Development of a clinical feeding assessment scale for very young infants in South Africa

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.

Preliminary psychometric performance of the Neonatal Feeding Assessment Scale

“…The development and content of the NFAS were discussed in a previous study (Viviers et al, 2016 ). The item selection in the sections of the NFAS was based on theoretical constructs related to neonatal and early infant feeding and the clinical assessment of feeding skills.…”

“…When a score of three or more yes responses is obtained, the assessment outcome indicates that OPD is likely to be present. At least one of the three yes responses required for reaching the final diagnosis of OPD must either be obtained in Section E or F (Viviers et al, 2016 ).…”

“…In a developing country such as South Africa there is a need for valid clinical assessment instruments for use by local speech-language therapists (SLTs) in neonatal dysphagia (Viviers, Kritzinger & Vinck, 2016 ). Such a need was also identified by Botha and Schoeman and indirectly implied in the South African practice guidelines for paediatric dysphagia, as no standardised clinical assessment instrument is recommended to use with neonates (Botha & Schoeman, 2011 ; SASHLA, 2011a ).…”

“…To respond to the need for a valid neonatal dysphagia assessment instrument for use in resource-constrained developing countries, the Neonatal Feeding Assessment Scale (NFAS) was developed and approved, using expert collaboration through the Delphi method (Viviers et al, 2016 ). Panel members agreed on a need for a validated NFAS.…”

“…Panel members agreed on a need for a validated NFAS. South African panel members favoured a comprehensive instrument while international members contributed to evidence-based item inclusion and the use of an objective scoring system (Viviers et al, 2016 ). Clinical assessment will never replace the gold standard of MBSS but may contribute significantly to complex clinical decision-making in neonatal dysphagia.…”