Psychometric properties of the SMART tool for infant oral feeding skill assessment

Premature and medically complex infants are at risk of feeding problems, specifically the delay in the development of independent oral feedings, which leads to prolonged hospital stays, higher costs, malnutrition, developmental delays, and family stress. Available oral feeding skill assessment tools lack strong psychometrics, feasibility, and cost-effectiveness. We developed a novel tool, the SMART tool, to address these barriers. The objective of this study was to establish the psychometric properties of the SMART tool for assessing infant oral feeding skills. The study design was a prospective, observational, multicenter trial. To establish criterion validity, we hypothesized that the performance of the SMART tool would be similar to that of a comparator tool, the Neonatal Eating Outcome Assessment (NEOA) tool. A convenience sample of 76 infants across four level-3 Neonatal Intensive Care Units were enrolled, and 136 complete feeding observations were included. Compared to NEOA, the SMART tool had a sensitivity of 0.76 (95% CI 0.63-0.89) and a specificity of 0.82 (95% CI 0.72-0.93), with a strong correlation (r = 0.7, p < 0.001). Inter-rater reliability of post-feed scores was 100% agreement. The SMART tool is valid, reliable, and feasible for assessing infant oral feeding skills.