and metrics; and (3) developmental outcome were investigated using χ(2) -analyses, t-tests, and linear regression. For reliability, six certified NOMAS evaluators rated five randomly selected NOMAS recordings and re-scored them 2 weeks later in a second randomized order. Reliability was calculated with Cohen's kappa statistics. Dysfunctional NOMAS scores were associated with lower Dubowitz scores [t=-2.14; mean difference -2.32 (95% confidence interval [CI] -0.157 to -4.49); p=0.036], higher stress on the NICU Network Neurobehavioral Scale (t=2.61; mean difference 0.073 [95% CI 0.017-0.129]; p=0.0110), and decreased transcerebellar diameter (t=-2.22; mean difference -2.04 [CI=-3.89 to -0.203]; p=0.03). No significant associations were found between NOMAS scores and 2-year outcome. Some concurrent validity was established with associations between NOMAS scores and measures of infant behavior and cerebral structure. The NOMAS did not show predictive validity in this study of preterm infants at high risk of developmental delay. Reliability was variable and suboptimal.