Preterm Oral Feeding Readiness Assessment Research Articles

Effects of oral stimulation on feeding readiness of preterm infants: A randomized controlled study

BackgroundFeeding readiness is an indicator to assess whether preterm infants can tolerate oral feeding. The Preterm Infant Oral Motor Intervention (PIOMI) may improve infant oral motor function and feeding skills. MethodsTo determine the PIOMI effect on feeding readiness, 46 preterm infants were randomly assigned to either the oral stimulation or standard care group. The Preterm Oral Feeding Readiness Assessment Scale (POFRAS) was used to repeatedly assess participants’ feeding readiness on Day 1 (baseline), Day 3, and Day 7. FindingsThe two groups had similar demographic characteristics. While the baseline POFRAS scores showed non-significant differences between the two groups, the oral stimulation group performed better on Days 3 and 7. DiscussionThe group-by-time interaction assessment indicated a marginally significant difference in the time trend of the POFRAS scores between the two groups. Application to practiceThese results can be helpful for achieving full oral feeding in the NICU.

Preterm oral feeding scale to assist in deciding initial oral feeding of preterm infants in neonatal intensive care units

BackgroundThe inconsistency in decisions to commence oral feeding indicates that health professionals require clearer guidelines to determine when to initiate oral feeding in preterm infants. This study applied the Taiwan version of Preterm Oral Feeding Readiness Assessment Scale (TW-POFRAS) to clinical decision-making, especially for preterm infants with a birth weight less than 1,500 g or gestational age (GA) less than 32 weeks. MethodsThis was a single-center observational cross-sectional study and 81 preterm infants were recruited. Lengths of stay from admission to initial one-meal oral feeding, to one-day all-meal oral feeding, and to discharge were analyzed. Scale scores, physician orders, and smooth oral intake of 5 mL of milk were analyzed. Kappa coefficients were examined to determine concordances within the results. ResultsAt least moderate concordance was evident (k = 0.492). Most preterm infants can begin to consume one meal of the least 5 mL of milk smoothly and proceed to consume a full day of meals with a week; they are typically discharged from the hospital within a month, except for those with a birth weight less than 1,500 g or a GA less than 32 weeks. For 17 of 81 participants, assessment results for physician orders, 5-mL milk consumption, and scale scores were inconsistent. Participants with a birth weight less than 1,500 g or GA less than 32 weeks were able to meet the 5-mL standard by the postmenstrual age of 35 weeks, at latest. ConclusionWe recommend that TW-POFRAS should be used in conjunction with physicians’ clinical decision-making for oral feeding readiness for preterm infants in the NICU.

The effect of non-nutritive sucking combined with oral motor stimulation and oral support on feeding performance in premature infants: A single-blind randomized-clinical trial.

Feeding problems are common in premature infants (PIs) and may lead to negative consequences such as malnutrition, dehydration, excessive weight loss, as well as developmental and psychological deficits. Moreover, they are associated with increased length of hospital stay/cost. There is not enough evidence on how feeding problems should be treated in PIs. The goal of this study was to investigate the effects of non-nutritive sucking combined with oral motor stimulation and oral support on feeding performance in PIs. A single-blind randomized clinical trial was performed on 44 PIs with feeding problems. Patients were randomly categorized into two groups: (1) combined intervention (CI) and (2) non-nutritive sucking (NNS). The CI group received NNS, oral motor stimulation and oral support simultaneously. Infants in both groups received 14 treatment sessions for 14 consecutive days. The Preterm Oral Feeding Readiness Assessment Scale (POFRAS) was used as the primary outcome measure. Weight, volume of milk intake, time to achieve full oral feeding, and length of hospital stay were secondary outcome measures. All measures were assessed before treatment, after the 7th session, after the 14th session, and after 7 days after the end of treatment. Both groups improved in all outcome measures across time (P < 0.001). The improvements in the POFRAS, volume of milk intake, and time to achieve full oral feeding were significantly greater in the CI group than the NNS group (P < 0.001). The improvements attained in weight and length of hospital stay were not significantly different between the CI and NNS groups (P > 0.05). Large effect sizes were found for POFRAS score in both CI (d = 3.98) and NNS (d = 2.19) groups. The current study showed that the combined intervention including NNS, oral motor stimulation, and oral support significantly improved the feeding performance in PIs.

The Validity and Reliability Study of the Turkish Version of the Preterm Oral Feeding Readiness Assessment Scale (T-POFRAS)

The Validity and Reliability Study of the Turkish Version of the Preterm Oral Feeding Readiness Assessment Scale (T-POFRAS)

Clinical Validation of the Preterm Oral Feeding Readiness Assessment Scale in Taiwan

PurposeA successful transition from gavage to full oral feeding is a decisive indicator for discharging premature infants from the neonatal intensive care unit. A clinically useful measure of oral feeding readiness would help nurses initiate implementation of the cue-based feeding model in Taiwan. The study aimed to assess the validity and reliability of the Traditional Chinese Preterm Oral Feeding Readiness Assessment Scale (TC-POFRAS). Design and methods81 preterm infants were enrolled and assessed by TC-POFRAS regarding their oral feeding readiness. This study included two phases. Phase 1 conducted a cross language validation procedure and item-level content validity indices (I-CVIs) for content validity were estimated. In phase 2, Cronbach's alpha for internal consistency at each category and total scale levels were estimated. A receiver operating characteristic (ROC) curve was estimated to explore the scale's performance. The optimal cut-off value of TC-POFRAS was identified by the best Youden's Index [maximum (sensitivity + specificity − 1)]. ResultsAll of the I-CVIs were 1.00. The whole Cronbach's alpha for internal consistency was 0.804 (95% CI = 0.736–0.862), and Cronbach's alpha values were between 0.538 (95% = 0.332–0.689) and 0.687 (95%CI = 0.572–0.781) for categories. The area under ROC was 92.2%, and an optimal cut-off value of TC-POFRAS was 29 (sensitivity: 0.938, specificity: 0.941). ConclusionsThe TC-POFRAS has been verified to be an effective and accurate instrument to determine the initiation of oral feeding in preterm infants. Practice implicationsThe TC-POFRAS is an appropriate and complementary assessment instrument for professionals to conveniently use in clinical practice.

Behavioral state and the premature’s readiness performance to begin oral feeding

ABSTRACT Objective: to evaluate the influence of behavioral states on the readiness of the premature infant to initiate breastfeeding. Methods: the study was transversal, observational and descriptive with 51 premature infants, attended at the Neonatal Intensive Care Unit (NICU), from a Baby-Friendly Hospital. The infants were evaluated using the "Preterm Oral Feeding Readiness Assessment Scale". The evaluation occurred close to the feeding time and was performed in preterm infants in two behavioral states, in deep sleep and alertness. Thus, preterm infants were self-controlled. For the data analysis, the T-Test and the McNemar Test were applied, with a significance level of 0.05. Results: there was a statistically significant difference in the behavior of premature infants in alert behavior and deep sleep. In the alert state, preterm infants showed greater readiness for oral feeding in the breast. The results highlight the importance of the behavioral state of prematurity for professionals working in NICUs. Conclusion: the behavioral state influences the beginning of premature infant feeding. The alertness behavioral status of premature infants is essential during neonatal speech therapy assistence.

Readiness for oral feeding and oral motor function in preterm infants

ABSTRACT Objective: this study aimed at investigating the Schedule Oral Motor Assessment (SOMA) tool to be used with preterm infants and to compare its results with the Preterm Oral Feeding Readiness Assessment Scale (POFRAS) to start oral feeding. Methods: a cross-sectional and quantitative study, consisting in a sample of 45 healthy and clinically stable preterm infants, assessed at their first oral feeding with two tools: the Schedule Oral Motor Assessment and Preterm Oral Feeding Readiness Assessment Scale. Stata 10.0 software was used for data analysis. Results: 10 preterm infants with readiness for oral feeding showed normal oral motor function, and 16, presented with oral motor dysfunction, did not show readiness for feeding (p &lt;0.05). The time of transition for full oral feeding was 13.5 (± 8.1) days for preterm infants with better results in both assessment tools, and 17.7 (± 10.9) days for those who did not show readiness for oral feeding and had oral motor dysfunction to initiate oral feeding, resulting in a given clinical relevance, even showing no significance (p&gt; 0.05). Conclusion: these results suggest that the Schedule Oral Motor Assessment can be an adjunctive method for evaluation of the oral motor function at the first oral feeding in preterm infants.

PO06 – Cross cultural validation of the preterm oral feeding readiness assessment scale (POFRAS)

PO06 – Cross cultural validation of the preterm oral feeding readiness assessment scale (POFRAS)

Clinical validation of the Preterm Oral Feeding Readiness Assessment Scale

INTRODUCTION: Health professionals have great difficulties to establish the adequate and safe time to start breast feeding in preterm infants. There is a need to develop a standardized tool to help health professionals to comprehensively evaluate preterm infant readiness to transition preterm infants´ feeding from gastric to oral, and encourage breast feeding practice in neonatal units. Aims: To clinical validate the accuracy of a Preterm Oral Feeding Readiness Assessment Scale with 60 clinically stable preterm infants. METHODS: Global accuracy, sensitivity and specificity of Preterm Oral Feeding Readiness Assessment Scale cut-offs, compared to milk intake through translactation, were estimated through ROC curves (Receiver Operating Characteristic Curves). RESULTS: The global accuracy of Preterm Oral Feeding Readiness Assessment Scale was 74.38%. The highest sensitivity and specificity were obtained for three cut-offs: 28, 29 and 30. Since higher specificity (75.68%) for the Preterm Oral Feeding Readiness Assessment Scale was found at a score cut-off=of 30 showed higher specificity (75.68%), it should be used as a cut-off score to select initiate breastfeeding the preterm newborns' oral feeding readiness. CONCLUSION: The Preterm Oral Feeding Readiness Assessment Scale is considered valid to assist health professionals to initiate preterm feeding in view of promoting safe and objective breastfeeding.