Feeding Assessment and Interventions using the Neonatal Eating Outcome Assessment (NEO)

Feeding Assessment and Interventions using the Neonatal Eating Outcome Assessment Course:

Oral feeding is one of the most complex tasks that an infant must master, and poor oral feeding is often the reason that preterm or medically complex infants experience prolonged hospitalization in the neonatal intensive care unit (NICU). An infant’s ability to take all feedings by mouth without supplemental means of nutrition is contingent upon multiple factors including arousal, reflex maturation, sensory and motor function, and coordination of suck–swallow–breathe synchrony. Due to medical factors, as well as immaturity of body systems, preterm and sick infants face challenges with oral feeding, which can lead to altered nutritional status, poorer developmental outcome, and difficulty with parent/child bonding.

Appropriate treatment of high risk infants with feeding problems relies on valid and reliable assessments to guide intervention. The Neonatal Eating Outcome (NEO) is a standardized feeding tool used by physical therapists, occupational therapists, and speech-language pathologists to comprehensively assess neonatal feeding and dysphagia. This assessment is unique not only due to its comprehensive nature, but also in that it assigns scores based on the current post-menstrual age, versus comparing preterm infants to infants at term equivalent age. 

This course will cover the basics of neonatal feeding, including pre-feeding skills assessment, medical factors that affect feeding performance and decision making, and cultural components of feeding. Participants will learn assessment of arousal/state organization, oral tone, oral motor skills, sucking patterns, suck-swallow-breathe coordination, bolus control/safety of swallow, respiratory control in feeding, and behavioral responses to feeding. Evaluation of these elements using the NEO will be taught in detail, as well as scoring, interpretation, and documentation of results. Treatment strategies based on NEO results will also be discussed.

Audience: This course in an introductory – intermediate level course for physical therapists, occupational therapists, and speech-language pathologists with an interest in learning the foundational skills of evaluating and treating feeding in the high risk infant in the hospital or community setting.

Participants will be exposed to fast paced information about oral feeding to strengthen an understanding of this advanced area and will gain practice with observational skills related to assessment using video case analysis. A certificate of participation in the course will be issued to participants. Following the course, the participant will then have up to 6 months to practice using the NEO in the NICU and can engage in reliability testing when ready. Reliability testing will entail access to selected videos with the participant entering scores that will be compared to other raters.  A certificate of reliability will be issued once the participant has achieved at least 80% agreement.

The workshop is for those who want to engage in video case analysis, gain advanced observation skills, and work toward reliability. The introduction course is for those that do not have previous exposure to the tool and want a general overview to get started. To learn more about the introduction course, see this page: https://nicutherapylab.regfox.com/neo-program-training

Trainers: Laura Madlinger and Bobbi Pineda

Schedule 

(all times in PST)

7:00am - 9:30am

Overview of feeding

Medical conditions & complications impacting feeding

Body systems supporting feeding  

Phases of swallowing

Common feeding progression in preterm infants 

Changes that occur shortly after the neonatal period (reflexes and anatomical)

Formulas, modes of nutrition, and modes of oral feeding

Breastfeeding considerations

Feeding equipment

Infant readiness

Assessment of feeding and available assessment tools

9:30am - 9:45am          

Break

9:45am - 10:15am   

Feeding interventions

Questions

10:15am - 12:15pm

Introduction to the NEO

NEO Section 1: Evaluation of pre-feeding behaviors*

NEO Section 2: Evaluation of oral feeding*

NEO Section 3: Observations at the end of feed*

Putting it all together: Scoring entirety of feeding*

NEO Section 4: Non-scored items

Introduction to video analysis

12:15pm - 1:00pm 

Lunch

1:00pm - 3:00pm

NEO Scoring Practice*

Reliability testing

*Includes video examples and/or case studies