{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T03:44:11Z","timestamp":1774928651348,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2008,1,14]],"date-time":"2008-01-14T00:00:00Z","timestamp":1200268800000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Paediatrica"],"published-print":{"date-parts":[[2008,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Objectives: Sucking problems in preterm infants can be specified by means of visual observation. The Neonatal Oral\u2010Motor Assessment Scale (NOMAS) is the visual observation method most commonly used to assess the non\u2010nutritive 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\u2010retest and inter\u2010rater reliability of NOMAS.<\/jats:p><jats:p>Methods: The 75 infants included in this study were born at 26\u201336 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.<\/jats:p><jats:p>Results: We found the test\u2010retest agreement of NOMAS to be \u2018fair\u2019 to \u2018almost perfect\u2019 (Cohen's kappa [\u03ba] between 0.33 and 0.94), whereas the inter\u2010rater agreement with respect to the diagnosis was \u2018moderate\u2019 to \u2018substantial\u2019 (Cohen's \u03ba, between 0.40 and 0.65). As a diagnostic tool, however, the current version of NOMAS cannot be used for both full\u2010term and preterm infants. For a measuring instrument such as NOMAS, one should aim at reliability coefficients for inter\u2010rater and test\u2010retest agreement of at least 0.8. A Cohen's \u03ba 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\u2010ordinate 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.<\/jats:p><jats:p>Conclusions: NOMAS should be re\u2010adjusted in order to improve inter\u2010rater agreement, and at the same time current insights into the development of sucking and swallowing should be incorporated in the method.<\/jats:p>","DOI":"10.1111\/j.1651-2227.2007.00577.x","type":"journal-article","created":{"date-parts":[[2008,4,29]],"date-time":"2008-04-29T18:23:44Z","timestamp":1209493424000},"page":"21-26","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["The reliability of the Neonatal Oral\u2010Motor Assessment Scale"],"prefix":"10.1111","volume":"97","author":[{"given":"Saakje P","family":"Da Costa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cees P","family":"Van Der 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