Haunted Landscapes: Nature, Supernature and the Environment

The Haunted Landscapes Symposium was organised as a literary event by staff from the writing course at Falmouth University. The symposium included an exhibition of paintings, prints and photographs, curated and selected by Laurence North and Neil Mcleod. Artists selected to exhibit also presented papers within the symposium's academic panels

The reliability of the neonatal oral-motor assessment scale

Objectives: 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. Methods: 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. Results: 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. Conclusions: 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

New scoring system improves inter-rater reliability of the Neonatal Oral-Motor Assessment Scale

Aim: The Neonatal Oral-Motor Assessment Scale (NOMAS) is a standardised tool to assess sucking patterns in infants to 48 weeks of postmenstrual age (PMA). In the Netherlands, the interpretation of specific NOMAS items has evolved, leading to a new scoring system. Recent research using the NOMAS describes a way of clustering the most frequent items, and the aim of this study was to determine whether those changes improved the inter-rater reliability. Methods: The inter-rater reliability was tested by two NOMAS-certified therapists who scored 120 video recordings of 40 preterm infants, admitted to the University Hospital of Dusseldorf, Germany, at 34, 37 and 44 weeks PMA, for normal, disorganised and dysfunctional diagnosis. The NOMAS comprised 28 items and five clusters of items. Results: The therapists agreed on the level of diagnoses for 116 of 120 recordings (Cohen's K 0.90), on an item level for 107 of 120 recordings (Cohen's K 0.78) and on a cluster level for 108 of 120 recordings (Cohen's K 0.90). Conclusion: The new scoring system improved the inter-rater reliability of the NOMAS on all levels, highlighting the importance of NOMAS user having a clear understanding on how to interpret and score each item

Revue industrielle : revue mensuelle technique et économique

15 novembre 18901890/11/15 (A21,N46)

The Association between Sucking Behavior in Preterm Infants and Neurodevelopmental Outcomes at 2 Years of Age

Objective To evaluate whether a specific period after birth (in weeks postmenstrual age [PMA]) and specific elements of sucking are associated with abnormal neurodevelopmental outcomes at age 2 years using a longitudinal approach. Study design Fifty-two preterm infants participated in this longitudinal cohort study (mean gestational age, 29.5 weeks; mean birth weight, 1197 g). We assessed the infants' sucking patterns at 37-50 weeks PMA using the Neonatal Oral-Motor Assessment Scale. At age 2 years, based on a neurologic examination and the Dutch version of the Bayley Scales of Infant and Toddler Development, Second Edition, we categorized the children as developing normally (n = 39) or abnormally (n = 13). ORs, including 95% CIs, were calculated to ascertain the risk of abnormal neurodevelopmental outcomes. Results The inability to sustain sucking at 46 weeks PMA (OR, 6.25; 95% CI, 1.29-30.35) and the absence of a mature sucking pattern at 44 weeks PMA (OR, 6.30; 95% CI, 1.40-28.32) significantly increased the odds of abnormal neurodevelopmental outcomes at age 2 years. The ORs of the Neonatal Oral-Motor Assessment Scale items assessing rhythmic jaw movements, rhythmic tongue movements, and coordination among sucking, swallowing, and respiration were high shortly after term, but failed to reach significance. Conclusion Specific elements of sucking at 4-6 weeks postterm are associated with abnormal neurodevelopmental outcomes in preterm infants at age 2 years. This period might be a sensitive time of infant development in which sucking behavior is an early marker of abnormal developmental outcomes. This finding may offer opportunities for early intervention

Sucking behaviour in infants born preterm and developmental outcomes at primary school age

AimTo determine the association between sucking in infants born preterm and developmental outcomes at 5 years. MethodThirty-four infants were included (mean gestational age 30wks 4d, mean birthweight 1407g). The Neonatal Oral-Motor Assessment Scale was used longitudinally from 37 to 50weeks postmenstrual age. At 5years, we assessed motor skills, intelligence, language, verbal memory, and behavioural problems. Linear regression analyses were performed to test whether aspects of sucking behaviour predicted these developmental outcomes. Where linear regression was not appropriate, Spearman's correlation coefficients were calculated between sucking and developmental outcomes. ResultsSucking was associated with total motor skills (B [unstandardized correlation coefficient for normally distributed data]=22.66, 95% confidence interval [CI] 6.61 to 38.71), balance (Spearman's =0.64, p InterpretationAbnormal sucking between 42 weeks and 50 weeks postmenstrual age may reflect abnormal neurological functioning in children born preterm. What this paper adds Sucking behaviour before 40 weeks postmenstrual age is not associated with developmental outcomes at 5 years. Persistently abnormal sucking behaviour is associated with balance, IQ, and language at 5 years. Sucking behaviour is not associated with behaviour or memory at 5 years. This article is commented on by Slattery on pages 784-785 of this issue

The Development of Sucking Patterns in Preterm, Small-for-Gestational Age Infants

OBJECTIVE: To determine whether the development of sucking patterns in small-for-gestational age (SGA) preterm infants differs from appropriate-for-gestational age (AGA) preterm infants. STUDY DESIGN: We assessed sucking patterns in 15 SGA and 34 AGA preterms (gestational age<or=36 weeks) longitudinally from 34 to 50 weeks postmenstrual age (PMA) using the Neonatal Oral-Motor Assessment Scale (NOMAS). At each measurement, we scored sucking as normal, dysfunctional, or disorganized. We examined the development of their sucking patterns in relation to clinical characteristics. RESULTS: SGA preterms developed a normal sucking pattern later than did AGA preterms (median, 50 versus 44 weeks PMA, P=.002). At term-equivalent age, none of the SGA and 38% of the AGA preterms showed normal sucking (P<.05); at 48 to 50 weeks PMA this was 54% and 81%, respectively (P=.064). Abnormal sucking including "incoordination" and dysfunctional sucking were more prevalent in SGA preterms than in AGA preterms (median, 11% versus 0% per infant, P<.05). A higher gestational age and z-score for birth weight were predictive of normal sucking at 50 weeks PMA. CONCLUSIONS: SGA preterms developed a normal sucking pattern later than AGA preterms. Many AGA preterms also developed a normal mature sucking pattern only after they had reached term age

Development of Sucking Patterns in Pre-Term Infants with Bronchopulmonary Dysplasia

Background: Pre-term infants with bronchopulmonary dysplasia (BPD) are at risk of acquiring brain abnormalities. Combined with ongoing breathing difficulties, this may influence the development of their sucking patterns. Objective: To determine the longitudinal development of sucking patterns from birth until 10 weeks' post-term age in pre-term infants with and without BPD. Methods: The sucking patterns of 16 pre-term infants with BPD and 15 pre-term infants without BPD were prospectively assessed with the Neonatal Oral-Motor Assessment Scale. The infants were matched for gestational age