The Validity and Reliability of Early Feeding Skills Assessment and Cue-Based Feeding Scales for Preterm Infants

Background: 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. Objectives: 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)). Methods: 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. Results: 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). Conclusions: 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.