Document Type

Presentation

Publication Date

4-10-2026

Faculty Mentor

Brooke Mulrenin

Abstract

The Implementation of the Neonatal Eating Outcome Assessment to Evaluate Oral Feeding Skills in the NICU

Katelyn Roloff, OTDS; Stacie Forehand, OTR/L; Brooke Mulrenin PhD, MOT, OTR/L

Division of Occupational Therapy, Medical University of South Carolina

Approximately 80% of preterm infants develop oral feeding difficulties during their neonatal intensive care unit (NICU) hospitalization (Pineda et al., 2020). Preterm infants often demonstrate inadequate feeding readiness, poor arousal/state regulation, physiological instability, and poor oral motor reflexes, all essential for independent feeding (Grabill et al., 2023; Pineda et al., 2020). Common feeding assessments rely on non-standardized clinical observation, have limited ability to track skill progression, and compare outcomes to term infant norms. These limitations lead to inconsistencies across clinicians, difficulties tailoring interventions, and delays in feeding progression and discharge readiness. The Neonatal Eating Outcome (NEO) Assessment is a standardized feeding assessment designed to assess oral motor and feeding skills in preterm infants and gauge normal versus abnormal progression across different postmenstrual ages(PMA) (Pineda et al., 2020). The purpose of this capstone was to enhance evidence-based neonatal feeding assessments within the NICU by educating the interprofessional team on the NEO and its benefits. Our aim was to implement the NEO alongside the Feeding Readiness Scale/Feeding Quality Scale to support safe feeding progression. Deliverables included education on the NEO, a training course with the developer, clinical workflow/implementation and sustainability guides, and prospective data collection of NEO, FQS, and FRS scores on preterm infants. Data was analyzed using descriptive statistics to compare Rasch scores across feeds to evaluate progression of skills and overall PMA treads, concluding that slower rates of improvement led to more discharge recommendations. Relationships between assessments were analyzed to evaluate consistency across measures and application for discharge recommendations. The results suggested utilizing the NEO for earlier identification of feeding concerns and FQS for confirmation later on. Ongoing training and implementation across the NICU will continue to establish clearer discharge recommendations for closer follow-up, standardized documentation for clinical use, and evaluate long-term clinical benefits for infants served in the NICU.

References

Grabill, M., Smith, J., Ibrahim, C., & Pineda, R. (2023). Prevalence of Early Feeding Alterations Among Preterm Infants and Their Relationship to Early Neurobehavior. The American Journal of Occupational Therapy, 77(3), 7703205170. https://doi.org/10.5014/ajot.2023.050123

Pineda, R., Prince, D., Reynolds, J., Grabill, M., & Smith, J. (2020). Preterm infant feeding performance at term equivalent age differs from that of full-term infants. Journal of Perinatology, 40(4), 646–654. https://doi.org/10.1038/s41372-020-0616-2

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