Reliability and validity of the neonatal feeding assessment scale (NFAS) for the early identification of dysphagia in moderate to late preterm neonates

Abstract

Background: A clinical feeding assessment instrument to assist with early identification of oropharyngeal dysphagia (OPD) in neonates was developed.Objective: To investigate the validity and reliability of the Neonatal Feeding Assessment Scale (NFAS) in comparison to the modified barium swallow study (MBSS) as gold standard.Method: A within-subject design was implemented. A group of 48 late premature neonates (mean gestational age 35.5 weeks) were sampled in the neonatal intensive care unit.Results: The NFAS consists of six subsections, including physiological stability, infant state, stress cues, screening of muscle tone and control, oral peripheral examination and feeding/swallowing assessment. 93% of participants (14/15) received confirmatory diagnosis of OPD on MBSS. The NFAS presented with high sensitivity (78.6%) and specificity (88.2%) scores. The positive predictive value was 78.6%. Subsequently the accuracy of the NFAS to identify the presence of OPD accurately was 85.4% when compared to MBSS. Inter-rater reliability was determined on 35% of the sample. The inter-rater agreement on overall instrument outcome was substantial beyond chance.Conclusion: The NFAS may be of use to clinicians to support the early identification of OPD in this population, especially in resource constrained settings working without access to MBSS and to reach under served neonates.Keywords: Inter-rater reliability, modified barium swallow study, Neonatal Feeding Assessment Scale (NFAS), oropharyngeal dysphagia diagnosis, validity.

Clinical and Instrumental Swallowing Assessments for Dysphagia

“…Included Studies for Question 1: DTA We included 4 cross-sectional studies that examined the DTA of various clinical or bedside screening evaluations compared to instrumental assessments for dysphagia. [7][8][9][10] These studies were conducted in Turkey, 7 the US, 10 Brazil, 9 and South Africa. 8 The studies included a total of 233 individuals.…”

“…[7][8][9][10] These studies were conducted in Turkey, 7 the US, 10 Brazil, 9 and South Africa. 8 The studies included a total of 233 individuals. Two of these studies included adults, 40 of whom had previously had an ischemic stroke 7 and 31 of whom had a diagnosis of Parkinson disease.…”

Evolution of swallowing and feeding abilities of neonates with hypoxic-ischaemic encephalopathy during hospitalisation: A case series

“…The NFAS assesses the following areas related to swallowing and feeding: physiological functioning; neonatal state; stress cues; motor performance; oral anatomy and primitive reflexes; and signs and symptoms of OPD (Viviers et al, 2019). It also provides a composite score that indicates whether OPD is pre-sent (Viviers et al, 2019).…”

“…The NFAS assesses the following areas related to swallowing and feeding: physiological functioning; neonatal state; stress cues; motor performance; oral anatomy and primitive reflexes; and signs and symptoms of OPD (Viviers et al, 2019). It also provides a composite score that indicates whether OPD is pre-sent (Viviers et al, 2019). Preliminary investigations into the psychometric properties of the NFAS have proven that it is a valid tool for describing neonatal feeding skills and that it shows acceptable interrater reliability (Viviers et al, 2017;Viviers et al, 2019).…”

“…It also provides a composite score that indicates whether OPD is pre-sent (Viviers et al, 2019). Preliminary investigations into the psychometric properties of the NFAS have proven that it is a valid tool for describing neonatal feeding skills and that it shows acceptable interrater reliability (Viviers et al, 2017;Viviers et al, 2019). VFSS were conducted using the CombiDiagnost R90 remote controlled fluoroscopy system (Koninklijke Philips N.V., Netherlands).…”