Improve the clinical effective decision of the oral feeding readiness in preterm infants: Revise and validate the TC-POFRAS

Hao, G., Ni, A., Chang, Y.J., Hall, K., Lee, S.H., Chiu, H.T., Yang, S.F., Sheu, K.L., Chen, S.C. | JNPM 2022;

Abstract: BACKGROUND: Currently there is limited information to guide health professionals regarding the optimal time frame to initiate safe and effective oral feedings to preterm infants. The study aims to revise and validate a streamlined version of the Traditional Chinese-Preterm Oral Feeding Readiness Assessment Scale, the TC-POFRAS®, and evaluate its construct validity in the clinical decisions regarding feeding readiness of preterm infants. METHODS: Eighty-one clinically stable preterm infants were assessed using the TC-POFRAS for oral feeding readiness. Item-total correlation analysis was used to check if any item was inconsistent with the averaged TC-POFRAS scores. Cronbach’s α coefficient was used to evaluate the inter-item consistency. Exploratory factor analysis was used to determine the coherence of variables to reorganize assessment domains. The revised version of TC-POFRAS (TC-POFRAS®) was developed and a new cut-off score based on discriminant accuracy was established. RESULTS: Based on the results from statistical analysis, five items (“lips posture,” “tongue posture,” “biting reflex,” “gag reflex,” and “tongue cupping”) were deleted from the original TC-POFRAS to form the TC-POFRAS®. The TC-POFRAS®’s global accuracy was 92.1%. The cut-off value of 19 was the one that presented the most optimization of sensitivity based on specificity. The TC-POFRAS® was reconstructed into corrected gestational age and five behavioral domains. CONCLUSIONS: The TC-POFRAS® is considered a valid, safe, and accurate objective instrument to assist health professionals to initiate oral feeding of preterm infants.

*Corresponding Author: 

Dr. Grace Hao, Department of Communication Science and Disorders, College of Health and Sciences, North Carolina Central University, 1033 H.M. Michaux Building, 710 Cecil Street, Durham, NC 27707, USA. Tel.: +1 919 530 7836; Fax: +1 919 484 0081; E-mail: