Innovative approach for assessing compliance with a complex longitudinal infant feeding protocol

A web-based feeding assessment tool was developed to incorporate an infant's age in days, weight, days since last measurement, daily energy requirements (kcal), fluid intake (oz), and formula/milk type into a computational algorithm to assess compliance with a complex longitudinal infant feeding protocol. The protocol required repeat assessments of eligibility every two weeks up to the age of three months, and monthly to either 7 or 9 months of age. The tool distinguishes minor departures from the feeding protocol, and signals the field staff when departures from the feeding protocol violated eligibility rules. The tool has been used at regular intervals with 300 participants from birth to 9 months of age and has yielded assessments for over 2,000 time points. Use of the tool standardizes the administration of the feeding assessment interview and reduces human error in determining eligibility based on a complex algorithm. The feeding assessment tool, together with the study management system in which it is embedded, were developed using the Microsoft .Net 3.5 framework, C# and Microsoft SQL Server, and was professionally hosted to maintain security and ensure availability. Access to the system and its components are regulated through a web-based Common Authentication Framework (CAF) Manager. This web-based tool enhanced study compliance within narrow feeding protocol and can be adapted to various feeding protocols, especially those with an interest in supplementation patterns in breastfeeding studies.