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

Abstract

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.

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

“…Between May 2014 and March 2017, 148 infants in Neonatal Intensive Care Unit (NICU) were referred for consultation to the Division of Pediatric Rehabilitation for feeding difficulty during the transition period from enteral tube feeding to oral feeding. Regarding all infants who were referred, a video recording was done for over 2 min, which was a necessary preparation for the NOMAS evaluation ( 12 , 16 ). Infants were eligible for inclusion if they were born preterm (<37 weeks), video recordings of oral feeding were obtained for more than 2 min for the NOMAS evaluation before 50 weeks of PMA, and if they were diagnosed with a disorganized sucking pattern in NOMAS.…”

“…Cluster 4 refers to the addition of at least one of the “incoordination” items to cluster 2 or 3. Incoordination items defined by the Dutch group include stress signals, such as head bobbing, extraneous movements of the body or limbs during sucking, choking, gagging, coughing, yelping, and grunting ( 16 ). Disorganized sucking patterns were further divided into incoordination-positive (cluster 4, which means stress signals) and incoordination-negative groups (clusters 2 and 3).…”

“…The observational items compatible with disorganization in the original NOMAS were divided into three groups according to the presence of arrhythmical, unable to sustain, and the incoordination items ( 16 ): cluster 2 (disorganized: arrhythmical), 3 (disorganized: arrhythmical + unable to sustain), and 4 (disorganized: arrhythmical + incoordination ± unable to sustain) (Table 1 ). Although this cluster system grouped various NOMAS findings into categories, the clinical usefulness of each item (arrhythmical, unable to sustain, and incoordination) has yet to be demonstrated.…”

“…Observational findings of the “incoordination of SSR that results in stress signals” in the NOMAS include nasal flaring, head turning, and extraneous movements of the body or limbs during sucking, as the description in the study by Palmer et al ( 17 ). The NOMAS working group in the Netherlands added further stress signs, such as choking, gagging, coughing, yelping, and grunting, to the findings of incoordination, and grouped these symptoms as cluster 4 ( 16 ). As the authors designated, these signs are essentially stress signals, and it is still unclear whether these clinical symptoms develop owing to lack of coordination in SSR.…”

A Novel System to Measure Infants’ Nutritive Sucking During Breastfeeding: the Breastfeeding Diagnostic Device (BDD)

“…More recently, feature tracking based video analysis was utilized to capture the infant sucking behavior to estimate sucking counts [22] . However, videotaping can be inaccurate and cannot reveal metrics relevant to intraoral pressure, which are critical components of the sucking microstructure [23] . Infants’ oral chamber geometry during breastfeeding is measured by ultrasound that illustrates the movement of anterior and posterior tongue, palate, nipple-areola complex and their relations during feeding process [15] , [24] – [27] .…”