yaser faryadras

 One of the fundamental factors in infants’ readiness to discharge from the Neonatal Intensive Care Unit (NICU) is attaining full oral feeding. Determining the infants’ development requires instruments to comprehensively assess the infants’ oral skills and the process of feeding.

 This study aimed to measure the validity and reliability of Early Feeding Skill assessment (EFS) and the subscales of the cue-based feeding (Oral Feeding Readiness scale (OFRS) and Oral Feeding Quality scale (OFQS)).

 Participants consisted of 30 preterm infants born at gestational age (GA) ≤ 34 weeks in Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Infants were enrolled by convenience sampling. Intraclass correlation coefficients (ICC) and Weighted Kappa were used to measure reliability, and Spearman and Pearson’s correlation coefficient were used to test convergent and discriminant validity.

 The inter- and intra-rater reliability of all dimensions of EFS were good (ICC ranged from 0.77 to 0.95) except intra-rater reliabiltiy for the ability to maintain physiologic stability and ability to coordinate swallowing was moderate. The inter-rater reliability of the cue-based feeding scales was excellent (Weighted Kappa of > 0.74). The intra-rater reliablity indicated good agreement for OFRS (Weighted Kappa = 0.73) and excellent agreement for OFQS (Weighted Kappa = 0.75). There was an inverse correlation between most subscales of EFS and cue-based feeding scales (P < 0.05), except the ability to maintain physiologic stability and ability to coordinate swallowing dimensions (P > 0.05). There was a significant correlation between the ability to maintain physiologic stability dimension and post menstrual age (PMA) (r = 38, (P < 0.05) and between the oral feeding recovery assessment and GA (r = 0.37, (P < 0.05). OFQS was inversely correlated with GA and PMA (P < 0.05).

 EFS and cue-based feeding scales are valid and reliable scales to assess the oral feeding skills of preterm infants; however, using only one of these scales solely to evaluate infants’ feeding process is not enough.

 One of the most critical criteria in making ready an infant for discharge from the neonatal intensive care unit (NICU) is full oral feeding attainment.

 The present study aimed at investigating the effectiveness of cue-based feeding in preterm infants.

 A randomized clinical trial study was designed to compare 37 preterm infants at a gestational age of ≤ 34 weeks in the cue-based feeding group (n = 18) and the scheduled feeding group (n = 19). All participants were evaluated by the Preterm Infant Oral Feeding Readiness Assessment Scale (PIOFRAS) and Early Feeding Skill (EFS) scale in four different stages. Outcome measures were weight (grams per day), duration of full oral feeding achievement, duration of hospitalization, postmenstrual age (PMA), and the score of PIOFRAS and EFS. A P-value of less than 0.05 has been considered statistically significant.

 The duration of full oral feeding achievement was shorter in the cue-based feeding group (3.55 ± 1.24 vs 6.68 ± 2.00, P < 0.001). Infants were discharged earlier in the cue-based feeding group (15.55 ± 5.38 vs 27.10 ± 7.90, P < 0.001). The mean score of PIOFRAS only on the day of discharge in the cue-based feeding group was more than the scheduled feeding group (32.61 ± 1.14 vs 31.90 ± 0.87, P = 0.03). The score of EFS in each dimension was inconsistent in each stage, and differences were observed between two groups in the full oral feeding stage.

 Although PIOFRAS and EFS demonstrated no difference significantly in most of the stages of achievement in oral feeding between the cue-based feeding group and the scheduled feeding, the process of attainment of oral feeding and discharge from the hospital was more rapid in the cue-based feeding group.