Neonatal Eating Outcome Assessment: tool development and inter-rater reliability

Roberta Pineda, Rachel Harris, Felicia Foci, Jessica Roussin, Michael Wallendorf

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Aim: To define the process of tool development and revision for the Neonatal Eating Outcome (NEO) Assessment and to report preliminary inter-rater reliability. Methods: Tool development consisted of a review of the literature and observations of feeding performance among 178 preterm infants born ≤32 weeks gestation. 11 neonatal therapy feeding experts provided structured feedback to establish content validity and define the scoring matrix. The tool was then used to evaluate feeding in 50 preterm infants born ≤32 weeks of gestation and 50 full-term infants. Multiple revisions occurred at each stage of development. Finally, six neonatal occupational therapists participated in reliability testing by independently scoring five videos of oral feeding of preterm infants using version 4 of the tool. Results: The intraclass correlation for the ‘prefeeding’ score was 0.71 (0.37–0.96), and the intraclass correlation for the ‘total’ score was 0.83 (0.56–0.98). Conclusion: The ‘total’ score had good to excellent reliability. Fleiss’ Kappa scores for all 18 scorable items ranged from slight agreement to moderate agreement. Items with the lowest Kappa scores were revised, and additional feedback from therapists engaged in reliability testing was incorporated, resulting in final version 5.

Original languageEnglish
Pages (from-to)414-424
Number of pages11
JournalActa Paediatrica, International Journal of Paediatrics
Issue number3
StatePublished - Mar 2018


  • Development
  • Feeding
  • Infant
  • NICU
  • Outcome
  • Preterm


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