Effect of phototherapy on blood pressure, heart rate, and body temperature in early preterm infants with gestational age < 32 weeks

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So it seems to be necessary to find out which parameters should be carefully observed during phototherapy. In this retrospective study, we analyzed mean arterial blood pressure (MAP), heart rate (HR), and body temperature (BT) in preterm infants under 32 weeks of gestational age before and after phototherapy. Methods In this study, we analyzed the medical records of 93 early preterm infants with gestational age 1,000 g admitted to the neonatal intensive care unit, treated with and without phototherapy, at a tertiary center in Korea. Changes in MAP, HR, and BT were analyzed before and after treatment. Results A total of 82 patients taking phototherapy and 11 control subjects were enrolled. In the phototherapy (PT) group, phototherapy was started on the second day after birth and lasted for 71 hours. In between-group analysis, HR was higher in the PT group 24 − 3 2hours after starting phototherapy (at 24hour; Median of differences 9bpm, p = 0.001, at 32hour; Median of differences 10bpm, p = 0.001), while there was no significant difference in MAP. The rate of MAP increase was lowered and HR was increased after phototherapy, in the PT group analysis, while HR was decreased in the control group. Conclusions After starting phototherapy in preterm infants less than 32 weeks of gestational age, the increasing trend in MAP was lowered and the HR was increased. When phototherapy was not performed, there was no change in MAP, and HR appeared to decrease. Blood Pressure Infant Premature Ductus Arteriosus Patent Phototherapy Figures Figure 1 Figure 2 Background The primary presentation of neonatal jaundice is an icteric skin color caused by an increase in bilirubin levels in the blood during the newborn period. It occurs in approximately 60% of full-term infants and 80% of premature infants in the early period of birth. Prematurity, low birth weight, small-for-gestational age, hemolytic disease, sepsis, exclusive breastfeeding, and genetic diseases are known risk factors of neonatal jaundice [ 1 , 2 ]. Bilirubin production higher than the excretion by the hepatic-enteric route causes unconjugated hyperbilirubinemia and can lead to acute and chronic bilirubin encephalopathy if not controlled [ 3 ]. The treatment options for neonatal jaundice include phototherapy, exchange transfusion, and intravenous immunoglobulin administration. Among these, phototherapy is widely used as the primary treatment option, while prophylactic phototherapy may also be administered if necessary [ 4 ]. Phototherapy for infants is performed using blue-green spectrum light with a wavelength and intensity of 430–490 nm and 30 µW/cm2/nm, respectively. Although phototherapy can effectively lower blood bilirubin concentrations, and is considered a safe treatment for neonatal jaundice, it is associated with various side effects. Cardiovascular effects, such as peripheral vasodilation, renal and mesenteric vasoconstriction, hypotension, tachycardia, decreased heart rate (HR) variability, and decreased cardiac output have been reported after phototherapy in full-term infants [ 5 – 9 ], however, little is known about the occurrence of these effects in premature infants. Premature infants are particularly vulnerable to hemodynamic changes that occur immediately after birth (fetal-to-neonatal transition) [ 10 ], which can cause cardiovascular insufficiency and necessitate interventions such as volume expansion, inotropic support, corticosteroid, and milrinone administration [ 11 , 12 ]. Although these treatments are usually provided to correct hemodynamic instability, they can lead to the development of intraventricular hemorrhage by directly affecting systemic blood pressure (BP) [ 13 , 14 ]. Prior research has indicated that premature infants are vulnerable to hemodynamic instability in the period immediately after birth, and that phototherapy may have a hemodynamic effect; however, this aspect has not received sufficient attention in the existing literature. Therefore, in this study, we analyzed the changes in BP, HR, and body temperature (BT) before and after phototherapy in premature infants with gestational age < 32 weeks. Materials and Methods Study characteristics This retrospective study analyzed the medical records of patients admitted to the neonatal intensive care unit at Wonju Severance Christian Hospital between January 1, 2017, and December 31, 2022. The study was approved by the Institutional Review Board of our hospital (approval no. CR323065). Inclusion & exclusion criteria In this study, we aimed to observe hemodynamic changes caused by phototherapy in early preterm infants (gestational age less than 32 weeks). According to our protocol, prophylactic phototherapy is performed on all premature infants with a birth weight of less than 1,000 g, so those with a birth weight of 1,000 g or more were eligible. Inclusion criteria: Premature infants with gestational age 1,000 g. Exclusion criteria : 5-Minute Apgar score < 6 Provision of prophylactic phototherapy for preterm infants (immediately after birth) Administration of vasopressors before starting phototherapy or during the phototherapy period Presence of major congenital anomalies Death before or during phototherapy Collection of vital signs In patients who underwent phototherapy, HR, BT, and systolic and diastolic BP were measured nine times at 8-h intervals over a total of 72 h, starting from 24 h before phototherapy to 48 h after the start of phototherapy. Thus, measurements ​​at time points 1, 2, and 3 were obtained ​​before phototherapy and those ​​at time points 4–9 were obtained ​​after phototherapy. A reference point for measurements in the control group was essential to allow comparisons between the two groups. Since phototherapy was, on average, initiated on the second day after birth in the phototherapy group (PT group), measurements of systolic and diastolic BP, HR, and BT in the control group were obtained using the same method from the first to third day after birth. Treatment protocol for hyperbilirubinemia in premature infants In our unit, daily total bilirubin (capillary or serum) measurements were performed routinely until the fifth day of life for premature infants with gestational age < 32 weeks, while bilirubin levels were measured every 12 h in infants undergoing phototherapy. If the total bilirubin level increased by more than 0.2 mg/dL per hour, bilirubin levels were measured every 6 h. Phototherapy was initiated when the total bilirubin concentration was above the threshold according to birth weight and age in hours, or when the total bilirubin concentration increased by more than 0.2 mg/dL per hour (Supplementary 1). Protocol for phototherapy The protocol for phototherapy in our unit can be summarized as follows: Blue-green spectrum light with a wavelength of 430–490 nm was irradiated over the widest area at an intensity of 30 µW/cm2/nm. The light source was maintained at a distance of 30–45 cm from the patient. Breastfeeding was continued if possible. Continuous, rather than intermittent, therapy was applied. Continuation or discontinuation of phototherapy was based on the trends in total bilirubin levels according to phototherapy thresholds by birth weight and age in hours. Devices used for phototherapy Phototherapy was administered using VISIANO 10 − 1 PS10 (GE Healthcare), Giraffe SPOT PT Lite Phototherapy System (Ohmeda Medical), and BiliBlanket Plus High-Output Phototherapy System (73RL) (Ohmeda Medical). Statistical analysis The Shapiro–Wilk test was used to confirm the normality of the data used in this study. Since the data in both groups did not show a normal distribution, a non-parametric statistical analysis method was applied (Supplementary 2). In this study, we sought to determine the differences in MAP, HR, and BT between the two groups over time. To compare the amount of change from the initially measured values (ΔMAP, ΔHR, ΔBT), we subtracted the measured value at time point 1 from the measured values at time points 2 to 9, and subsequently performed the Mann–Whitney U test. The Friedman test was performed to analyze the changes in variables over time within each group, and a Bonferroni post-hoc analysis was performed if the variables showed significant differences. We applied R for statistical analysis, and significance was confirmed by p -values less than 0.05. Results Baseline characteristics Among 134 preterm infants with gestational age < 32 weeks, 93 were enrolled after applying the exclusion criteria. Among these, 82 received phototherapy while 11 did not. The median (95% confidence interval [CI]) gestational age and birth weight of all patients were 30 weeks (27–31 weeks) and 1.4 kg (1.0–2.0 kg), respectively. Gestational age and birth weight differed between the two groups: the gestational age was 31 weeks (31–31 weeks) in the control group and 29 weeks (29–30 weeks) in the PT group ( p < 0.001), while birth weight was 1.6 kg (1.6–1.8 kg) in the control group and 1.4 kg (1.2–1.6 kg) in the PT group ( p = 0.001). Patient characteristics are shown in Table 1 . Table 1 Baseline characteristics Control (n = 11) Phototherapy (n = 82) p-value Male (n, %) 7 (63.6%) 39 (47.6%) 0.496 A IUP, weeks (median, 95% CI) 31 [31] 29 [29,30] 0.000* Birth weight, kg (median, 95% CI) 1.6 [1.6;1.8] 1.4 [1.2;1.6] 0.001* APGAR score (median, 95% CI) 1min 6 [6.0;8.0] 6 [4.0;7.0] 0.060 5min 9 [8.0;9.0] 8 [8.0;8.5] 0.176 Blood pressure at birth, mmHg (median, 95% CI) systolic BP 48 [44.0;59.0] 53 [51.0;55.0] 0.428 diastolic BP 25 [21.0;27.0] 28.5 [21.0;32.0] 0.182 mean BP 31 [28,38] 36 [33,38] 0.353 Heart rate at birth, bpm (median, 95% CI) 157 [149,176] 151.5 [147,154] 0.112 Body temperature at birth, ˚C (median, 95% CI) 36.5 [36.5;36.8] 36.5 [36.3;36.5] 0.002* Blood gas analysis at birth (median, 95% CI) pH 7.3 [7.2;7.4] 7.3 [7.2;7.3] 0.472 Base excess -2.9 [-5.7;-0.4] -3.8 [-4.2; 2.6] 0.940 Respiratory distress syndrome (n, %) 5 (45.5%) 49 (59.8%) 0.564 B hs-PDA (n, %) 1 ( 9.1%) 14 (17.1%) 0.811 Antenatal steroid (n, %) 0.801 complete 5 (45.5%) 38 (46.3%) incomplete 5 (45.5%) 31 (37.8%) none 1 ( 9.1%) 13 (15.9%) Initiation of phototherapy, day (median, 95% CI) - 2 [0; 4] Duration of phototherapy, hours (median, 95% CI) - 71.0 [32.0; 119.0] A = intrauterine period, B = hemodynamically significant patent ductus arteriosus The 1 minute/5 minute Apgar score was 6 (6–8)/9(8–9) in the control group and 6 (4–7)/8 (8-8.5) in the PT group ( p = 0.06, p = 0.176). The MAP at admission was 31 mmHg (28–38 mmHg) in the control group and 36 mmHg (33–38 mmHg) in the PT group ( p = 0.353), while the HR at admission was 157 bpm (149–176 bpm) in the control group and 151.5 bpm (147–154 bpm) in the PT group ( p = 0.112). The two groups showed no significant differences in the number of cases requiring prenatal steroid administration, or the incidences of respiratory distress syndrome and hs-PDA ( p = 0.801, p = 0.564, and p = 0.811, respectively). In the PT group, phototherapy began, on average, on the second day after birth, and continued for 71 h (32–119 h). Between-group differences in vital signs with time MAP The two groups showed no significant difference in MAP. Although MAP was higher in the PT group than in the control group, it tended to be somewhat lower at time point 7 (32 h after the start of phototherapy; Table 2 , Fig. 1 ). Table 2 Changes in mean arterial pressure, heart rate, body temperature before and after phototherapy ; between-group analysis (median, 95% CI) Mean arterial pressure Timepoint Control (N = 11) Phototherapy (N = 82) Median of differences p-value before phototherapy 1 31.3 [28.7; 37.3] 38.3 [33.7; 43.0] 7 - 2 35.7 [31.2; 36.3] 39.3 [35.0; 44.3] 3.6 0.739 3 38.0 [35.3; 43.8] 41.3 [36.7; 46.0] 3.3 0.369 after phototherapy 4 39.3 [33.8; 42.3] 42.5 [37.0; 46.7] 3.2 0.817 5 38.0 [36.2; 40.2] 41.7 [36.7; 47.7] 3.7 0.347 6 39.3 [35.3; 44.4] 42.2 [40.1; 43.7] 2.9 0.320 7 42.6 [36.1; 44.5] 41.7 [40.7; 43.9] -0.9 0.284 8 36.0 [34.0; 43.0] 42.3 [41.4; 44.5] 6.3 0.643 9 38.3 [36.5; 42.2] 43.7 [39.0; 49.0] 5.4 0.552 Heart rate before phototherapy 1 157 [144,162] 145 [142,148] 7 - 2 140 [132,161] 142 [139,145] 2 0.436 3 143 [139,150] 145 [141,147] 2 0.173 after phototherapy 4 143 [136,148] 144 [142,148] 1 0.075 5 145 [138,150] 149 [144,150] 4 0.065 6 138 [131,142] 148 [145,151] 10 0.001 7 142 [135,148] 151 [149,154] 9 0.001 8 144 [140,154] 151 [147,152] 7 0.062 9 146 [137,154] 147 [146,151] 1 0.076 Body temperature before phototherapy 1 36.5 [36.5; 36.7] 36.5 [36.5; 36.7] 0 - 2 36.8 [36.6; 37.2] 36.7 [36.5; 36.8] -0.1 0.103 3 36.6 [36.5; 36.9] 36.7 [36.5; 36.9] 0.1 0.834 after phototherapy 4 36.6 [36.5; 37.0] 36.6 [36.5; 36.9] 0 0.623 5 36.7 [36.5; 36.9] 36.7 [36.5; 36.8] 0 0.534 6 36.7 [36.5; 37.0] 36.7 [36.5; 36.9] 0 0.646 7 36.5 [36.5; 36.7] 36.6 [36.5; 36.9] 0.1 0.684 8 36.7 [36.5; 36.9] 36.6 [36.5; 36.9] -0.1 0.676 9 36.7 [36.5; 36.8] 36.6 [36.5; 36.8] -0.1 0.663 HR In comparison with the control group, the average HR in the PT group was significantly higher by 9–10 beats/min at time points 6 and 7 (24–32 h after PT; p = 0.001, p = 0.001; Table 2 , Fig. 2 ). BT The two groups showed no significant difference in BT after phototherapy (Table 2 , Supplementary 3). Within-group differences in vital signs with time(post-hoc analysis) MAP The MAP showed significant changes over time in the PT group, but not in the control group (Supplementary 4). Post-hoc analysis in the PT group showed that the MAP at time points 4–9 was higher than that at time point 1, while the MAP at time point 9 was higher than that at time point 2. After initiation of phototherapy, the rate of increase in MAP seemed to decrease; however, this reduction was not significant (Table 3 ). Table 3 In-Group differences of Mean arterial pressure and HR, phototherapy group(post-hoc) MAP, timepoint 1 2 3 4 5 6 7 8 2 1.2 ‡ (1.000) 3 2.7 (0.136) 1.5 (1.000) 4 3.7 (0.004)* 2.5 (0.201) 1.0 (1.000) 5 3.3 (0.017)* 2.1 (0.572) 0.6 (1.000) − 0.4 (1.000) 6 3.5 (0.009)* 2.3 (0.354) 0.8 (1.000) − 0.2 (1.000) 0.2 (1.000) 7 3.2 (0.028)* 2.0 (0.808) 0.5 (1.000) − 0.5 (1.000) − 0.1 (1.000) − 0.3 (1.000) 8 4.1 (< 0.001)* 2.9 (0.066) 1.4 (1.000) 0.4 (1.000) 0.8 (1.000) 0.6 (1.000) 0.9 (1.000) 9 5.1 (< 0.001)* 3.9 (0.002)* 2.4 (0.300) 1.4 (1.000) 1.8 (1.000) 1.6 (1.000) 1.9 (1.000) 1.0 (1.000) HR, timepoint 1 2 3 4 5 6 7 8 2 -1.5 (1.000) 3 -0.8 (1.000) 0.7 (1.000) 4 -0.3 (1.000) 1.2 (1.000) 0.5 (1.000) 5 0.8 (1.000) 2.3 (0.390) 1.6 (1.000) 1.1 (1.000) 6 1.1 (1.000) 2.6 (0.145) 2.0 (0.857) 1.5 (1.000) 0.4 (1.000) 7 2.8 (0.090) 4.3 (0.000)* 3.6 (0.005) 3.1 (0.032)* 2.0 (0.800) 1.7 (1.000) 8 2.1 (0.722) 3.6 (0.007)* 2.9 (0.071) 2.4 (0.320) 1.3 (1.000) 0.9 (1.000) -0.8 (1.000) 9 1.4 (1.000) 2.9 (0.070) 2.2 (0.477) 1.7 (1.000) 0.6 (1.000) 0.2 (1.000) -1.4 (1.000) -0.7 (1.000) HR We conducted a post-hoc analysis, as both groups showed changes in HR over time in the Friedman test. In the PT group, the HR at time points 7 and 8 appeared to be higher than that at time point 2, while the HR at time point 7 was higher than that at time point 4 (Table 3 ). In contrast, in the control group, the HR at time point 6 appeared to be lower than that at time point 1 (Supplementary 5). BT The within-group analysis of BT showed no changes over time (Supplementary 4). Discussion We hypothesized that the MAP may decrease and HR may increase following phototherapy in early preterm infants. In the PT group, the MAP after phototherapy (time points 4–9) was higher than that before phototherapy (time point 1), but the MAP measurements obtained after phototherapy (after time point 4) did not differ significantly from each other. In other words, the MAP, which had been gradually increasing before phototherapy, stopped increasing after phototherapy (Table 3 ). However, the control group showed no changes in MAP across all time points. These results are noteworthy, because BP is known to gradually increase after birth in premature infants [ 15 ]. As such, these findings imply that phototherapy may inhibit the increase in MAP in premature infants with a gestational age < 32 weeks. Consistent with the findings of previous studies [ 16 , 17 ], the HR in the PT group 24–32 hours after phototherapy was higher than that before phototherapy, whereas the HR decreased or did not change over time in the control group. Taken together, these results indicate that phototherapy may increase HR in premature infants with gestational age < 32 weeks. We further analyzed the changes in BT over time because HR is greatly affected by BT, but our findings showed no change in BT within each group. Further, the incidence of hemodynamically significant PDA did not change after phototherapy (9.1% in the control group and 17.1% in the PT group, p = 0.811). To date, several mechanisms have been proposed to explain how phototherapy affects the hemodynamic status of preterm infants. To begin, vasoactive mediators may play a potential role with regard to the effects of phototherapy on hemodynamics in preterm infants. When patients receive phototherapy, a biphasic response occurs in the subcutaneous vessels. In the first phase, passive vasodilation occurs as a result of direct skin heating and myogenic autoregulation of the subcutaneous vessels. This is followed by active vasodilation through axonal reflexes, which is mediated by nerve C-fibers and the release of vasomediators such as nitric oxide (NO) and endothelin (ET)-116. These mechanisms can result in the dilation of blood vessels after phototherapy, which has been supported by several previous studies [ 16 – 18 ]. In one study of premature infants with an average gestational age of 36 weeks and birth weight of 2.86 kg, urine NO levels significantly increased after phototherapy, but HR and BP showed no changes [ 16 ]. Another study of premature infants with an average gestational age of 32 weeks and birth weight of 1.97 kg reported that the NO levels and BP showed no changes 6 h after phototherapy, while BT and HR increased significantly [ 17 ]. One study reported that at 12 and 24 h after phototherapy, both blood NO and ET levels tended to increase in premature infants with gestational age 32 weeks, while both NO and ET levels remained unchanged in full-term infants. Moreover, while full-term infants and premature infants with gestational age > 32 weeks showed no changes in MAP and HR following phototherapy, MAP decreased and HR increased in premature infants with gestational age < 32 weeks (Supplementary 6) [ 18 ]. Our results are partly consistent with those of the aforementioned studies. Unlike the findings reported in previous studies, we found an increase in MAP; however, the upward trend appeared to be slowing, indicating that the MAP in early preterm infants may be affected by phototherapy. Conversely, HR was found to increase, similar to the results of previous studies, whereas ET-1 and NO levels were not analyzed in the present study. Nevertheless, the previously reported findings for the changes in these levels are discrepant, and well-designed studies are necessary to determine whether clinically relevant changes in the levels of vasomediators occur following phototherapy in early preterm infants. Second, phototherapy can also change the hemodynamic status of preterm infants by affecting PDA patency. PDA patency is determined by complex factors such as blood oxygen tension, pulmonary vascular resistance, myocardial function, platelet adherence, systemic vascular resistance, and vasomediators such as prostaglandins, endothelin, angiotensin II, and bradykinin [ 19 , 20 ]. The combined influence of these factors may impede spontaneous closure of the PDA, thus triggering hs-PDA, which is often used as a reference point to determine the need for treatment. Although a definition of hs-PDA has not been clearly established, the broad consensus suggests that PDA is significant if patients show some signs of clinical deterioration (hypotension, pulmonary edema, oliguria, etc.) with echocardiographic evidence (LA/Ao ratio ≥ 1.4, ductus arteriosus diameter ≥ 1.4 mm/kg body weight, left ventricular enlargement, holodiastolic flow reversal in the descending aorta, etc.) [ 21 , 22 ]. Because hs-PDA is a major factor affecting the early hemodynamic characteristics of preterm infants, the effect of phototherapy on the incidence and severity of hs-PDA is an important factor worth considering. In relation to this, Barefield et al. reported a significant relationship between phototherapy and the incidence of PDA in extremely low birth weight (ELBW) infants weighing < 1,000 g [ 23 ]. Bozkaya et al. reported that chest shielding during phototherapy in ELBW infants reduced the incidence and severity of hs-PDA (reduction in hs-PDA and the LA/Ao ratio) [ 24 ]. Conversely, some studies have shown that chest shielding during PT does not influence hs-PDA [ 25 – 28 ]; thus, the effects of phototherapy on the incidence and severity of hs-PDA remain debatable. Further well-designed studies, such as a randomized controlled trials with a sufficiently large sample size, analyzing serial changes in echocardiographic characteristics during phototherapy is needed, particularly in early preterm infants. While we widely use phototherapy for the treatment and prophylaxis of hyperbilirubinemia, these findings suggest caution when applying phototherapy in clinical practice. As study results remain controversial, hemodynamic status should be carefully monitored when starting phototherapy in early preterm infants. Our study had some limitations. Firstly, in our unit, all ELBW infants with birth weights less than 1,000 g were treated with prophylactic phototherapy starting immediately after birth; therefore, they were excluded from the study. However, at the same time, they are likely to be the most vulnerable to the side effects of phototherapy; thus, it seems necessary to include ELBW infants in future studies. Although the changes in MAP and HR were statistically significant, their absolute values were small; therefore, their clinical significance was difficult to determine. Additionally, this was a retrospective study with a small sample size, which limited statistical analysis and interpretation. Conclusions After starting phototherapy in premature infants less than 32 weeks of gestational age, we observed that the increasing trend in MAP was lowered and the heart rate increased. When phototherapy was not performed, there was no change in MAP, and HR appeared to decrease. Additionally, hsPDA incidence did not vary depending on phototherapy in this study. Considering these results, we emphasize that a vital sign monitoring protocol during phototherapy is necessary, especially in early preterm infants. Declarations Ethics approval and consent to participate The study was approved by the Institutional Review Board of Yonsei University Wonju College of Medicine(approval no. CR323065, date: 04/07/2023). Consent for publication : Not applicable. Availability of data and materials The datasets generated and analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request. Competing interests The authors declare that there is no conflict of interest to disclose. Funding : None Authors' contributions Conception: TW Shin; data acquisition: TW Shin, EJ Lee; Analysis: TW Shin, HW Choi; Interpretation of data; TW Shin, HW Choi; Original draft: TW Shin; Draft revision; YM Yoo. All authors reviewed the results and approved the final version of the article. Acknowledgements The authors thank the children and their families who participated in this study. References Bhutani VK, Stark AR, Lazzeroni LC, Poland R, Gourley GR, Kazmierczak S, et al. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J Pediatr. 2013;162:477–e4821. 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Hamrick SEG, Sallmon H, Rose AT, Porras D, Shelton EL, Reese J, et al. Patent ductus arteriosus of the preterm infant. Pediatrics. 2020;146:e20201209. Hamrick SEG, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics. 2010;125:1020–30. Zonnenberg I, de Waal K. The definition of a haemodynamic significant duct in randomized controlled trials: a systematic literature review. Acta Paediatr. 2012;101:247–51. Barefield ES, Dwyer MD, Cassady G. Association of patent ductus arteriosus and phototherapy in infants weighing less than 1000 grams. J Perinatol. 1993;13:376–80. Bozkaya D, Dizdar EA, Ertekin Ö, Derme T, Umaç HA. Effect of phototherapy on the ductus arteriosus diameter in extremely premature infants: A randomised controlled trial. Early Hum Dev. 2023;183:105820. Kapoor S, Mishra D, Chawla D, Jain S. Chest shielding in preterm neonates under phototherapy-a randomised control trial. Eur J Pediatr. 2021;180:767–73. Rosenfeld W, Sadhev S, Brunot V, Jhaveri R, Zabaleta I, Evans HE. Phototherapy effect on the incidence of patent ductus arteriosus in premature infants: prevention with chest shielding. Pediatrics. 1986;78:10–4. Surmeli-Onay O, Yurdakok M, Karagoz T, Erkekoglu P, Ertugrul I, Takci S, et al. A new approach to an old hypothesis; phototherapy does not affect ductal patency via PGE2 and PGI2. J Matern Fetal Neonatal Med. 2015;28:16–22. Travadi J, Simmer K, Ramsay J, Doherty D, Hagan R. Patent ductus arteriosus in extremely preterm infants receiving phototherapy: does shielding the chest make a difference? A randomized, controlled trial. Acta Paediatr. 2006;95:1418–23. Additional Declarations No competing interests reported. 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It occurs in approximately 60% of full-term infants and 80% of premature infants in the early period of birth. Prematurity, low birth weight, small-for-gestational age, hemolytic disease, sepsis, exclusive breastfeeding, and genetic diseases are known risk factors of neonatal jaundice [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Bilirubin production higher than the excretion by the hepatic-enteric route causes unconjugated hyperbilirubinemia and can lead to acute and chronic bilirubin encephalopathy if not controlled [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The treatment options for neonatal jaundice include phototherapy, exchange transfusion, and intravenous immunoglobulin administration. Among these, phototherapy is widely used as the primary treatment option, while prophylactic phototherapy may also be administered if necessary [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Phototherapy for infants is performed using blue-green spectrum light with a wavelength and intensity of 430\u0026ndash;490 nm and 30 \u0026micro;W/cm2/nm, respectively.\u003c/p\u003e \u003cp\u003eAlthough phototherapy can effectively lower blood bilirubin concentrations, and is considered a safe treatment for neonatal jaundice, it is associated with various side effects. Cardiovascular effects, such as peripheral vasodilation, renal and mesenteric vasoconstriction, hypotension, tachycardia, decreased heart rate (HR) variability, and decreased cardiac output have been reported after phototherapy in full-term infants [\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], however, little is known about the occurrence of these effects in premature infants. Premature infants are particularly vulnerable to hemodynamic changes that occur immediately after birth (fetal-to-neonatal transition) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], which can cause cardiovascular insufficiency and necessitate interventions such as volume expansion, inotropic support, corticosteroid, and milrinone administration [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Although these treatments are usually provided to correct hemodynamic instability, they can lead to the development of intraventricular hemorrhage by directly affecting systemic blood pressure (BP) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrior research has indicated that premature infants are vulnerable to hemodynamic instability in the period immediately after birth, and that phototherapy may have a hemodynamic effect; however, this aspect has not received sufficient attention in the existing literature. Therefore, in this study, we analyzed the changes in BP, HR, and body temperature (BT) before and after phototherapy in premature infants with gestational age\u0026thinsp;\u0026lt;\u0026thinsp;32 weeks.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy characteristics\u003c/h2\u003e \u003cp\u003eThis retrospective study analyzed the medical records of patients admitted to the neonatal intensive care unit at Wonju Severance Christian Hospital between January 1, 2017, and December 31, 2022. The study was approved by the Institutional Review Board of our hospital (approval no. CR323065).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInclusion \u0026amp; exclusion criteria\u003c/h2\u003e \u003cp\u003eIn this study, we aimed to observe hemodynamic changes caused by phototherapy in early preterm infants (gestational age less than 32 weeks). According to our protocol, prophylactic phototherapy is performed on all premature infants with a birth weight of less than 1,000 g, so those with a birth weight of 1,000 g or more were eligible.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria:\u003c/h2\u003e \u003cp\u003ePremature infants with gestational age\u0026thinsp;\u0026lt;\u0026thinsp;32 weeks and birth weight\u0026thinsp;\u0026gt;\u0026thinsp;1,000 g.\u003c/p\u003e \u003cp\u003e \u003cem\u003eExclusion criteria\u003c/em\u003e:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e5-Minute Apgar score\u0026thinsp;\u0026lt;\u0026thinsp;6\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eProvision of prophylactic phototherapy for preterm infants (immediately after birth)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAdministration of vasopressors before starting phototherapy or during the phototherapy period\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePresence of major congenital anomalies\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDeath before or during phototherapy\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCollection of vital signs\u003c/h2\u003e \u003cp\u003eIn patients who underwent phototherapy, HR, BT, and systolic and diastolic BP were measured nine times at 8-h intervals over a total of 72 h, starting from 24 h before phototherapy to 48 h after the start of phototherapy. Thus, measurements ​​at time points 1, 2, and 3 were obtained ​​before phototherapy and those ​​at time points 4\u0026ndash;9 were obtained ​​after phototherapy. A reference point for measurements in the control group was essential to allow comparisons between the two groups. Since phototherapy was, on average, initiated on the second day after birth in the phototherapy group (PT group), measurements of systolic and diastolic BP, HR, and BT in the control group were obtained using the same method from the first to third day after birth.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eTreatment protocol for hyperbilirubinemia in premature infants\u003c/h2\u003e \u003cp\u003eIn our unit, daily total bilirubin (capillary or serum) measurements were performed routinely until the fifth day of life for premature infants with gestational age\u0026thinsp;\u0026lt;\u0026thinsp;32 weeks, while bilirubin levels were measured every 12 h in infants undergoing phototherapy. If the total bilirubin level increased by more than 0.2 mg/dL per hour, bilirubin levels were measured every 6 h.\u003c/p\u003e \u003cp\u003ePhototherapy was initiated when the total bilirubin concentration was above the threshold according to birth weight and age in hours, or when the total bilirubin concentration increased by more than 0.2 mg/dL per hour (Supplementary 1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eProtocol for phototherapy\u003c/h2\u003e \u003cp\u003eThe protocol for phototherapy in our unit can be summarized as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eBlue-green spectrum light with a wavelength of 430\u0026ndash;490 nm was irradiated over the widest area at an intensity of 30 \u0026micro;W/cm2/nm.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe light source was maintained at a distance of 30\u0026ndash;45 cm from the patient.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eBreastfeeding was continued if possible.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eContinuous, rather than intermittent, therapy was applied.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eContinuation or discontinuation of phototherapy was based on the trends in total bilirubin levels according to phototherapy thresholds by birth weight and age in hours.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDevices used for phototherapy\u003c/h2\u003e \u003cp\u003ePhototherapy was administered using VISIANO 10\u0026thinsp;\u0026minus;\u0026thinsp;1 PS10 (GE Healthcare), Giraffe SPOT PT Lite Phototherapy System (Ohmeda Medical), and BiliBlanket Plus High-Output Phototherapy System (73RL) (Ohmeda Medical).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe Shapiro\u0026ndash;Wilk test was used to confirm the normality of the data used in this study. Since the data in both groups did not show a normal distribution, a non-parametric statistical analysis method was applied (Supplementary 2). In this study, we sought to determine the differences in MAP, HR, and BT between the two groups over time. To compare the amount of change from the initially measured values (ΔMAP, ΔHR, ΔBT), we subtracted the measured value at time point 1 from the measured values at time points 2 to 9, and subsequently performed the Mann\u0026ndash;Whitney U test. The Friedman test was performed to analyze the changes in variables over time within each group, and a Bonferroni post-hoc analysis was performed if the variables showed significant differences. We applied R for statistical analysis, and significance was confirmed by \u003cem\u003ep\u003c/em\u003e-values less than 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics\u003c/h2\u003e \u003cp\u003eAmong 134 preterm infants with gestational age\u0026thinsp;\u0026lt;\u0026thinsp;32 weeks, 93 were enrolled after applying the exclusion criteria. Among these, 82 received phototherapy while 11 did not. The median (95% confidence interval [CI]) gestational age and birth weight of all patients were 30 weeks (27\u0026ndash;31 weeks) and 1.4 kg (1.0\u0026ndash;2.0 kg), respectively. Gestational age and birth weight differed between the two groups: the gestational age was 31 weeks (31\u0026ndash;31 weeks) in the control group and 29 weeks (29\u0026ndash;30 weeks) in the PT group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while birth weight was 1.6 kg (1.6\u0026ndash;1.8 kg) in the control group and 1.4 kg (1.2\u0026ndash;1.6 kg) in the PT group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). Patient characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhototherapy (n\u0026thinsp;=\u0026thinsp;82)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (63.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (47.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.496\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e\u003cem\u003eA\u003c/em\u003e\u003c/sup\u003eIUP, weeks (median, 95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 [31]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 [29,30]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth weight, kg (median, 95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.6 [1.6;1.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4 [1.2;1.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPGAR score (median, 95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 [6.0;8.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 [4.0;7.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 [8.0;9.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 [8.0;8.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood pressure at birth, mmHg (median, 95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esystolic BP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 [44.0;59.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 [51.0;55.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.428\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ediastolic BP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 [21.0;27.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.5 [21.0;32.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emean BP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 [28,38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 [33,38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.353\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart rate at birth, bpm (median, 95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e157 [149,176]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e151.5 [147,154]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody temperature at birth, ˚C (median, 95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.5 [36.5;36.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.5 [36.3;36.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood gas analysis at birth (median, 95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.3 [7.2;7.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.3 [7.2;7.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.472\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBase excess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.9 [-5.7;-0.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.8 [-4.2; 2.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.940\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory distress syndrome (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (45.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (59.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.564\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e\u003cem\u003eB\u003c/em\u003e\u003c/sup\u003ehs-PDA (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 ( 9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.811\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntenatal steroid (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecomplete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (45.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (46.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eincomplete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (45.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (37.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 ( 9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (15.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInitiation of phototherapy, day (median, 95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 [0; 4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of phototherapy, hours (median, 95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.0 [32.0; 119.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eA\u003c/em\u003e\u0026thinsp;=\u0026thinsp;intrauterine period, \u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;hemodynamically significant patent ductus arteriosus\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe 1 minute/5 minute Apgar score was 6 (6\u0026ndash;8)/9(8\u0026ndash;9) in the control group and 6 (4\u0026ndash;7)/8 (8-8.5) in the PT group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.176). The MAP at admission was 31 mmHg (28\u0026ndash;38 mmHg) in the control group and 36 mmHg (33\u0026ndash;38 mmHg) in the PT group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.353), while the HR at admission was 157 bpm (149\u0026ndash;176 bpm) in the control group and 151.5 bpm (147\u0026ndash;154 bpm) in the PT group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.112).\u003c/p\u003e \u003cp\u003eThe two groups showed no significant differences in the number of cases requiring prenatal steroid administration, or the incidences of respiratory distress syndrome and hs-PDA (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.801, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.564, and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.811, respectively). In the PT group, phototherapy began, on average, on the second day after birth, and continued for 71 h (32\u0026ndash;119 h).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBetween-group differences in vital signs with time\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eMAP\u003c/h2\u003e \u003cp\u003eThe two groups showed no significant difference in MAP. Although MAP was higher in the PT group than in the control group, it tended to be somewhat lower at time point 7 (32 h after the start of phototherapy; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChanges in mean arterial pressure, heart rate, body temperature before and after phototherapy ; between-group analysis (median, 95% CI)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean arterial pressure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTimepoint\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl (N\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePhototherapy (N\u0026thinsp;=\u0026thinsp;82)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMedian of\u003c/p\u003e \u003cp\u003edifferences\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ebefore phototherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.3 [28.7; 37.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.3 [33.7; 43.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.7 [31.2; 36.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.3 [35.0; 44.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.739\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.0 [35.3; 43.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.3 [36.7; 46.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eafter phototherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.3 [33.8; 42.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.5 [37.0; 46.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.817\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.0 [36.2; 40.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.7 [36.7; 47.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.347\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.3 [35.3; 44.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.2 [40.1; 43.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.320\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.6 [36.1; 44.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.7 [40.7; 43.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.284\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.0 [34.0; 43.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.3 [41.4; 44.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.643\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.3 [36.5; 42.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.7 [39.0; 49.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ebefore phototherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e157 [144,162]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e145 [142,148]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140 [132,161]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142 [139,145]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.436\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143 [139,150]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e145 [141,147]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eafter phototherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143 [136,148]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e144 [142,148]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145 [138,150]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149 [144,150]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138 [131,142]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e148 [145,151]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142 [135,148]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151 [149,154]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e144 [140,154]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151 [147,152]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146 [137,154]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e147 [146,151]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody temperature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ebefore phototherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.5 [36.5; 36.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.5 [36.5; 36.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.8 [36.6; 37.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.7 [36.5; 36.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.6 [36.5; 36.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.7 [36.5; 36.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.834\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eafter phototherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.6 [36.5; 37.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.6 [36.5; 36.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.623\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.7 [36.5; 36.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.7 [36.5; 36.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.534\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.7 [36.5; 37.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.7 [36.5; 36.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.646\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.5 [36.5; 36.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.6 [36.5; 36.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.684\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.7 [36.5; 36.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.6 [36.5; 36.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.676\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.7 [36.5; 36.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.6 [36.5; 36.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eHR\u003c/h2\u003e \u003cp\u003eIn comparison with the control group, the average HR in the PT group was significantly higher by 9\u0026ndash;10 beats/min at time points 6 and 7 (24\u0026ndash;32 h after PT; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eBT\u003c/h2\u003e \u003cp\u003eThe two groups showed no significant difference in BT after phototherapy (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Supplementary 3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eWithin-group differences in vital signs with time(post-hoc analysis)\u003c/h2\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003eMAP\u003c/h2\u003e \u003cp\u003eThe MAP showed significant changes over time in the PT group, but not in the control group (Supplementary 4). Post-hoc analysis in the PT group showed that the MAP at time points 4\u0026ndash;9 was higher than that at time point 1, while the MAP at time point 9 was higher than that at time point 2. After initiation of phototherapy, the rate of increase in MAP seemed to decrease; however, this reduction was not significant (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIn-Group differences of Mean arterial pressure and HR, phototherapy group(post-hoc)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAP, timepoint\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.2\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003cp\u003e(0.136)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.7\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.004)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003cp\u003e(0.201)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.3\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.017)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003cp\u003e(0.572)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.4\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.5\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.009)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003cp\u003e(0.354)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.2\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.2\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.028)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003cp\u003e(0.808)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.5\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.1\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.3\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.1\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(\u0026lt;\u0026thinsp;0.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003cp\u003e(0.066)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e5.1\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(\u0026lt;\u0026thinsp;0.001)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3.9\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.002)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003cp\u003e(0.300)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHR,\u003c/p\u003e \u003cp\u003etimepoint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.5\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.8\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.3\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003cp\u003e(0.390)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003cp\u003e(0.145)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003cp\u003e(0.857)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003cp\u003e(0.090)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4.3\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.000)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003cp\u003e(0.005)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.1\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.032)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003cp\u003e(0.800)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003cp\u003e(0.722)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3.6\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.007)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003cp\u003e(0.071)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003cp\u003e(0.320)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.8\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003cp\u003e(0.070)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003cp\u003e(0.477)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.4\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.7\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eHR\u003c/h2\u003e \u003cp\u003eWe conducted a post-hoc analysis, as both groups showed changes in HR over time in the Friedman test. In the PT group, the HR at time points 7 and 8 appeared to be higher than that at time point 2, while the HR at time point 7 was higher than that at time point 4 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In contrast, in the control group, the HR at time point 6 appeared to be lower than that at time point 1 (Supplementary 5).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eBT\u003c/h2\u003e \u003cp\u003eThe within-group analysis of BT showed no changes over time (Supplementary 4).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe hypothesized that the MAP may decrease and HR may increase following phototherapy in early preterm infants. In the PT group, the MAP after phototherapy (time points 4\u0026ndash;9) was higher than that before phototherapy (time point 1), but the MAP measurements obtained after phototherapy (after time point 4) did not differ significantly from each other. In other words, the MAP, which had been gradually increasing before phototherapy, stopped increasing after phototherapy (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, the control group showed no changes in MAP across all time points. These results are noteworthy, because BP is known to gradually increase after birth in premature infants [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. As such, these findings imply that phototherapy may inhibit the increase in MAP in premature infants with a gestational age\u0026thinsp;\u0026lt;\u0026thinsp;32 weeks.\u003c/p\u003e \u003cp\u003eConsistent with the findings of previous studies [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], the HR in the PT group 24\u0026ndash;32 hours after phototherapy was higher than that before phototherapy, whereas the HR decreased or did not change over time in the control group. Taken together, these results indicate that phototherapy may increase HR in premature infants with gestational age\u0026thinsp;\u0026lt;\u0026thinsp;32 weeks. We further analyzed the changes in BT over time because HR is greatly affected by BT, but our findings showed no change in BT within each group. Further, the incidence of hemodynamically significant PDA did not change after phototherapy (9.1% in the control group and 17.1% in the PT group, p\u0026thinsp;=\u0026thinsp;0.811).\u003c/p\u003e \u003cp\u003eTo date, several mechanisms have been proposed to explain how phototherapy affects the hemodynamic status of preterm infants. To begin, vasoactive mediators may play a potential role with regard to the effects of phototherapy on hemodynamics in preterm infants. When patients receive phototherapy, a biphasic response occurs in the subcutaneous vessels. In the first phase, passive vasodilation occurs as a result of direct skin heating and myogenic autoregulation of the subcutaneous vessels. This is followed by active vasodilation through axonal reflexes, which is mediated by nerve C-fibers and the release of vasomediators such as nitric oxide (NO) and endothelin (ET)-116. These mechanisms can result in the dilation of blood vessels after phototherapy, which has been supported by several previous studies [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In one study of premature infants with an average gestational age of 36 weeks and birth weight of 2.86 kg, urine NO levels significantly increased after phototherapy, but HR and BP showed no changes [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Another study of premature infants with an average gestational age of 32 weeks and birth weight of 1.97 kg reported that the NO levels and BP showed no changes 6 h after phototherapy, while BT and HR increased significantly [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. One study reported that at 12 and 24 h after phototherapy, both blood NO and ET levels tended to increase in premature infants with gestational age\u0026thinsp;\u0026lt;\u0026thinsp;32 weeks; NO levels increased and ET levels did not change in premature infants with gestational age\u0026thinsp;\u0026gt;\u0026thinsp;32 weeks, while both NO and ET levels remained unchanged in full-term infants. Moreover, while full-term infants and premature infants with gestational age\u0026thinsp;\u0026gt;\u0026thinsp;32 weeks showed no changes in MAP and HR following phototherapy, MAP decreased and HR increased in premature infants with gestational age\u0026thinsp;\u0026lt;\u0026thinsp;32 weeks (Supplementary 6) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Our results are partly consistent with those of the aforementioned studies. Unlike the findings reported in previous studies, we found an increase in MAP; however, the upward trend appeared to be slowing, indicating that the MAP in early preterm infants may be affected by phototherapy. Conversely, HR was found to increase, similar to the results of previous studies, whereas ET-1 and NO levels were not analyzed in the present study. Nevertheless, the previously reported findings for the changes in these levels are discrepant, and well-designed studies are necessary to determine whether clinically relevant changes in the levels of vasomediators occur following phototherapy in early preterm infants.\u003c/p\u003e \u003cp\u003eSecond, phototherapy can also change the hemodynamic status of preterm infants by affecting PDA patency. PDA patency is determined by complex factors such as blood oxygen tension, pulmonary vascular resistance, myocardial function, platelet adherence, systemic vascular resistance, and vasomediators such as prostaglandins, endothelin, angiotensin II, and bradykinin [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The combined influence of these factors may impede spontaneous closure of the PDA, thus triggering hs-PDA, which is often used as a reference point to determine the need for treatment. Although a definition of hs-PDA has not been clearly established, the broad consensus suggests that PDA is significant if patients show some signs of clinical deterioration (hypotension, pulmonary edema, oliguria, etc.) with echocardiographic evidence (LA/Ao ratio\u0026thinsp;\u0026ge;\u0026thinsp;1.4, ductus arteriosus diameter\u0026thinsp;\u0026ge;\u0026thinsp;1.4 mm/kg body weight, left ventricular enlargement, holodiastolic flow reversal in the descending aorta, etc.) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Because hs-PDA is a major factor affecting the early hemodynamic characteristics of preterm infants, the effect of phototherapy on the incidence and severity of hs-PDA is an important factor worth considering. In relation to this, Barefield et al. reported a significant relationship between phototherapy and the incidence of PDA in extremely low birth weight (ELBW) infants weighing\u0026thinsp;\u0026lt;\u0026thinsp;1,000 g [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Bozkaya et al. reported that chest shielding during phototherapy in ELBW infants reduced the incidence and severity of hs-PDA (reduction in hs-PDA and the LA/Ao ratio) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Conversely, some studies have shown that chest shielding during PT does not influence hs-PDA [\u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]; thus, the effects of phototherapy on the incidence and severity of hs-PDA remain debatable. Further well-designed studies, such as a randomized controlled trials with a sufficiently large sample size, analyzing serial changes in echocardiographic characteristics during phototherapy is needed, particularly in early preterm infants.\u003c/p\u003e \u003cp\u003eWhile we widely use phototherapy for the treatment and prophylaxis of hyperbilirubinemia, these findings suggest caution when applying phototherapy in clinical practice. As study results remain controversial, hemodynamic status should be carefully monitored when starting phototherapy in early preterm infants.\u003c/p\u003e \u003cp\u003eOur study had some limitations. Firstly, in our unit, all ELBW infants with birth weights less than 1,000 g were treated with prophylactic phototherapy starting immediately after birth; therefore, they were excluded from the study. However, at the same time, they are likely to be the most vulnerable to the side effects of phototherapy; thus, it seems necessary to include ELBW infants in future studies.\u003c/p\u003e \u003cp\u003eAlthough the changes in MAP and HR were statistically significant, their absolute values were small; therefore, their clinical significance was difficult to determine. Additionally, this was a retrospective study with a small sample size, which limited statistical analysis and interpretation.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAfter starting phototherapy in premature infants less than 32 weeks of gestational age, we observed that the increasing trend in MAP was lowered and the heart rate increased. When phototherapy was not performed, there was no change in MAP, and HR appeared to decrease. Additionally, hsPDA incidence did not vary depending on phototherapy in this study. Considering these results, we emphasize that a vital sign monitoring protocol during phototherapy is necessary, especially in early preterm infants.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Board of Yonsei University Wonju College of Medicine(approval no. CR323065, date: 04/07/2023).\u003c/p\u003e\n\u003cp\u003eConsent for publication : Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe datasets generated and analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding : None\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception: TW Shin; data acquisition: TW Shin, EJ Lee; Analysis: TW Shin, HW Choi; Interpretation of data; TW Shin, HW Choi; Original draft: TW Shin; Draft revision; YM Yoo.\u0026nbsp;All authors reviewed the results and approved the final version of the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the children and their families who participated in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBhutani VK, Stark AR, Lazzeroni LC, Poland R, Gourley GR, Kazmierczak S, et al. 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Acta Paediatr. 2006;95:1418\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Blood Pressure, Infant, Premature, Ductus Arteriosus, Patent, Phototherapy","lastPublishedDoi":"10.21203/rs.3.rs-4747422/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4747422/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePhototherapy is a widely used treatment for neonatal hyperbilirubinemia, but the potential risks in early preterm infants are not well known. So it seems to be necessary to find out which parameters should be carefully observed during phototherapy. In this retrospective study, we analyzed mean arterial blood pressure (MAP), heart rate (HR), and body temperature (BT) in preterm infants under 32 weeks of gestational age before and after phototherapy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this study, we analyzed the medical records of 93 early preterm infants with gestational age\u0026thinsp;\u0026lt;\u0026thinsp;32 weeks and birth weight\u0026thinsp;\u0026gt;\u0026thinsp;1,000 g admitted to the neonatal intensive care unit, treated with and without phototherapy, at a tertiary center in Korea. Changes in MAP, HR, and BT were analyzed before and after treatment.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 82 patients taking phototherapy and 11 control subjects were enrolled. In the phototherapy (PT) group, phototherapy was started on the second day after birth and lasted for 71 hours. In between-group analysis, HR was higher in the PT group 24\u0026thinsp;\u0026minus;\u0026thinsp;3 2hours after starting phototherapy (at 24hour; Median of differences 9bpm, p\u0026thinsp;=\u0026thinsp;0.001, at 32hour; Median of differences 10bpm, p\u0026thinsp;=\u0026thinsp;0.001), while there was no significant difference in MAP. The rate of MAP increase was lowered and HR was increased after phototherapy, in the PT group analysis, while HR was decreased in the control group.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAfter starting phototherapy in preterm infants less than 32 weeks of gestational age, the increasing trend in MAP was lowered and the HR was increased. When phototherapy was not performed, there was no change in MAP, and HR appeared to decrease.\u003c/p\u003e","manuscriptTitle":"Effect of phototherapy on blood pressure, heart rate, and body temperature in early preterm infants with gestational age \u0026lt; 32 weeks","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-26 14:03:11","doi":"10.21203/rs.3.rs-4747422/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f1ab08eb-d513-4bed-8055-fc49e3366a2b","owner":[],"postedDate":"August 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-21T09:39:09+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-26 14:03:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4747422","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4747422","identity":"rs-4747422","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}