- •The TC-POFRAS is an effective scale for predicting premature infants' readiness for oral feeding.
- •Healthcare professionals may use the TC-POFRAS to assess and assist in determining whether to initiate oral feeding for preterm infants in clinical practice.
A successful transition from gavage to full oral feeding is a decisive indicator for discharging premature infants from the neonatal intensive care unit. A clinically useful measure of oral feeding readiness would help nurses initiate implementation of the cue-based feeding model in Taiwan. The study aimed to assess the validity and reliability of the Traditional Chinese Preterm Oral Feeding Readiness Assessment Scale (TC-POFRAS).
Design and methods
81 preterm infants were enrolled and assessed by TC-POFRAS regarding their oral feeding readiness. This study included two phases. Phase 1 conducted a cross language validation procedure and item-level content validity indices (I-CVIs) for content validity were estimated. In phase 2, Cronbach's alpha for internal consistency at each category and total scale levels were estimated. A receiver operating characteristic (ROC) curve was estimated to explore the scale's performance. The optimal cut-off value of TC-POFRAS was identified by the best Youden's Index [maximum (sensitivity + specificity − 1)].
All of the I-CVIs were 1.00. The whole Cronbach's alpha for internal consistency was 0.804 (95% CI = 0.736–0.862), and Cronbach's alpha values were between 0.538 (95% = 0.332–0.689) and 0.687 (95%CI = 0.572–0.781) for categories. The area under ROC was 92.2%, and an optimal cut-off value of TC-POFRAS was 29 (sensitivity: 0.938, specificity: 0.941).
The TC-POFRAS has been verified to be an effective and accurate instrument to determine the initiation of oral feeding in preterm infants.
The TC-POFRAS is an appropriate and complementary assessment instrument for professionals to conveniently use in clinical practice.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Pediatric Nursing: Nursing Care of Children and Families
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Relationship of neonatal oral motor assessment scale to feeding performance of premature infants.Journal of Neonatal Nursing. 2012; 18: 30-36
- Interneonatal intensive care unit variation in growth rates and feeding practices in healthy moderately premature infants.Journal of Perinatology. 2005; 25: 478-485
- National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications.The Lancet. 2012; 379: 2162-2172
- Assessment for oral feeding in preterm infants.Vol. 28. Codas, 2016: 284-288 (No. 3)
- Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: A prospective population-based study.Archives of Disease in Childhood. Fetal and Neonatal Edition. 2015; 100: F479-F485
- A pilot study of oral-motor dysfunction in “at-risk” infants.Physical & Occupational Therapy in Pediatrics. 1985; 5: 13-26
- Comparative research methodology: Cross-cultural studies.International Journal of Psychology. 1976; 11: 215-229
- Eating behaviour of children 1.5–3.5 years born preterm: Parents’ perceptions.Journal of Paediatrics and Child Health. 2002; 38: 72-78
- Severity of disease as main predictor for mortality in patients with pyogenic liver abscess.The American Journal of Surgery. 2009; 198: 164-172
- Instruments for assessing readiness to commence suck feeds in preterm infants: Effects on time to establish full oral feeding and duration of hospitalisation.Cochrane Database of Systematic Reviews. 2016; 8
- The reliability of the neonatal oral-motor assessment scale.Acta Paediatrica. 2008; 97: 21-26
- Meta analysis: Effects of interventions on premature infants feeding.The Journal of Perinatal & Neonatal Nursing. 2000; 14: 62-77
- “It’s a long-term process”: Description of daily family life when a child has a feeding disorder.Journal of Pediatric Health Care. 2018; 32: 340-347
- G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.Behavior Research Methods. 2007; 39: 175-191
- Correlates of specific childhood feeding problems.Journal of Paediatrics and Child Health. 2003; 39: 299-304
- Identification of a pivotal period in the oral feeding progression of preterm infants.American Journal of Perinatology. 2019; 36: 530-536
- Reliability of an instrument to assess the readiness of preterm infants for oral feeding.Pró-Fono Revista de Atualização Científica. 2007; 19: 143-150
- Clinical validation of the preterm oral feeding readiness assessment scale.Revista Latino-Americana de Enfermagem. 2013; 21: 140-145
- Oral feeding readiness assessment in premature infants.MCN: The American Journal of Maternal/Child Nursing. 2015; 40: 96-104
- Dysphagia: Clinical management in adults and children.Elsevier Health Sciences, 2015
- How do we determine oral readiness in infants?.Infant. 2016; 12: 10-12
- Identification of neonates at risk of developing feeding problems in infancy.Developmental Medicine and Child Neurology. 2000; 42: 235-239
- A review of psychometric properties of feeding assessment tools used in neonates.Journal of Obstetric, Gynecologic & Neonatal Nursing. 2008; 37: 338-349
- Predictors of the time to attain full oral feeding in late preterm infants.Acta Paediatrica. 2016; 105 (e1-e6)
- Impact of prematurity and co-morbidities on feeding milestones in neonates: A retrospective study.Journal of Perinatology. 2010; 30: 201-208
- Eating difficulties in children born late and moderately preterm at 2 y of age: A prospective population-based cohort study.The American Journal of Clinical Nutrition. 2016; 103: 406-414
- The interrater and intrarater reliability of the Preterm Infant Oral Feeding Readiness Assessment Scale.Journal of Modern Rehabilitation. 2019; 13: 31-38
- Cue-based oral feeding clinical pathway results in earlier attainment of full oral feeding in premature infants.Journal of Perinatology. 2007; 27: 572
- Oral feeding readiness in preterm infants: A concept analysis.Advances in Neonatal Care. 2013; 13: 230-237
- Development of suck and swallow mechanisms in infants.Annals of Nutrition and Metabolism. 2015; 66: 7-14
- Enteral nutrition in preterm infants during hospitalization.in: Lin C.-H. Recommendation on nutritional care of Taiwan preterm infants. Taiwan Elsevier, 2018: 19-35 (E-Publishing Inc)https://www1.cgmh.org.tw/chldhos/intr/c4a60/index.files/work%20files/Recommendation%20on%20Nutritional%20Care%20of%20Taiwan%20Preterm%20Infants.pdf
- Evaluation and treatment of swallowing disorders.2nd ed. 1942 (Austin)
- Clinicians guide for cue-based transition to oral feeding in preterm infants: An easy-to-use clinical guide.Journal of Evaluation in Clinical Practice. 2018; 24: 80-88
- Changing feeding documentation to reflect infant-driven feeding practice.Newborn and Infant Nursing Reviews. 2007; 7: 155-160
- Determination and quantification of content validity.Nursing Research. 1986; 35: 382-385
- Feeding problems and dysphagia in six-month-old extremely low birth weight infants.Advances in Speech Language Pathology. 2000; 2: 9-17
- State of the science: Feeding readiness in the preterm infant.The Journal of Perinatal & Neonatal Nursing. 2004; 18: 353-368
- The development of sucking patterns and physiologic correlates in very-low-birth-weight infants.Nursing Research. 1993; 42: 100-105
- The maturation and coordination of sucking, swallowing, and respiration in preterm infants.The Journal of Pediatrics. 2003; 142: 36-40
- Non-nutritive sucking scoring system for preterm newborns.Acta Paediatrica. 2008; 97 (Oslo, Norway : 1992): 1370-1375
- Gastrointestinal maturation and feeding.in: Seminars in perinatology. Vol. 30. WB Saunders, 2006, April: 77-80 (No. 2)
- Validazione linguistico-culturale della scala di valutazione POFRAS-Preterm Oral feeding readiness assessment scale.SCENARIO: Official Italian Journal of ANIARTI. 2018; 35https://web.a.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=15925951&AN=129411319&h=8cTq2dAeHeizMa7rRzMPNDr%2bSQ1l%2buUjv5%2bOcqHGkQRhvNiIZPSYeau79jKG2ubKLIVW0KZtnMTi4xEGAq8h7Q%3d%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d15925951%26AN%3d129411319
- Changes in oral feeding in preterm infants 2 weeks after hospital discharge.Newborn and Infant Nursing Reviews. 2012; 12: 202-206
- The content validity index: Are you sure you know what’s being reported? Critique and recommendations.Research in Nursing & Health. 2006; 29: 489-497
- The complexity of feeding problems in 700 infants and young children presenting to a tertiary care institution.Journal of Pediatric Gastroenterology and Nutrition. 2003; 37: 75-84
- Nipple feeding premature infants: A different perspective.Neonatal Network: NN. 1990; 8: 9
- Cue-based feeding in the NICU: Using the infant’s communication as a guide.Neonatal Network. 2013; 32: 404-408
- A checklist for evaluating the usefulness of rating scales.The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie. 1993; 38: 140-148
- Measuring the accuracy of diagnostic systems.Science. 1988; 240: 1285-1293
- The use of Cronbach’s alpha when developing and reporting research instruments in science education.Research in Science Education. 2018; 48: 1273-1296
- Making sense of Cronbach’s alpha.International Journal of Medical Education. 2011; 2: 53
- The early feeding skills assessment for preterm infants.Neonatal Network. 2005; 24: 7-16
- Psychometric properties of the Early Feeding Skills assessment tool.Advances in Neonatal Care. 2018; 18: E13-E23
- Contributing to content validity of the Infant-Driven Feeding Scales© through Delphi surveys.Newborn and Infant Nursing Reviews. 2014; 14: 88-91
- Feeding readiness in preterm infants: The relationship between preterm behavioral state and feeding readiness behaviors and efficiency during transition from gavage to oral feeding.MCN: American Journal of Maternal Child Nursing. 2005; 30: 52-59
- The relationship between birth weight and feeding maturation in preterm infants.. 2009; 98: 286-290
- Do infants born very premature and who have very low birth weight catch up with their full term peers in their language abilities by early school age?.Journal of Speech, Language, and Hearing Research. 2018; 61: 53-65
- Assess of validity and reliability of Chinese version of Preterm Infant Oral Feeding Readiness Assessment Scale.Chinese Journal of Applied Clinical Pediatrics. 2013; : 501-505https://doi.org/10.3760/cma.j.issn.2095-428X.2013.07.007
Published online: February 26, 2021
Accepted: February 2, 2021
Received in revised form: January 30, 2021
Received: February 12, 2020
© 2021 Published by Elsevier Inc.