To establish the psychometrics of the Neonatal Oral Motor Assessment Scale (NOMAS).


In this prospective cohort study of 75 preterm infants (39 females, 36 males) born at or before 30 weeks gestation (mean gestational age 26.56wks, SD 1.90, range 23–30wks; mean birthweight 967.33g, SD 288.54, range 480–2240), oral feeding was videotaped before discharge from the neonatal intensive care unit (NICU). The NOMAS was used to classify feeding as normal, disorganized, or dysfunctional. Neurobehavior was assessed at term equivalent, and infants underwent magnetic resonance imaging. Children returned for developmental testing at 2 years corrected age. Associations between NOMAS scores and (1) neurobehavior; (2) cerebral injury and metrics; and (3) developmental outcome were investigated using χ2-analyses, t-tests, and linear regression. For reliability, six certified NOMAS evaluators rated five randomly selected NOMAS recordings and re-scored them 2 weeks later in a second randomized order. Reliability was calculated with Cohen's kappa statistics.


Dysfunctional NOMAS scores were associated with lower Dubowitz scores [t=−2.14; mean difference −2.32 (95% confidence interval [CI] −0.157 to −4.49); p=0.036], higher stress on the NICU Network Neurobehavioral Scale (t=2.61; mean difference 0.073 [95% CI 0.017–0.129]; p=0.0110), and decreased transcerebellar diameter (t=−2.22; mean difference −2.04 [CI=−3.89 to −0.203]; p=0.03). No significant associations were found between NOMAS scores and 2-year outcome.


Some concurrent validity was established with associations between NOMAS scores and measures of infant behavior and cerebral structure. The NOMAS did not show predictive validity in this study of preterm infants at high risk of developmental delay. Reliability was variable and suboptimal.