Psychometric Properties of the SMART Feeding Tool

Completed

• Conditions: Feeding Disorder of Infancy or Early Childhood; Dysphagia of Newborn; Malnutrition, Infant; Premature Infant Disease; Trauma and Stressor Related Disorders; Feeding; Difficult, Newborn; Nurse's Role; Deglutition Disorders in Infants

• Registration Number: NCT05729828
• Lead Sponsor: Wake Forest University Health Sciences

Brief Summary

This observational study aims to evaluate the psychometric properties of a new infant feeding tool called "SMART Tool" in the neonatal intensive care unit. The main questions it aims to answer are:

1. To design a feeding tool to assess oral motor and neurobehavioral skills in neonates

2. To establish psychometrics of the new tool by doing reliability and validity tests.

Detailed Description

Research supports the use of infant-directed feeding practices versus a volume-driven approach. Infant-directed feeding practices provide developmentally supportive and neuroprotective care to fragile feeders. In addition, various assessment tools exist to evaluate both breast and bottle feeding. Assessment tools are crucial to feeders with guidance in their decision-making, identifying when an infant is ready to feed and recognizing any feeding-related safety concerns.

The scoring of a tool should provide an opportunity to reflect on the strengths and areas of deficit in feeding events and allow feeders to modify feeding practices for the next attempt or pursue further assessment by a feeding specialist. Few tools exist to evaluate both oral skills and neurobehavioral skills. Some tools available have inadequate psychometric data to support their use. If robust psychometrics exist, the length and complexity of the device may intimidate users and deter consistent use.

The SMART tool was developed to capture the multifaceted aspects of feeding while remaining brief in its administration time. The tool provides an opportunity to evaluate skills and develop a plan after feeding to provide consistent quality care. Additionally, tracking scores over time helps in patient safety for the goal of a high-reliability organization.

This study has two objectives: 1. to create a new tool using synactive development theory and trauma-informed care approach for neonates and 2. to establish this tool's psychometrics (validity and reliability). This multicenter trial will be done over four sites (NICU) in Advocate Aurora Health (AAH) to observe feeding events in neonates. Before and after each feed, scoring of feeding quality will be done to do psychometrics. If the study succeeds, this tool will be employed in clinical care in all the NICUs of AAH.

Acronyms \& Abbreviations:

* AAH: Advocate Aurora Health

* NEOA: Neonatal Eating Outcome Assessment Tool

* NICU: Neonatal Intensive care unit

* PMA: Postmenstrual age (weeks)

* SMART: State of Arousal, Motor Tone, Autonomic Instability, Response to Stimulation, Total Oral Skills

Study Timeline

• Study Start: 2021-05-05
• Primary Completion: 2022-01-23
• Study Completion: 2022-02-10
• Study First Submitted: 2023-01-23
• Study First Submitted QC: 2023-02-13
• Study First Posted: 2023-02-15
• Status Verified: 2024-12
• Last Update Submitted: 2024-12-05
• Last Update Posted: 2024-12-11

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 76

Inclusion Criteria

1. At least 33 weeks, 0 days PMA
2. Able to tolerate enteral feedings
3. Parental consent available

Exclusion Criteria

1. Respiratory support of more than two liter-per-minute oxygen via nasal cannula

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Criteria Validity: Compare SMART Tool vs. NEOA Tool (version 5.8) Scores	12 months	The scale of the two tools is as follows: NEOA: feeding challenge (18 to 57), questionable (58 to 76), normal (77 to 90). SMART: caution (under 60), developing (60 to 90), capable (above 90). Higher scores are better on both scales.; Sample size = 50 feeding events. Observers will not do any intervention. Data analysis: post-feed scores per feeding event.
Test Retest Reliability of SMART Tool	12 months	Using SMART Tool, one observer will rate two feeding events of the same infant. Observer = 1, Feedings events = 20 The observer will not do any intervention. Data analysis: pre-feed and post-feed scores per feeding event.
Inter Rater Reliability of SMART Tool	12 months	Using SMART Tool, two observers will rate one feeding event of an infant. Observers = 2, Feedings events = 10. Observers will not do any intervention. Data analysis: pre-feed and post-feed scores per feeding event.

Trial Locations

Locations (4)

Advocate Illinois Masonic Medical Center; 🇺🇸 Chicago, Illinois, United States

Advocate Good Samaritan Hospital; 🇺🇸 Downers Grove, Illinois, United States

Advocate Children's Hospital - Oak Lawn; 🇺🇸 Oak Lawn, Illinois, United States

Advocate Children's Hospital - Park Ridge; 🇺🇸 Park Ridge, Illinois, United States