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Infant and Young Child FeedingSAFESTNCT07136610

Standardized Application of Feeding Evaluations Using SMART Tool

A study testing SMART Tool in people with Infant and Young Child Feeding, run by Wake Forest University Health Sciences at 14 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Premature and medically complex infants have delayed development of oral feeding skills, leading to prolonged hospitalization, costs, and family stress. There is no "gold standard" infant feeding skill assessment tool for bedside clinicians. Read more about this study

Who is it for?
Ages Up to 1 year
Conditions the study is for
Infant and Young Child Feeding
What is being tested?
SMART Tool
Could I receive a placebo?
No, everyone receives an active treatment
How many people
3,500 participants
Where
14 sitesUnited States
Study dates
1 Aug 2025to Jul 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Up to 1 year
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Infants born between August 1, 2025, and July 31, 2026, AND admitted to NICU

Who cannot join

  • No oral feeding started by July 15, 2026

Trial locations and contacts

14 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Ravi Mishra, MBBS,MD,FAAP contact

804.464.7472

ravi.mishra@aah.org

Cynthia Liracrame, RN contact

773.296.7977

cynthia.liracrame@aah.org

14 sites in 1 country

United States14 sites, 14 recruiting
  • Advocate Good Shepherd Hospital

    Barrington, Illinois, 60010

    Hope Reis, NPD, 804-464-7472, hope.reis@aah.org

    Jenna Felix, RN

    Recruiting
  • Advocate Trinity Hospital

    Chicago, Illinois, 60617

    Karen Beagles, RN, 804-464-7472, karen.beagles@aah.org

    Amber Barnes, RN

    Recruiting
  • Advocate Sherman Hospital

    Elgin, Illinois, 60123

    Cynthia Manly, RN, 804-464-7472, cynthia.manly@aah.org

    Julie Vannoord

    Recruiting
  • Aurora Medical Center Grafton

    Grafton, Wisconsin, 53024

    Julie Bulgrin, NPD, 804-464-7472, julie.bulgrin@aah.org

    Julie Bulgrin, NPD

    Recruiting
  • Aurora BayCare Medical Center

    Green Bay, Wisconsin, 54311

    Erica Huettl, NPD, 804-464-7472, erica.huettl@aah.org

    Halli Schneiderwendt, RN

    Recruiting
  • Aurora Medical Center Kenosha

    Kenosha, Wisconsin, 53142

    Margaret Loehrke, NPD, 804-464-7472, margaret.loehrke@aah.org

    Samantha Goodenough, RN

    Recruiting
  • Advocate Condell Medical Center

    Libertyville, Illinois, 60048

    Heidi Gutwoski, NPD, 804-464-7472, heidi.gutowski@aah.org

    Heidi Gutwoski, NPD

    Recruiting
  • Aurora Sinai Medical Center

    Milwaukee, Wisconsin, 53233

    Kate Scythe, NPD, 804-464-7472, katelyn.scythe@aah.org

    Shannon Brandel, SLP

    Recruiting
  • Advocate Christ Medical Center (Advocate Children's Hospital - Oak Lawn)

    Oak Lawn, Illinois, 60453

    Edythe Oliver, NPD, 804-464-7472, edythe.oliver@aah.org

    Katlynn Alanza, RN

    Recruiting
  • Aurora Medical Center Oshkosh

    Oshkosh, Wisconsin, 54904

    Abbey Schonscheck, RN, 804-464-7472, abbey.schonscheck@aah.org

    Wendy Roesler, RN

    Recruiting
  • Advocate Lutheran General Hospital (Advocate Children's Hospital - Park Ridge)

    Park Ridge, Illinois, 60068

    Katie Kurnick, NPD, 804-464-7472, katie.kurncik@aah.org

    Angela Lake, RN

    Recruiting
  • Aurora Medical Center - Sheboygan County

    Sheboygan, Wisconsin, 53081

    Michaele Schramm, RN, 804-464-7472, michaele.schramm@aah.org

    Sara Jeanty, NPD

    Recruiting
  • Aurora Medical Center - Summit

    Summit, Wisconsin, 53066

    Dawn Hron, NPD, 804-464-7472, dawn.hron@aah.org

    Dawn Hron, NPD

    Recruiting
  • Aurora West Allis Medical Center

    West Allis, Wisconsin, 53227

    Shannon Schubel, NPD, 804-464-7472, shannon.schubel@aah.org

    Carlye Butler, RN

    Recruiting

Other trials in United States

About this study

Premature and medically complex infants have delayed development of oral feeding skills, leading to prolonged hospitalization, costs, and family stress. There is no "gold standard" infant feeding skill assessment tool for bedside clinicians. The research team developed a novel feeding skill assessment, the SMART Tool, to monitor infant feeding skill development in the neonatal intensive care unit. This study aims to determine whether this tool improves clinical outcomes, including reduced hospital days and enhanced safety and quality of infant feedings.

Read the detailed description

The current recommendation for preventing infant feeding problems is to provide cue-based feeding, which entails optimizing feeding based on infant cues, including behavioral and physiological signs of stress. These recommendations rely on appropriately recognizing infant feeding cues to inform care instead of applying time-based, volume-driven care irrespective of cues. Care providers vary widely in their subjective assessment of feeding skills, often because they lack standard education on feeding skill assessment and a "gold standard" tool to objectively measure infant oral feeding skill levels. This robust, step-wedge, cluster randomized trial was designed to evaluate the effect of implementing the SMART Tool in 14 different Neonatal Intensive Care Units (NICU) in the Advocate Health Midwest Region. The SMART Tool is a novel feeding assessment tool developed at Advocate Illinois Masonic Medical Center to objectively measure feeding readiness and skill. The psychometric properties were tested through a research study, and strong validity and reliability were established. The Advocate Health Midwest Region NICU standardization committee approved this tool as the sole feeding skill assessment tool to be used at each oral feed (eight times a day) for all NICU infants. Data on infants in the NICU will abstracted from the medical record at the time of discharge or death. The study will use PRISM and the REAIM Framework. The implementation framework consists of three parts that interact to influence outcomes (contextual factors, roll-out strategies, outcomes).

Being tested
SMART Tool
Keywords
premature infants, medically complex infants, infant feeding, feeding skills assessment, length of stay, infant developmental assessment, dysphagia of newborn, cluster randomized trial, length of NICU stay, breastfeeding
Medical subject headings
Premature Birth, Breast Feeding

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • SMART ToolBehavioural

    Also called feeding skill assessment

    The intervention in this implementation study involves (1) integrating the SMART Tool into electronic health records (EPIC), (2) educating all NICU staff (about 850 nurses, lactation consultants, speech-language pathologists, and physicians), and (3) Quality improvement to reinforce learning.

Study groups in NCT07136610
Study groupRoleWhat they receive
SMART ToolExperimentalFeeding skill assessment, the SMART Tool to monitor infant feeding skill development in the neonatal intensive care unit.
Receives: Behavioral: SMART Tool

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Length of hospital stay

    Days from birth to discharge

    Measured: Month 6

  2. Number of days to full oral feeds

    Days from birth to full oral feeds

    Measured: Month 6

  3. Percent of Nasogastric tube days

    Proportion of days with NG

    Measured: Month 6

Secondary outcomes (1)
  1. Home Tube Feeding

    Proportion of infants discharged home with nasogastric tube or gastrosotomy tubes

    Measured: Month 6

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Aug 2025
  2. Study start1 Aug 2025
  3. Primary completionJul 2027 (estimated)
  4. Study completionJul 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
3,500 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07136610
Sponsor's protocol ID
IRB00132685
Acronym
SAFEST
Status last verified
Jul 2026
First submitted
15 Aug 2025
Last updated
29 Jul 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Hussey MA, Hughes JP. Design and analysis of stepped wedge cluster randomized trials. Contemp Clin Trials. 2007 Feb;28(2):182-91. doi: 10.1016/j.cct.2006.05.007. Epub 2006 Jul 7.

    PubMed 16829207
  • Hemming K, Taljaard M. Key considerations for designing, conducting and analysing a cluster randomized trial. Int J Epidemiol. 2023 Oct 5;52(5):1648-1658. doi: 10.1093/ije/dyad064.

    PubMed 37203433
  • Glasgow RE, Trinkley KE, Ford B, Rabin BA. The Application and Evolution of the Practical, Robust Implementation and Sustainability Model (PRISM): History and Innovations. Glob Implement Res Appl. 2024;4(4):404-420. doi: 10.1007/s43477-024-00134-6. Epub 2024 Aug 31.

    PubMed 39568619
  • Browne JV, Jaeger CB, Kenner C; Gravens Consensus Committee on Infant and Family Centered Developmental Care. Executive summary: standards, competencies, and recommended best practices for infant- and family-centered developmental care in the intensive care unit. J Perinatol. 2020 Sep;40(Suppl 1):5-10. doi: 10.1038/s41372-020-0767-1.

    PubMed 32859958
  • Russ SA, Hotez E, Berghaus M, Verbiest S, Hoover C, Schor EL, Halfon N. What Makes an Intervention a Life Course Intervention? Pediatrics. 2022 May 1;149(Suppl 5):e2021053509D. doi: 10.1542/peds.2021-053509D.

    PubMed 35503318
  • Sanders MR, Hall SL. Trauma-informed care in the newborn intensive care unit: promoting safety, security and connectedness. J Perinatol. 2018 Jan;38(1):3-10. doi: 10.1038/jp.2017.124. Epub 2017 Aug 17.

    PubMed 28817114
  • Samane S, Yadollah ZP, Marzieh H, Karimollah HT, Reza ZM, Afsaneh A, Als H. Cue-based feeding and short-term health outcomes of premature infants in newborn intensive care units: a non-randomized trial. BMC Pediatr. 2022 Jan 6;22(1):23. doi: 10.1186/s12887-021-03077-1.

    PubMed 34991513
  • Pineda R, Harris R, Foci F, Roussin J, Wallendorf M. Neonatal Eating Outcome Assessment: tool development and inter-rater reliability. Acta Paediatr. 2018 Mar;107(3):414-424. doi: 10.1111/apa.14128. Epub 2017 Dec 8.

    PubMed 29059481
  • Thoyre SM, Shaker CS, Pridham KF. The early feeding skills assessment for preterm infants. Neonatal Netw. 2005 May-Jun;24(3):7-16. doi: 10.1891/0730-0832.24.3.7.

    PubMed 15960007
  • Lubbe W. Clinicians guide for cue-based transition to oral feeding in preterm infants: An easy-to-use clinical guide. J Eval Clin Pract. 2018 Feb;24(1):80-88. doi: 10.1111/jep.12721. Epub 2017 Mar 2.

    PubMed 28251754
  • Crapnell TL, Rogers CE, Neil JJ, Inder TE, Woodward LJ, Pineda RG. Factors associated with feeding difficulties in the very preterm infant. Acta Paediatr. 2013 Dec;102(12):e539-45. doi: 10.1111/apa.12393. Epub 2013 Sep 30.

    PubMed 23952198
  • Adams-Chapman I, Bann CM, Vaucher YE, Stoll BJ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Association between feeding difficulties and language delay in preterm infants using Bayley Scales of Infant Development-Third Edition. J Pediatr. 2013 Sep;163(3):680-5.e1-3. doi: 10.1016/j.jpeds.2013.03.006. Epub 2013 Apr 10.

    PubMed 23582139
  • Goday PS, Huh SY, Silverman A, Lukens CT, Dodrill P, Cohen SS, Delaney AL, Feuling MB, Noel RJ, Gisel E, Kenzer A, Kessler DB, Kraus de Camargo O, Browne J, Phalen JA. Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework. J Pediatr Gastroenterol Nutr. 2019 Jan;68(1):124-129. doi: 10.1097/MPG.0000000000002188.

    PubMed 30358739
  • Alshaikh B, Yusuf K, Dressler-Mund D, Mehrem AA, Augustine S, Bodani J, Yoon E, Shah P; Canadian Neonatal Network (CNN) and Canadian Preterm Birth Network (CPTBN) Investigators. Rates and Determinants of Home Nasogastric Tube Feeding in Infants Born Very Preterm. J Pediatr. 2022 Jul;246:26-33.e2. doi: 10.1016/j.jpeds.2022.03.012. Epub 2022 Mar 14.

    PubMed 35301017
  • Macias R, Peterson D, Korkis L, Edson R, Gall R. Prevalence and Impact of Feeding-Related Events on Hospital Stay in Preterm and Term Newborns. Adv Neonatal Care. 2023 Dec 1;23(6):541-546. doi: 10.1097/ANC.0000000000001115. Epub 2023 Oct 19.

    PubMed 37862366

Questions about this trial

What is this clinical trial studying?

A study testing SMART Tool in people with Infant and Young Child Feeding, run by Wake Forest University Health Sciences at 14 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 29 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 14 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Ravi Mishra, MBBS,MD,FAAP (804.464.7472, ravi.mishra@aah.org), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Length of hospital stay (time frame: Month 6). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07136610, which also lists 17 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Jul 2026.

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