Neonatal Eating Assessment Tool - Mixed Breastfeeding and Bottle-Feeding (NeoEAT - Mixed Feeding): factor analysis and psychometric properties

Abstract

Background: Early identification of feeding difficulty in infancy is critical to supporting breastfeeding and ensuring optimal nutrition for brain development. The Neonatal Eating Assessment Tool (NeoEAT) is a parent-report assessment that currently has two versions: NeoEAT - Breastfeeding and NeoEAT - Bottle-feeding for use in breast and bottle-fed infants, respectively. There are currently no valid and reliable parent-report measures to assess feeding through a combination of both breast and bottle delivery. The purpose of this study was to conduct a factor analysis and test the psychometric properties of a new measure, the NeoEAT - Mixed Breastfeeding and Bottle-Feeding (NeoEAT - Mixed Feeding), including internal consistency reliability, test-retest reliability, construct validity and known-groups validity.

Methods: Parents of infants younger than 7 months who had fed by both bottle and breast in the previous 7 days were invited to participate. Internal consistency reliability was tested using Cronbach's α. Test-retest reliability was tested between scores on the NeoEAT - Mixed Feeding completed 2 weeks apart. Construct validity was tested using correlations between the NeoEAT - Mixed-Feeding, the Infant Gastroesophageal Reflux Questionnaire - Revised (I-GERQ-R), and the Infant Gastrointestinal Symptoms Questionnaire (IGSQ). Known-groups validation was tested between healthy infants and infants with feeding problems.

Results: A total of 608 parents participated. Exploratory factor analysis revealed a 68-item scale with 5 sub-scales. Internal consistency reliability (Cronbach's α = .88) and test-retest reliability (r = 0.91; p < .001) were both acceptable. Construct validity was demonstrated through correlations with the I-GERQ-R (r = 0.57; p < .001) and IGSQ (r = 0.5; p < .001). Infants with feeding problems scored significantly higher on the NeoEAT - Mixed Feeding, indicating more problematic feeding symptoms, than infants without feeding problems (p < .001), supporting known-groups validity.

Conclusions: The NeoEAT - Mixed Feeding is a 68-item parent-reported measure of breast- and bottle-feeding behavior for infants less than 7 months old that now has evidence of validity and reliability for use in clinical practice and research. The NeoEAT - Mixed Feeding can be used to identify infants with problematic feeding, guide referral decisions, and evaluate response to interventions.

Keywords: Bottle feeding; Breast feeding; Feeding behavior; Patient reported outcome measures; Psychometrics; Surveys and questionnaires.

Fig. 1

Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRIMSA) diagram of literature search results. Diagram retrieved from: http://prisma-statement.org/PRISMAStatement/FlowDiagram.aspx

Fig. 2

NeoEAT-Mixed Feeding subscale score differences between infants with feeding problems and infants with no feeding concerns. Note that high scores indicate more symptoms of problems in each subscale area. * Indificates p < .05. Infants in the “No Feeding Concerns” group had none of the following: history of preterm birth, genetic disorder, congenital heart disease, daily prescription medication use, developmental delay, diagnose or undiagnose feeding problem, feeding tube, structural abnormality of the face, mouth, or gastrointestinal tract, or difficulty with breast- or – bottle-feeding. Infants with a feeding problem were reported by parents as having a parent-identified feeding problem, a diagnose feeding problem, and/or need for a feeding tube