Assessment/Measurement

Predicting Bottle-Feeding Performance Using a Reorganized Neonatal

Oral–Motor Assessment Scale
Tsu-Hsin Howe, PhD, OTR, FAOTA1, Ching-Fan Sheu, PhD2

Downloaded from http://research.aota.org/ajot/article-pdf/75/Supplement_2/7512500030p1/45923/ajot30_1630408858_68662.pdf by Integracion Sensorial Acis, Adriana Ramirez on 12 November 2022
1New York University, New York, NY, USA; 2National Cheng Kung University, Tainan City, Taiwan

DOI: 10.5014/ajot.2021.75S2-PO30
Date presented: April 23, 2021
Primary Author and Speaker: Tsu-Hsin Howe, tsuhsin.howe@nyu.edu

Compared to full-term infants, a higher percentage of preterm infants experience feeding problems (Jadcherla, 2017). The
development of instruments to assess feeding behaviors is essential not only to evaluate an infant’s ability to achieve good
nutritional and growth status but also to allow clinicians to observe infants’ neurobehavioral maturation indirectly. The Neonatal
Oral–Motor Assessment Scale (NOMAS) is a clinical tool commonly used to evaluate the oral–motor skills of neonates who
demonstrate reflexive sucking. Compared to other neonatal clinical feeding assessment tools, the NOMAS appeared to have been
examined more thoroughly psychometrically than others despite its own limitations (Howe, Lin, Fu, Su, & Hsieh, 2008). The validation
of the psychometric properties of the NOMAS remains inconclusive (Longoni et al., 2018), and overlapping items found in the
NOMAS created problems of redundancy in the test construct (Howe, Sheu, Hsieh, & Hsieh, 2007). The purpose of this study was,
therefore, to re-organize the items of NOMAS by deleting or combining redundant items listed in the assessment, and to examine the
predictability of the newly structured items of NOMAS on infants’ feeding performance. A retrospective study was conducted to
collect records of NOMAS of a sample of preterm infants during their stays in the neonatal intensive care unit. Longitudinal data of
686 preterm infants with adjusted age ranged 29.43 to 54.43 weeks (M ± SD = 35.95 ± 2.72 weeks), weight at observed feed ranged
from 1,125 g to 4,090 g (M ± SD = 2030 ± 463.95 g), over the course of one to 13 visits were collected. The 28 items of the NOMAS
were re-organized and re-structured into 15 items with 7 items in the jaw category and 8 items in the tongue category. A random-
effects regression, generalized linear mixed-effect model trees, and IRT partial credit model were used to analyze the longitudinal
data. The results showed that in addition to the adjusted age and weight at observed feed, jaw depression and jaw initiation were the
significant predictors for successful bottle feed. Despite the NOMAS is a valuable checklist for clinical use, most of the items listed in
the NOMAS did not show significant predictability of feeding performance under the rigorous psychometric testing. The findings of this
study have implications for researchers that more work is warranted to establish the eligibility of the NOMAS as a true outcome
measure. As an occupational therapy practitioner, one should caution the application of the NOMAS as a means only to describe
observed oral-motor skills but not to measure the neurodevelopmental outcomes.

References
Howe, T.-H., Lin, K.-C., Fu, C.-P., Su, C.-T., & Hsieh, C.-L. (2008). A review of psychometric properties of feeding assessment tools used in neonates.
Journal of Obstetric, Gynecologic & Neonatal Nursing, 37(3), 338-349. https://doi.org/10.1111/j.1552-6909.2008.00240.x
Jadcherla, S. R. (2017). Advances with neonatal aerodigestive science in the pursuit of safe swallowing in infants: invited review. Dysphagia, 32(1), 15-26.
https://doi.org/10.1007/s00455-016-9773-z
Longoni, L., Provenzi, L., Cavallini, A., Sacchi, D., Scotto, d. M. G., & Borgatti, R. (2018). Predictors and outcomes of the Neonatal Oral Motor Assessment Scale
(NOMAS) performance: a systematic review. European journal of pediatrics. https://doi.org/10.1007/s00431-018-3130-1.

The American Journal of Occupational Therapy, August 2021, Vol. 75, Supplement 2