da Costa Saakje P, van der Schans Cees P
School for Health Care Studies, Hanze University Groningen, University for Applied Sciences, Eyssoniusplein 18, 9714 CE Groningen, The Netherlands.
Acta Paediatr. 2008 Jan;97(1):21-6. doi: 10.1111/j.1651-2227.2007.00577.x.
Sucking problems in preterm infants can be specified by means of visual observation. The Neonatal Oral-Motor Assessment Scale (NOMAS) is the visual observation method most commonly used to assess the non-nutritive sucking (NNS) and nutritive sucking (NS) skills of infants up to approximately 8 weeks postterm. During the first 2 min of a regular feeding the infant's sucking skill is assessed, either immediately or on video. Although NOMAS has been used since 1993, little is known about the method's reliability. The aim of our study was to determine the test-retest and inter-rater reliability of NOMAS.
The 75 infants included in this study were born at 26-36 weeks postmenstrual age (PMA). Four observers participated in the study. They were trained and certified to administer NOMAS in the Netherlands by M.M. Palmer between 2000 and 2002.
We found the test-retest agreement of NOMAS to be 'fair' to 'almost perfect' (Cohen's kappa [kappa] between 0.33 and 0.94), whereas the inter-rater agreement with respect to the diagnosis was 'moderate' to 'substantial' (Cohen's kappa, between 0.40 and 0.65). As a diagnostic tool, however, the current version of NOMAS cannot be used for both full-term and preterm infants. For a measuring instrument such as NOMAS, one should aim at reliability coefficients for inter-rater and test-retest agreement of at least 0.8. A Cohen's kappa of 0.6 or less we find unacceptable. Nonetheless, by observing sucking and swallowing according to a protocol much useful information can be gathered about the development of an infant's sucking skills. For instance, whether the infant is able to co-ordinate sucking and swallowing, whether the infant can maintain sucking, swallowing and breathing during the continuous phase and whether the infant is able to suck rhythmically with equally long bursts. In addition, NOMAS offers useful aids for intervention.
NOMAS should be re-adjusted in order to improve inter-rater agreement, and at the same time current insights into the development of sucking and swallowing should be incorporated in the method.
通过视觉观察可明确早产儿的吸吮问题。新生儿口腔运动评估量表（NOMAS）是最常用于评估孕龄约8周以内婴儿非营养性吸吮（NNS）和营养性吸吮（NS）技能的视觉观察方法。在常规喂养的前2分钟内，可即时或通过视频评估婴儿的吸吮技能。尽管自1993年以来NOMAS就已被使用，但对该方法的可靠性知之甚少。我们研究的目的是确定NOMAS的重测信度和评分者间信度。
本研究纳入的75名婴儿出生时的孕龄为26 - 36周。四名观察者参与了研究。他们于2000年至2002年期间在荷兰接受了M.M.帕尔默的培训并获得了使用NOMAS的认证。
我们发现NOMAS的重测一致性为“一般”到“几乎完美”（科恩kappa系数[kappa]在0.33至0.94之间），而评分者间在诊断方面的一致性为“中等”到“较高”（科恩kappa系数在0.40至0.65之间）。然而，作为一种诊断工具，当前版本的NOMAS不能同时用于足月儿和早产儿。对于像NOMAS这样的测量工具，评分者间和重测一致性的信度系数应至少达到0.8。我们认为科恩kappa系数为0.6或更低是不可接受的。尽管如此，通过按照方案观察吸吮和吞咽，可以收集到许多关于婴儿吸吮技能发展的有用信息。例如，婴儿是否能够协调吸吮和吞咽，在连续阶段是否能够维持吸吮、吞咽和呼吸，以及是否能够有节奏地吸吮且吸吮时长相等。此外，NOMAS为干预提供了有用的辅助。
应重新调整NOMAS以提高评分者间的一致性，同时应将当前对吸吮和吞咽发育的认识纳入该方法中。
