الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 189 |  |  |
| | | from | 189 | | |
Abstract
Feeding problems are common in preterm infants. Progression to oral feeding should be guided by each individual infant’s ability. Thus, the infant can tolerate the demand of this complex and critical developmental process. Opportunity to feed orally regardless volume speeds the transition to full oral feeding (FOF) and hospital discharge. Early evaluation of feeding skills and good evaluation prior to initiation of feeding is a must to enhance oral feeding performance. Initially, evaluate the severity level of infants’ symptoms and identify the most probable functional weakness. Then, a proper support or feeding therapy should be considered to resolve the problem. Consequently, less tube feeding complications, rapid transition from tube to oral feeding and early feeding dependency will be achieved. This will lead to early hospital discharge, less medical care costs and early mother infant reunion. There is a need for validated neonatal feeding assessment tool in Egypt. A locally developed score may contribute to standardized evaluation approach for those high risk fragile neonates. The aim of the study was to develop a clinical bedside oral feeding skills assessment scale. This new tool would define oral feeding readiness and help to achieve early safe successful oral feeding experience. Additionally, we assessed the accuracy and the impact of the new developed tool. The MEFSA Scale was constructed by fulfilling the advantages of other literature available tools and overcome the limitations as much as possible. Then it was applied to all preterm infants who fulfilled inclusion and exclusion criteria in four months (intervention group, 41 infants). The obtained results were compared to preterm infant’s findings in the previous four months who followed the standard NICU protocol of feeding (control group, 40 infants). The two groups were compared as regard SOF-PMA, SOF-weight, transition from SOF to FOF, FOF-PMA, FOF-weight, period of Ryle feeding, weight gain and finally discharge characters. The intervention group infants showed earlier SOF, rapid transition to FOF and earlier FOF with shorter duration of Ryle tube feeding. Infants were discharged earlier and in younger PMA with better weight than the control group. There was sufficient weight gain in both groups. The follow up visits results showed a significant improvement of OFS with sufficient weight gain and without any clinical complications. Furthermore, there was a significant gradual removal of the recommended interventions. Eventually, we effectively have successful feeders not just successfully fed infants. This study concluded that MEFSA successfully identifies areas of strength and areas in which support is required. Thus safe, effective and successful oral feeding had been achieved. MEFSA also provides an infant cued based framework. It serves a developmental conceptualization of infant oral feeding skills and planning individualized interventions. It supports the idea of respecting the infants’ cues by watching the infant from moment to moment before, during and after feeding. This frame work combines three assessment sections followed by appropriate individualized recommendations. Close follow up till oral feeding dependency is essential.