There is a dearth of validated neonatal feeding assessment instruments available for
use in clinical practice in resource-constrained developing contexts. The Neonatal
Feeding Assessment Scale (NFAS) was developed to identify and diagnose
oropharyngeal dysphagia (OPD) in neonates. The main aim of the study was to
develop and test the psychometric performance of a clinical assessment scale for
the early identification and diagnosis of OPD in the high-risk neonatal population in
South Africa. To meet the main aim, the research project was divided into three
separate studies.
The research design across the three studies was an exploratory sequential mixedmethod
design. The NFAS was developed using the Delphi method in the first study.
Two international and three South African speech-language therapists (SLTs)
formed the expert panel that participated in two rounds of electronic questioning to
develop the instrument. For the second and third studies, a comparative crosssectional
within-subject design was used. In the second study the participants were
20 neonates with a median age of 35.0 weeks gestational age (GA) in a 29-bed
neonatal intensive care unit (NICU). In the third study 48 participants with a median
age of 35.5 weeks GA were included. During the second study the preliminary
psychometric performance of the NFAS was determined and in the third study, the
final psychometric properties of the NFAS were determined to describe the validity
and reliability of the NFAS.
The NFAS was developed and approved, using expert collaboration through the
Delphi method in the first study. All participants agreed on the need for the
development of a valid clinical feeding assessment instrument to use with the highrisk
neonatal population. The initial NFAS consisted of 240 items across 8 sections;
after the Delphi process was implemented, the final format was reduced to 211 items
across 6 sections. The final format of the NFAS is scored using a binary scoring
system guiding the clinician to identify the presence or absence of OPD. All
members agreed on the format, the scoring system and the feeding constructs
addressed in the final format of the NFAS.
The second study showed that 9 out of 20 participants presented with OPD on the
NFAS. Comparison of NFAS results with modified barium swallow studies (MBSS). indicated that all participants with OPD were correctly identified (100% specificity).
The sensitivity was 78.6%, indicating that three participants were falsely identified
with OPD on the NFAS. The instrument took approximately 30 minutes to complete
during observation of a habitual feeding session with the mother. Inter-rater reliability
was determined on 50% (n=10) of the study sample. Substantial agreement (80%)
was obtained between two raters in five of the six sections of the NFAS and on the
diagnostic outcome of the scale. The preliminary performance of the NFAS appeared
to be promising. The formal validation process of the NFAS then followed on a larger
sample in the third study.
Results of the third study indicated that 15 of the 48 participants were identified with
OPD on the NFAS, whereas 14 of these 15 infants were diagnosed on MBSS. A
sensitivity score of 78.6% was obtained, with specificity determined to be 88.2% for
the newly developed NFAS. The subsequent accuracy of the NFAS to identify OPD
correctly was 85.4% when compared with the MBSS outcome. Inter-rater reliability
was determined using 35% of the sample. The agreement on overall instrument
outcome between the two raters was considered substantial beyond chance, with
Cohen's Kappa at 0.598, with an asymptotic standard error of 0.211. The scale may
be of use to SLTs working without MBSS equipment and to reach underserved
preterm neonates. Inexperienced SLTs may benefit from observational prompts
provided by the NFAS. The NFAS may be suitable for use in South Africa and similar
developing contexts to identify and diagnose high-risk neonates with OPD. / Thesis (DPhil)--University of Pretoria, 2016. / Speech-Language Pathology and Audiology / DPhil / Unrestricted
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:up/oai:repository.up.ac.za:2263/60440 |
| Date | January 2016 |
| Creators | Viviers, Maria Magdalena |
| Contributors | Kritzinger, Alta M. (Aletta Margaretha), marimviviers@gmail.com, Vinck, Bart M. |
| Publisher | University of Pretoria |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Rights | © 2017 University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria. |
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