Research Article| Volume 59, e84-e92, July 2021

Clinical Validation of the Preterm Oral Feeding Readiness Assessment Scale in Taiwan

Published:February 26, 2021DOI:


      • 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.

      Practice implications

      The TC-POFRAS is an appropriate and complementary assessment instrument for professionals to conveniently use in clinical practice.


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