Psychometric Properties of the SMART Feeding Tool
Condition: Feeding; Difficult, Newborn; Premature Infant Disease; Dysphagia of Newborn; Nurse's Role; Feeding Disorder of Infancy or Early Childhood; Trauma and Stressor Related Disorders; Deglutition Disorders in Infants; Malnutrition, Infant
MeSH terms: Deglutition Disorders; Infant, Premature, Diseases; Malnutrition; Infant Nutrition Disorders; Feeding and Eating Disorders; Trauma and Stressor Related Disorders
Study type: Observational

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
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Neonates above 33 weeks, 0 days PMA in NICU
      
Keywords: neonate; dysphagia; trauma informed care; infant and family centred developmental care; synactive developmental theory; psychometrics; deglutition; pediatric feeding disorder; SMART Tool; life course health development