Feeding In Preterm Neonates Research Articles

Slow verses rapid advancement of enteral feed in preterm neonates of 28-34 weeks of gestational age with abnormal antenatal umbilical artery Doppler: A randomised controlled trial

Background: Necrotising enterocolitis (NEC) is the commonest and most serious gastrointestinal neonatal emergency. In preterm infants with evidence of abnormal Doppler flow velocities in the fetal umbilical artery, suboptimal intestinal perfusion is postulated to increase the risk of feed intolerance and NEC.Objectives: To compare the effect of slow versus rapid enteral feeding in preterm neonates with abnormal antenatal umbilical artery Doppler.Method: This is a randomised controlled trial; we randomised into a slow and a fast group; we randomised separately into subcategories based on the weight. Sample size was calculated as 82. Data analysis was done using SPSS version 23. For group comparisons of categorical data, Chi-squared test was used. If expected frequency in the contingency tables was <5 for more than 25% cells, Fisher’s exact test was used. For non-parametric continuous data Mann-Whitney test was applied. Statistical significance was kept at p<0.05 and power at 80%.Results: In neonates with slow and rapid feeding with birth weight <1250g, percentage of 2b (30% and 26.7% respectively) was more compared to other stages, whereas in group with birth weight ≥1250g rapid feeding group Ia (14.3%) was more in slow feeding group and 1a and 2a equal in rapid feeding group with no statistical significance. The mean duration of stay hospital was less in rapid feeding group in both birth strata. The sepsis percentage was more in the slow feeding group. Regarding mortality in both groups, there was no statistical difference.Conclusions: In this study the type of feeding did not affect NEC or feeding intolerance in preterm infants. Rapid feeding had a significant impact on sepsis and length of stay in preterm infants.

Randomised controlled trial to compare the effect of PIOMI (structured) and routine oromotor (unstructured) stimulation in improving readiness for oral feeding in preterm neonates.

Oral motor stimulation interventions improve oral feeding readiness and earlier full oral feeding in preterm neonates. However, using a structured method may improve the transition time to full oral feeds and feeding efficiency with respect to weight gain and exclusive breastfeeding when compared to an unstructured intervention. To compare the effect of Premature Infant Oral Motor Intervention (PIOMI) and routine oromotor stimulation (OMS) on oral feeding readiness. Randomised controlled trial conducted in a neonatal intensive care unit between June-December 2022. Preterm neonates, 29+0-33+6 weeks corrected gestational age, were studied. The intervention group received PIOMI and the control group received OMS. Primary outcome: time to oral feeding readiness by Premature Oral Feeding Readiness Assessment Scale (POFRAS) score ≥30. Secondary outcomes: time to full oral feeds, duration of hospitalisation, weight gain, and exclusive breastfeeding rates. A total of 84 neonates were included and were randomised 42 each in PIOMI and OMS groups. The mean chronological age and time to oral feeding readiness were lower by 4.6 and 2.7 days, respectively, for PIOMI. The transition time to full oral feeds was 2 days lower for PIOMI and the duration of hospitalisation was 8 days lower. The average weight gain was 4.9 g/kg/day more and the exclusive breastfeeding rates at 1 month and 3 months post-discharge were higher by 24.5% and 27%, respectively, for the PIOMI group. The subgroup analysis of study outcomes based on sex and weight for gestational age showed significant weight gain on oral feeds in neonates receiving PIOMI. Similarly, the subgroup analysis based on gestational age favoured the PIOMI group with significantly earlier transition time and weight gain on oral feeds for the neonates >28 weeks of gestational age. The odds of achieving oral feeding readiness by 30 days [OR 1.558 (0.548-4.426)], full oral feeds by 45 days [OR 1.275 (0.449-3.620)], and exclusive breastfeeding at 1 month [OR 6.364 (1.262-32.079)] and 3 months [3.889 (1.186-12.749)] after discharge were higher with PIOMI. PIOMI is a more effective oromotor stimulation method for earlier and improved oral feeding in preterm neonates. https://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=70054&EncHid=34792.72281&modid=1&compid=19','70054det', identifier, CTRI/2022/06/043048.

Nifty cup versus katori-spoon feeding in preterm infants – Study protocol of a randomized controlled trial

Preterm neonates need an alternative method of feeding before breastfeeding. : To compare the Nifty cup with Katori-spoon feeding in preterm neonates on full gavage feeds and deemed fit for oral feeding.This open-label, parallel, randomized controlled trial will be done at the step-down unit of a tertiary care center in Northern India. We will include preterm neonates (< 34 weeks gestation) on gavage feeds. Our primary outcome will be the time taken to achieve full oral feeds (defined as 150 mL/kg/day) and the duration of the feeding transition. The secondary outcomes will be time to attain full breastfeeds, time spent during the feeding sessions, spillage of feeds, adverse events (including mortality), anthropometry (weight, length, occipitofrontal circumference) at discharge, and duration of hospitalization.We will also take the opinion of mothers/caregivers and nurses on Nifty cup use by the use of an indigenously designed questionnaire. We will need 94 participants to detect a significant difference of 3 days in transition duration with 5% α error and 80% power. To account for non-compliance/crossover, we will enroll 106 participants (53 in each group).We will do intention to treat analysis. All data will be analyzed using SPSS version 23 statistical software for Windows. We will do a regression analysis to determine if the intervention is an independent predictor of time to full oral feeds after adjusting for pre-specified variables like gestational age, birth weight, and PMA at enrolment.The study will provide evidence on the best feeding method for feeding preterm neonates. This evidence will guide nurses/health care professionals in deciding the feeding method for preterm infants.

Feeding in Preterm Neonates With Antenatal Doppler Abnormalities: A Systematic Review and Meta-Analysis.

In this systematic review and meta-analysis, we attempted to determine the most appropriate feed initiation and advancement practices in preterm neonates with antenatal Doppler abnormalities. We included randomized controlled trials comparing different feed initiation and advancement practices in neonates with antenatal Doppler abnormalities. The databases of PubMed, Embase, Cochrane, CINAHL, Scopus, and Google Scholar were searched on February 25, 2022. The risk of bias was assessed using the Risk of Bias tool, version 2. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RevMan 5.4 was used for data analysis. Of the 1499 unique records identified, 7 studies were eligible for inclusion (6 on feed initiation, 1 on feed advancement). Early enteral feeding did not increase NEC stage 2 or more [risk ratio (RR) 1.12, 95% confidence interval (CI) 0.71-1.78; 6 studies, 775 participants] and mortality (RR 0.83, 95% CI 0.47-1.48; 5 studies, 642 participants). A trend was noted towards an increase in feeding intolerance (RR 1.23, 95% CI 0.98-1.56; 5 studies, 715 participants). There was a significant reduction in age at full enteral feeds, duration of total parental nutrition, and rates of hospital-acquired infections. Rapid feed advancement decreased the age at full enteral feeds without affecting other outcomes. The overall certainty of the evidence was rated low. Heterogeneity was not significant. There is low-certainty evidence that early feed initiation in preterm neonates with antenatal Doppler abnormalities does not increase rates of NEC and mortality. There is insufficient data on the speed of feed advancement.

Effect of early feeding regimen in pre-terms with abnormal antenatal dopplers: a prospective analytical COHORT study

Background: Enteral feeding in preterm neonates with intrauterine growth restriction (IUGR) and absent or reversed end diastolic flow (AREDF) on umbilical artery (UA) Doppler is delayed owing to an increased risk of necrotizing enterocolitis (NEC). Delaying enteral feeding with longer duration of parenteral nutrition (PN) carries an increased risk of various neonatal morbidities.Methods: It was a prospective observational non randomized cohort study. Data was collected prospectively from the NICU records. Neonates fulfilling the inclusion criteria were classified as early feeding regimen and late feeding regimen. A strict feeding regimen was followed. Data was analyzed for primary and secondary outcomes.Results: The 50 neonates were enrolled. Baseline characteristics were comparable. A significantly higher time to full feeds was recorded in the delayed feeding regimen by a mean of 3.9 days. The duration of hospital stay was significantly higher for delayed feeding regimen (+12.7 days). Days of mechanical ventilation were also significantly higher (+1.6 days) in the neonates in delayed feeding group. There was no difference in the incidence of feed intolerance, NEC, incidence of culture positive sepsis and mortality across the two regimens, however neonates in the delayed feeding group needed longer support with parenteral nutrition.Conclusions: Early feeding will lead to earlier time to full feeds and decreased duration of hospital stay without additional increase the incidence of feeding intolerance and NEC in neonates with AEDF/REDF. Individualized feeding strategy in these compromised neonates should be the primary objective to optimize outcomes.

Mother's Own Milk Feeding in Preterm Newborns Admitted to the Neonatal Intensive Care Unit or Special-Care Nursery: Obstacles, Interventions, Risk Calculation.

Early nutrition of newborns significantly influences their long-term health. Mother’s own milk (MOM) feeding lowers the incidence of complications in preterm infants and improves long-term health. Unfortunately, prematurity raises barriers for the initiation of MOM feeding and its continuation. Mother and child are separated in most institutions, sucking and swallowing is immature, and respiratory support hinders breastfeeding. As part of a quality-improvement project, we review the published evidence on risk factors of sustained MOM feeding in preterm neonates. Modifiable factors such as timing of skin-to-skin contact, strategies of milk expression, and infant feeding or mode of delivery have been described. Other factors such as gestational age or neonatal complications are unmodifiable, but their recognition allows targeted interventions to improve MOM feeding. All preterm newborns below 34 weeks gestational age discharged over a two-year period from our large German level III neonatal center were reviewed to compare institutional data with the published evidence regarding MOM feeding at discharge from hospital. Based on local data, a risk score for non-MOM feeding can be calculated that helps to identify mother–baby dyads at risk of non-MOM feeding.

Effect of an early oral stimulation program on oral feeding in preterm neonates

ObjectiveTo evaluate the effect of prefeeding oral stimulation program on feeding performance, weight gain, and length of hospital stay of preterm infants in neonatal ICUs.BackgroundPrevious research has declared that poor oral-motor developments in premature infants are common. So, most of the preterm infants require individualized therapy. Early intervention of oral-motor management on feeding pattern improves the outcome.Patients and methodsTo reach the goal of this research, a case–control study was conducted. A total of 50 preterm infants were divided into two groups: (a) interventional group (25 preterm infants), which received prefeeding oral stimulation program by stimulation of the oral and perioral structures for 5 min for 10 days and was started immediately after delivery, and (b) control group (25 preterm infants), which did not receive stimulation. Postmenstrual age, total intake volume, body weight, the transition time from initiation of oral feeding to full oral feeding, and feeding efficiency were calculated.ResultsWe found that the mean oral feeding duration was significantly lower among intervention group compared with control group (P = 0.04). The percentage of weight change was significantly higher among intervention group compared with control group (P = 0.03).ConclusionOur study reveals that early sensory oral-motor stimulation with nonnutritive sucking in preterm infants may be effective to expedite oral feeding and hospital discharge. A touch therapy program may confer a statistically significant weight gain for premature babies at much shorter intervals, which leads to a shorter hospital stay.

A Quality Initiative to Improve Mother's Own Milk Feeding in Preterm Neonates.

Background: The rates of "any" human milk use in neonatal intensive care units have improved during the last decade. However, efforts to help mothers in expressing and maintaining mother's own milk (MOM) through discharge remain a concern. This study aims to improve MOM in preterm neonates. Methods: The study was a quality improvement (QI) initiative conducted from May 2018 to April 2019. All preterm neonates <34 weeks were included. In the "initiation phase" (May 2018 to August 2018), a breastfeeding support group was formed and mothers were given structured antenatal and postnatal counseling regarding MOM using videos and leaflets. This improved MOM rates when compared with retrospective controls. In the continuation phase (August-2018 to April-2019), various plan-do-study-act cycles were conducted to test strategies such as frequent telephonic reminders, standardization of Kangaroo mother care, nonnutritive sucking protocols, and involving family members during daily counseling sessions. The initiation and continuation phases were compared with the retrospective baseline data. Results: Of a total of 125 preterm neonates, 27 were excluded for various reasons. Within 3 months of initiating the study, the proportion of neonates who received MOM within first 24 hours improved from 24% in retrospective controls to 82.9% in the initiation phase (p < 0.0001) and remained stable at 90.3% in the continuation phase. The amount of MOM received on day 1 increased significantly (p < 0.0001) from a median of 0 mL to 1 mL in the initiation phase and was maintained at 3 mL in the continuation phase. Amount of MOM increased significantly on day 3 (p = 0.0003) and day 7 (p = 0.03). Babies discharged on MOM also improved significantly (p = 0.005) from 48.3% in the retrospective cohort to 77.4% in the continuation phase. The number of babies receiving total parenteral nutrition decreased significantly (p = 0.02) from 54.6% to 26.7%. Conclusions: QI has shown promising results in improving MOM in preterm neonates.

A quality initiative to improve exclusive breast milk feeding in preterm neonates.

Background and ObjectivePreterm babies thrive well on exclusive breastfeeding with fewer complications. In a retrospective analysis, challenges were noticed in the form of delayed first milk expression and frequency of expression, which was limited to 2–3 times a day. A quality improvement initiative was designed to increase the exclusive breast milk feeding rates in admitted preterm babies. The purpose of the present study is to evaluate the proportion of preterm neonates receiving mother's own milk by day 7 of life after such an initiative.MethodsThe quality improvement initiative was conducted at a level 3 neonatal intensive care unit from May 10, 2018, to August 10, 2018. Inborn preterm neonates <34 weeks with a minimum hospital stay of 7 days were included. Neonates of critically sick mothers and neonates having major congenital malformations were excluded. Mothers were given structured antenatal counseling regarding expressing breast milk (EBM). Postnatal visits were conducted to provide information through a video and a leaflet and formation of breastfeeding support group.ResultsA total of 30 babies were recruited during a period of 3 months and compared to historical controls. The median age of the first EBM improved from 2.5 days to 1.16 days, and the amount of EBM on the first day improved from 0.24 ml to 2.6 ml (p = .002). The proportion of babies receiving EBM on the first day improved from 24% to 80% (p = .0001), and at the end of 7 days, it increased to 73% from 46% (p = .02). The factors time to reach full enteral feeds, time to regain birth weight, rate of necrotizing enterocolitis, rate of sepsis, and proportion of babies on exclusive mother's milk during discharge appear comparable in both the groups.ConclusionsA simple quality improvement approach through the formation of breastfeeding support group, antenatal counseling, and postnatal support for breast milk expression has made a significant improvement in milk expression from mothers delivered prematurely. It reflects on a team approach using the available resources.

Current Practices Related to Feeding Preterm Neonates with Expressed Breast Milk: A Pilot Project

A pilot project was conducted to assess current practices related to feeding pretermneonates with expressed breast milk. The present project was conducted with the objectives to assess current practices related to feeding preterm neonates with expressed breast milk admitted in tertiary level hospital, North India. Practices related to expressed breast milk feeding in preterm neonates was assessed in 4 steps. In step one of Information and current practices related to expression of breast milk among mothers was assessed. Practices in neonatal unit revealed that 92% of mothers had knowledge about feeding schedule of babies. In context to infection control practices 96% mothers washed hands, 92% wore gown, and all mothers (100%) used boiled utensils. Eighty two percent mothers expressed milk at least eight times in 24hour including once during night. Feeding detail of preterm neonates revealed that amount of expressed breast milk fed was very less as compare to enteral feed calculated per day

Expressed Breast Milk feeding in Preterm Neonates: Barriers and suggested facilitators

Expressed Breast Milk feeding in Preterm Neonates: Barriers and suggested facilitators

Expressed Breast Milk feeding in Preterm Neonates: Barriers and suggested facilitators

Expressed Breast Milk feeding in Preterm Neonates: Barriers and suggested facilitators

To study the effect of early versus late trophic feeding in preterm neonates with mild respiratory distress syndrome

Background: The respiratory distress syndrome in preterm neonates is mostly due to surfactant deficiency. The incidence and severity of respiratory distress syndrome are related inversely to the gestational age of the newborn infant. The early nutritional support, in these preterm neonates with respiratory distress, prevents complications, and maintains positive energy balance. Objective: The aim was to study the effect of early versus late trophic feeding in preterm neonates with mild respiratory distress syndrome. Materials and Methods: This was a prospective study conducted in babies admitted to neonatal intensive care unit (NICU) from January 2013 to January 2016 in Military Zonal Hospital. A total of 200 babies with a gestational age &lt;37 weeks and birth weight between 1200 and 2000 g were evaluated and divided into the early and late group. In early group, the nutritional support in the form of expressed breast milk 15 ml/kg/day in preterm neonates with mild respiratory distress was given within 24 h of life and in late group after 48 h of life. Results: The early nutritional support in preterm neonates with mild respiratory distress decreases the requirement of oxygen and caffeine, helps to reach early full feeds, decrease in the incidence of necrotizing enterocolitis, early weight gain and early discharge from hospital. Conclusion: In our study findings, certainly suggest the benefits of early trophic feed compared to late in preterm neonates with mild respiratory distress. It seems that better education of mothers for expressing their milk and handing to NICU for use in trophic feeding is important. However the large randomized controlled trial is required to validate the above findings.

Early versus Late Enteral Feeding in Preterm Intrauterine Growth Restricted Neonates with Antenatal Doppler Abnormalities: An Open-Label Randomized Trial.

Enteral feeding in preterm neonates with intrauterine growth restriction (IUGR) and absent or reversed end diastolic flow (AREDF) on umbilical artery (UA) Doppler is delayed owing to an increased risk of necrotizing enterocolitis (NEC). Delaying enteral feeding with longer duration of parenteral nutrition (PN) carries an increased risk of sepsis. To study early versus late feeding in preterm IUGR neonates for time required to attain sufficient feed volume to discontinue PN and increased risk of NEC or feed intolerance (FI). Open-label randomized controlled trial. Tertiary care neonatal unit and fetal-maternal medicine unit in India. Preterm intrauterine growth restricted neonates' ≤32 weeks with AREDF on UA Doppler enrolled from 1 January 2014 to 31 July 2015. Randomized to receive early or late feeding using mothers own or donor breast milk as per a feed initiation and advancement protocol. Time in days required to attain sufficient feed volume allowing discontinuation of PN and incidence of NEC in neonates fed early versus late. There were 77 eligible neonates. Sixty-two neonates were included and stratified as extreme preterm (27-29 weeks) (n = 20) and very preterm (30-32 weeks) (n = 42). Ten extreme preterm and 21 very preterm neonates were randomized to each early feeding and late feeding arm. There was a significantly faster attainment of sufficient feeds in the early feeding arm of both the stratified groups [extreme preterm: median 14 days (Interquartile range IQR: 12-15) compared with 18 days (IQR: 18-20), hazard ratio (HR): 1.59, 95% CI: 0.626-4.078; very preterm: 12 days (IQR: 10-14) as compared with 16 days (IQR 15-17), HR: 1.89, 95% CI: 1.011-3.555]. There was no difference in the incidence of NEC, FI and combined outcome of NEC and FI. Early feeding in preterm IUGR neonates with AREDF on antenatal UA Doppler allowed earlier discontinuation of PN, allowing birth weight to be regained earlier and did not increase the incidence of NEC and FI.

Current Resources for Evidence-Based Practice, January/February 2017

Current Resources for Evidence-Based Practice, January/February 2017

Oromotor Stimulation for Transition from Gavage to Full Oral Feeding in Preterm Neonates: A Randomized controlled trial.

To assess the effect of additional oromotor stimulation along with routine care on transition from gavage to full oral feeding in preterm neonates. 51 neonates (28-34 weeks) randomized to receive either oromotor stimulation along with routine care (n=25, intervention), or routine care alone (n=26, control) (which included Kangaroo mother care and non-nutritive sucking). Median (IQR) days to reach partial and full spoon feed were significantly lesser [5(3-9.5) vs 10(5-15) P=0.006; and 7(5-14.5) vs 12.5(7-21); P=0.03] in intervention than in control group, respectively. A significantly higher number (56%) in intervention group as compared to control group (31%) achieved partial direct breast feeding at discharge (P=0.01). Oromotor stimulation along with routine care reduces the duration of gavage feeding in preterm neonates.

Incidence of feeding intolerance in preterm neonates in neonatal intensive care units, Port Said, Egypt

Introduction: The feeding of preterm neonates is one of the main challenges facing the neonatologist. Feeding intolerance can be defined by difficulty in ingestion or digestion of the milk that causes a disruption in the enteral feeding plan due to the manifestation of clinical symptoms. These symptoms include gastric residuals, emesis, abdominal distention, visible bowel loops, and change in the character of stool. Aim: To determine the incidence of feeding intolerance in preterm neonates. Methods: Study was carried out on 998 preterm neonates admitted at neonatal intensive care units of Port-Said in the period from 1st August 2014 till the 1st of March 2015. Inclusion criteria included Preterm infants of both genders from day 0 to day 28 of life and with gestational age from 28 to below 37 weeks (confirmed by maternal last menstrual period). Diagnosis of feeding intolerance depended on presence of one or more signs that leading to interruption of the enteral feeding regime of the preterm as; increased gastric residuals of the previous feeding, emesis, abdominal distention, bloody stool, diarrhea and visible bowel loops. Results: The incidence of feeding intolerance in preterm was 2.6%. Conclusion: The percentage of feeding intolerance in Port-Said, Egypt is 2.6% of the preterm neonate.

Intestinal Blood Flow by Doppler Ultrasound: The Impact of Gestational Age and Time from First Enteral Feeding in Preterm Neonates

To explore whether superior mesenteric artery (SMA) peak systolic velocity (PSV) on Doppler ultrasound varies by gestational age (GA) and time from first enteral feeding and has an impact on feeding intolerance. Preterm neonates were assigned to three GA groups at birth, group I: 31 to 356/7 weeks, group II: 27 to 306/7 weeks, and group III: ≤ 266/7 weeks. SMA PSV and clinical and feeding parameters were assessed before and after enteral feed, with the first enteral feed designated as time 1, time 2 = 1 to 4 days (after first feed), time 3= 5 to 7 days, time 4 = 8 to 14 days, and time 5 = 15 to 28. Forty-one patients completed the study (group I: n = 17, group II: n = 12, group III: n = 12). There was no significant difference in SMA PSV change after feeding between groups at the start of enteral feeding (p = 0.12). There were differences in change in SMA PSV after feeding at times 2, 3 and 5 (p = 0.003, p = 0.004, p = 0.009, respectively). Patients with feeding intolerance exhibited a smaller increase in SMA PSV after feeding. There were significant differences in PSV by GA group. SMA PSV change after feeding was lower in patients who had feeding intolerance compared with those who did not.

Modulation of Intestinal Inflammation by Minimal Enteral Nutrition With Amniotic Fluid in Preterm Pigs

Necrotizing enterocolitis (NEC) is a severe inflammatory disorder, associated with the difficult transition from parenteral to enteral feeding after preterm birth. We hypothesized that minimal enteral nutrition (MEN) with amniotic fluid (AF), prior to enteral formula feeding, would improve resistance to NEC in preterm pigs. Experiment 1: IEC-6 cells were incubated with porcine (pAF) and human AF (hAF) to test AF-stimulated enterocyte proliferation and migration in vitro. Experiment 2: Cesarean-delivered, preterm pigs were fed parenteral nutrition and MEN with pAF, hAF, or control fluid (MEN-pAF, MEN-hAF, or MEN-CTRL; all n = 9) for 2 days before tissue collection. Experiment 3: Preterm pigs were fed MEN diets as in experiment 2, but followed by 2 days of enteral formula feeding, which predisposes to NEC (NEC-pAF, NEC-hAF, or NEC-CTRL; n = 10-12). Both pAF and hAF stimulated enterocyte proliferation and migration in vitro. In experiment 2, MEN-pAF and MEN-hAF pigs showed increased body weight gain and reduced intestinal interleukin (IL)-8 and colonic IL-6 levels, indicating reduced inflammatory response. In experiment 3, body weight gain was highest in the 2 groups fed AF as MEN, but NEC incidences were similar (NEC-pAF) or increased (NEC-hAF) compared with controls. Intake of pAF or hAF improved body growth and modulated intestinal inflammatory cytokines during a period of parenteral nutrition, but did not protect against later formula-induced NEC in preterm pigs. Further studies are required to show if MEN feeding with species-specific AF, combined with an optimal enteral diet (eg, human milk), will improve adaptation during the transition from parenteral to enteral feeding in preterm neonates.

Effects of Lipofundin® on the Measurement of Total Bilirubin by Spectrophotometry

Background: Jaundice occurs frequently in neonates and can cause severe neurological complications; hence, hyperbilirubinemia is usually monitored by direct spectrophotometry. However, lipemia, resulting from inborn disorders or parenteral feeding of preterm neonates with lipid emulsion, may interfere with certain laboratory assessments. Here, we evaluated whether artificial lipemia also interferes with bilirubin measurement by direct spectrophotometry. Methods: Total bilirubin levels were assessed by the spectrophotometry when serial concentrations of Lipofundin®, medium-chain triglycerides, or a stabilizer solution, were added to cord blood samples from five full-term and five preterm newborn infants. Results: In blood specimens from ten neonates, spectrophotometry-determined bilirubin levels proportionally and significantly increased in the presence of Lipofundin® at least 1% v/v or 10% medium-chain triglycerides at least 10% v/v in all pre-term and full-term infants. The stabilizer solution caused no interference. Conclusion: Lipofundin® in the cord blood interferes with spectrophotometric measurement of total bilirubin; this effect is mainly related to triglyceride levels and has implications for management of neonates with jaundice.