Quality Indicators for Evaluation of Neonatal Basic Care in Nutrition and Feeding: A Scoping Review and Modified Delphi Study
7 affiliations
- 1Health Services Research Group, Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- 2Methodology of Biomedical Research and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Spain
- 3Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- 4Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
- 5Department of Nursing, Universitat de València, 46010 Valencia, Spain
- 6Fundamental and Clinical Nursing Department, Nursing Faculty, University of Barcelona (UB), 08907 Barcelona, Spain
- 7Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain
Abstract
Background/Objectives: Despite the clinical relevance of nutrition and feeding in neonatal intensive care, no consensus-based set of quality indicators currently exists to systematically evaluate basic nutritional care in hospitalised neonates. This study aimed to identify, agree through expert consensus and prioritise a structured set of nursing-sensitive quality indicators for this domain. Methods: A two-phase methodological study combined a Scoping Review (Joanna Briggs Institute methodology; prospectively registered on OSF; reported per PRISMA-ScR) and a two-round modified Delphi study based on the RAND/UCLA Appropriateness Method. Four databases (PubMed, Embase, Scopus, and Cochrane Library; 2020–2025) were searched, complemented by snowball and the grey literature. Twenty-seven candidate indicators synthesised inductively into eight domains were rated by 23 expert nurses across three dimensions (appropriateness, clinical validity, and feasibility) on a nine-point Likert scale. Results: Retention from Round 1 to Round 2 was 87% (n = 20). Twenty-two indicators (81.5%) were classified as appropriate and five (18.5%) as uncertain, in all cases because of feasibility. The overall median for appropriateness and clinical validity was 9.0 in both rounds. Feasibility showed greater variability, with an 18% mean IQR reduction after Round 2. Indicators reaching consensus were distributed across structure (n = 3, 13.6%), process (n = 16, 72.7%) and outcome (n = 3, 13.6%) dimensions. An exploratory post-hoc prioritisation analysis identified four implementation tiers; the five Tier 1 indicators ranked in the top five under every weighting scheme tested. Conclusions: This consensus-based set provides a structured basis for monitoring neonatal nutritional care quality and for reducing clinical variability. Validation by a broader interdisciplinary panel including families, and prospective testing in routine practice, are required before its use in clinical dashboards or benchmarking.
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BibTeX
@article{sainzrozas2026quality,
title = {{Quality Indicators for Evaluation of Neonatal Basic Care in Nutrition and Feeding: A Scoping Review and Modified Delphi Study}},
author = {Pablo Buck Sainz-Rozas and Dimelza Osorio Sánchez and Pablo García Molina and Evelin Balaguer-López and Sergio Alonso Fernández},
journal = {Nutrients},
year = {2026},
month = sep,
doi = {10.3390/nu18193230},
url = {https://europepmc.org/article/PMC/PMC13666701},
note = {CC BY},
}
RIS
TY - JOUR
TI - Quality Indicators for Evaluation of Neonatal Basic Care in Nutrition and Feeding: A Scoping Review and Modified Delphi Study
AU - Pablo Buck Sainz-Rozas
AU - Dimelza Osorio Sánchez
AU - Pablo García Molina
AU - Evelin Balaguer-López
AU - Sergio Alonso Fernández
PY - 2026
DA - 2026/09/30
JO - Nutrients
DO - 10.3390/nu18193230
UR - https://europepmc.org/article/PMC/PMC13666701
AB - Background/Objectives: Despite the clinical relevance of nutrition and feeding in neonatal intensive care, no consensus-based set of quality indicators currently exists to systematically evaluate basic nutritional care in hospitalised neonates. This study aimed to identify, agree through expert consensus and prioritise a structured set of nursing-sensitive quality indicators for this domain. Methods: A two-phase methodological study combined a Scoping Review (Joanna Briggs Institute methodology; prospectively registered on OSF; reported per PRISMA-ScR) and a two-round modified Delphi study based on the RAND/UCLA Appropriateness Method. Four databases (PubMed, Embase, Scopus, and Cochrane Library; 2020–2025) were searched, complemented by snowball and the grey literature. Twenty-seven candidate indicators synthesised inductively into eight domains were rated by 23 expert nurses across three dimensions (appropriateness, clinical validity, and feasibility) on a nine-point Likert scale. Results: Retention from Round 1 to Round 2 was 87% (n = 20). Twenty-two indicators (81.5%) were classified as appropriate and five (18.5%) as uncertain, in all cases because of feasibility. The overall median for appropriateness and clinical validity was 9.0 in both rounds. Feasibility showed greater variability, with an 18% mean IQR reduction after Round 2. Indicators reaching consensus were distributed across structure (n = 3, 13.6%), process (n = 16, 72.7%) and outcome (n = 3, 13.6%) dimensions. An exploratory post-hoc prioritisation analysis identified four implementation tiers; the five Tier 1 indicators ranked in the top five under every weighting scheme tested. Conclusions: This consensus-based set provides a structured basis for monitoring neonatal nutritional care quality and for reducing clinical variability. Validation by a broader interdisciplinary panel including families, and prospective testing in routine practice, are required before its use in clinical dashboards or benchmarking.
SN - 2072-6643
ER -