Saakje da Costa

The reliability of the neonatal oral-motor assessment scale

Objectives: Sucking problems in preterm infants can be specified by means of visual observation. The Neonatal Oral‐Motor Assessment Scale (NOMAS) is the visual observation method most commonly used to assess the non‐nutritive sucking (NNS) and nutritive sucking (NS) skills of infants up to approximately 8 weeks postterm. During the first 2 min of a regular feeding the infants sucking skill is assessed, either immediately or on video. Although NOMAS has been used since 1993, little is known about the methods reliability. The aim of our study was to determine the test‐retest and inter‐rater reliability of NOMAS.

Development of sucking patterns in pre-term infants with bronchopulmonary dysplasia

Background: Pre-term infants with bronchopulmonary dysplasia (BPD) are at risk of acquiring brain abnormalities. Combined with ongoing breathing difficulties, this may influence the development of their sucking patterns. Objective: To determine the longitudinal development of sucking patterns from birth until 10 weeks’ post-term age in pre-term infants with and without BPD. Methods: The sucking patterns of 16 pre-term infants with BPD and 15 pre-term infants without BPD were prospectively assessed with the Neonatal Oral-Motor Assessment Scale. The infants were matched for gestational age (<30 weeks). We recorded approximately 12 feeding episodes per infant, from 34 until 50 weeks’ post-menstrual age. We diagnosed the infants’ sucking patterns as normal, dysfunctional, or disorganized. Then, we examined the development of the sucking patterns in relation to relevant clinical characteristics. Results: Thirty (21%) of 142 feeding episodes of the pre-term infants with BPD and 36 (23%) of 156 of those without BPD were diagnosed as normal (non-significant). Of the abnormal patterns, 3 were diagnosed as dysfunctional and 229 as disorganized. Before term-equivalent age, definitely abnormal sucking patterns were more prevalent in the pre-term infants with BPD than in those without BPD: 69 (49%) and 47 (30%) episodes, respectively (χ2 = 10.7, p < 0.01). In particular, the abnormal patterns including the item ‘incoordination’, defined as the inability to coordinate sucking and swallowing with breathing, were more prevalent: 36 and 15%, respectively (χ2 = 6.37, p < 0.05). There was no difference between the two groups regarding the age at which they acquired normal sucking patterns. Relevant clinical characteristics did not influence the development of the sucking patterns. Conclusions: The developmental characteristicof sucking patterns in infants with BPD was that these infants were unable to coordinate swallowing with breathing. This was the case especially prior to term-equivalent age; after term-equivalent age, the development of sucking closely resembled that of pre-term infants without BPD.

Exposure to texture of foods for 8‐month‐old infants: Does the size of the pieces matter?

This study examined the effect of meals varying in amount, size, and hardness of food pieces on the development of the chewing capabilities of 8-month-old infants. The study also examined changes in shivering, gagging, coughing, choking, and their ability to eat from a spoon. In an in-home setting two groups were given commercially available infant meals and fruits, purees with either less, smaller and softer or more, larger and harder pieces. Both groups were given these foods for 4 weeks and were monitored several times during this period. After the 4-week exposure period infants in both groups were given the same five test foods. Structured questionnaires with questions on eating behavior and the childs development were conducted 6 times in the 4 to 12-month period and video analyses of feedings were conducted 4 times between 8 and 9 months. After the 4-week exposure period, the group that had been exposed to the foods with more, larger and harder pieces showed a significantly higher rating for chewing a piece of carrot and potato for the first time, but not for a piece of banana nor for mashed foods. Shivering, gagging, coughing, choking, and ability to eat from a spoon were not different between the two groups. These results contribute to the insight that exposure to texture is important for young children to learn how to handle texture. PRACTICAL APPLICATIONS: (a) The study shows the feasibility of testing the effects of texture interventions on chewing capability and oral responses such as gagging, coughing, and choking in infants. (b) The study contributes to the insight that exposure to food texture to learn how to handle texture is important for infants and showed that exposing children to a higher amount of larger pieces improves their chewing capability for a piece of carrot and potato, at least immediately after the intervention.

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

The Neonatal Oral‐Motor Assessment Scale (NOMAS) is a standardised tool to assess sucking patterns in infants to 48 weeks of postmenstrual age (PMA). In the Netherlands, the interpretation of specific NOMAS items has evolved, leading to a new scoring system. Recent research using the NOMAS describes a way of clustering the most frequent items, and the aim of this study was to determine whether those changes improved the inter‐rater reliability.

Sucking behaviour in infants born preterm and developmental outcomes at primary school age

To determine the association between sucking in infants born preterm and developmental outcomes at 5 years.