Effect of the Application of Humanized Nursing Care on the Clinical Outcomes of Neonates with Hyperbilirubinemia

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Humanized care is a comprehensive approach that focuses on the nutritional, therapeutic and hygienic needs of neonates, which helps in the resolution of hyperbilirubinemia. Method A quasi experimental design was utilized in this study to evaluate the effect of humanized nursing care application on the clinical outcomes of neonates with hyperbilirubinemia. It was carried out at the Neonatal Intensive Care Unit at Tanta Main University Hospital. A total of 120 neonates with hyperbilirubinemia who fit the inclusion criteria were blindly assigned to both the study and control groups. The data were collected using the biosocial-demographic characteristics of the studied neonates and neonatal clinical outcome measures for humanized care. Results On the seventh day after receiving humanized care, total bilirubin levels in the study group decreased to 4.03 ± 1.48 compared to 10.21 ± 2.08 in the control group; there was also a decline in the time of jaundice regression with a mean of 3.966 ± 1.09 in the study group compared to 4.66 ± 1.29. in the control group. The mean days of phototherapy were 1.83 ± 0.73 in the study group and 2.41 ± 1.01 in the control group. Additionally, oxygen saturation increased significantly on the 7th day in the study group compared to the control group; the mean amount of daily milk intake was 752.8 ± 262.9 ml in the study group compared with 600.76 ± 290.31 ml in the control group. Conclusion Applying humanized care improved neonatal clinical outcomes, including O 2 saturation, jaundice regression, enhanced newborn feeding and decreased duration of phototherapy. Clinical Humanized care Hyperbilirubinemia Outcomes Neonates Introduction Neonatal hyperbilirubinemia is the most common reason for hospitalization in the first week of life worldwide. It may have an effect on 60% and 80% of term and preterm neonates, respectively. ( 1 , 2 ) Neonatal jaundice is characterized by yellowish staining of a newborn's skin and other membranes, which indicates elevated levels of unconjugated bilirubin in the blood. ( 1 ) When a newborn's total blood bilirubin level exceeds 5 mg/dl, jaundice becomes clinically evident. Newborns may experience both pathological and physiological types of jaundice. The main causes of pathological jaundice are abnormalities in bile acid production, liver metabolism, and excessive bilirubin secretion. ( 3 ) Physiological jaundice usually disappears on its own, while pathologic jaundice frequently needs therapeutic intervention. ( 4 ) Excessive amounts of bilirubin accumulate in the bloodstream and affect the brain, possibly leading to mental retardation, hearing loss, vision impairments, or even death. When jaundice is not treated, kernicterus starts to develop, which can lead to serious problems, such as permanent brain impairment. Therefore, early diagnosis and prompt treatment to reduce bilirubin levels are essential for prevention. ( 5 ) Currently, there are numerous methods for treating hyperbilirubinemia, including medication, phototherapy, and blood exchange transfusion. However, phototherapy is used as the primary mode of treatment ( 6 , 7 ) . Phototherapy involves the application of fluorescent light to newborn naked skin to facilitate bilirubin excretion through photoisomerization, which converts bilirubin's chemical structure from one that is insoluble to one that is soluble for easy excretion. ( 8 ) The environment inside neonatal intensive care units (NICUs) is characterized by high stress due to different factors, such as mechanical noise from equipment, movement of people, parallel and loud conversations, and handling of neonates. Therefore, these NICUs have been seeking ways to improve their environment, creating a more humanized environment and reducing stressful factors ( 9 ) . Humanization practices have increasingly stood out in the healthcare field, especially when present in situations in which the environment is a stressful factor for the neonate, directly impacting his/her treatment. These humanization practices include nonpharmacological treatments and noninvasive procedures that can alleviate pain, anxiety, or even fear, increase well-being and even improve neonatal clinical outcomes. ( 10 , 11 ) The World Health Organization (WHO) describes "humanized care" as the act of human interaction and cooperation. It makes an effort to enhance and appreciate the essential spirit of life. ( 12 ) It has significant potential for physical and emotional intimacy between neonates and professionals, as well as between neonates and their families, from the perspective of health care intervention. ( 13 , 14 ) Feeding techniques, gentle stroking, kinesthetic stimulation, and bird nest care are the major components of humanized nursing care ( 15 , 16 ) . Feeding not only provides a proper supply of essential nutrients but also promotes the recovery of gastrointestinal function and a normal frequency of defecation for neonatal jaundice patients. Feeding strategies include breast feeding or artificial feeding, such as formula milk (oral or nasogastric tube) and parenteral nutrition. Adequate breastfeeding promotes normal intestinal flora establishment in newborns as well as physical growth and development, all of which help fight against physiological jaundice. ( 17 ) Consequently, most of the care given in NICUs is provided by neonatal nurses, who have the ability to modify feeding schedules to enhance feeding tolerance, assist mothers in starting and maintaining a milk supply, and facilitate the expression, handling, and storage of milk. To support the newborn's normal, healthy physical, psychological, and emotional development, nurses can also learn strategies and techniques for feeding the neonates, providing oral care and skin-to-skin care (also known as Kangaroo care), and creating opportunities for fostering parent-child interactions. ( 18 ) Additionally, nurses attach the nasogastric (NG) feeding tubes to neonates who are unable to receive oral feeding, maintain feeding tubes, provide neonates with appropriate nutrients, and avoid complications. The newborns were encouraged to sleep on their right side to reduce the possibility that they would spit up after eating. Finally, the type, amount of milk, residual volume, and any complications were recorded. ( 19 ) Neonatal massage and kinesthetic stimulation are recognized as noninvasive, supplemental treatments that do not need specialized equipment and are safe for neonates older than 31 weeks. Daily massage can enhance physiological development, improve a infant's respiration and heart rate, and improve communication between nurses and neonates. It can also alleviate colic and abdominal bloating. Moreover, massage can increase meconium elimination and prevent bilirubin from re-entering the circulatory system through the portal system, which lowers blood bilirubin levels. ( 20 , 21 ) Hence, pediatric nurses should frequently stroke the whole body of neonates from top to bottom after disinfecting their hands and applying kinesthetic stimuli, such as active range-of-motion movements in the lower and upper extremities that involve changing the newborn's position between supine and prone. ( 22 ) Nesting care is a sort of developmental care that is well liked in the NICU due to its ease of application, accessibility of materials, and absence of size restrictions. It can maintain the newborn's curved limb position, minimize unexpected movement and excessive limb extension, and improve the comfort and sleep quality of the newborn by establishing boundaries around them. ( 23 ) Significance of the study Despite evidence-based guidelines for monitoring and treating hyperbilirubinemia, failure to prevent and manage neonatal hyperbilirubinemia results in permanent disability and even death. The humanization of care is a broad and inclusive program that includes and values excellence in the quality of care. Since it can prevent the onset of certain sequalae that affect newborns. Jean Watson supports the idea that, nurses in all settings, especially critical care units, should strengthen their humanistic role throughout the hospitalization process. Humanized care should not simply remain a theoretical concept, but rather be implemented through the recognition of the importance of the human touch and the individuality that are essential in NICUs. ( 24 – 26 ) . However, studies of the combination between feeding strategies, gent stroking and kinesthetic stimulation and bird’s nest care as a humanized nursing care for neonates with hyperbilirubinemia are limited. Hence, this study was designed to evaluate the effect of the application of humanized nursing care on the clinical outcomes of neonates with hyperbilirubinemia. Aim of the study This study was conducted to evaluate the effect of the application of humanized nursing care on the clinical outcomes of neonates with hyperbilirubinemia. Research hypothesis neonatal clinical outcomes are expected to be improved after applying humanized nursing care for neonates with hyperbilirubinemia. Operational definition Humanized care is a comprehensive strategy that promotes the discharge of newborns and attends to the nutritional, therapeutic, psychological, and hygienic aspects of neonatal nursing. In the current study, humanized nursing care included feeding strategies, gentle stroking, kinesthetic stimulation and bird’s nest care. Clinical outcomes : is a good outcome when the neonate improved after applying humanized nursing care such as reducing bilirubin level, decrease duration of phototherapy, improve oxygen saturation, and increase amount of daily milk intake. Subjects And Methods Design In the present study, a quasi-experimental research design was used. Setting The research was performed in the Neonatal Intensive Care Unit (NICU), Tanta Main University Hospital, which is affiliated with the Ministry of Higher Education and Scientific Research. Sample: Using the following criteria, the Epi-Info computer calculated the sample size : The total number of neonates with hyperbilirubinemia is approximately 300/year. The sample size calculation was found to be 120 neonates using the Epi-info software statistical package. This calculation is based on a type I error of 0.05 and a confidence level of 95%. Inclusion criteria : The inclusion criteria for the neonates included neonates with hyperbilirubinemia, both sexes, more than 35 weeks, who were from the first day to ten days undergoing phototherapy and in the same therapeutic plan and treatment modalities. Neonates who had severe infectious disease and severe cardiac, hepatic, and renal insufficiency were excluded. Eligible neonates who fulfilled the inclusion criteria were divided into two groups. Each group consisted of 60 neonates. The study group received routine care as well as humanized nursing care, in contrast to the control group, while the control group received only routine care. Two tools were used in the current study: Tool I: Biosocial characteristics of the studied neonates : including gestational age, postnatal age, type of hyperbilirubinemia, weight, signs and symptoms of hyperbilirubinemia and treatment modalities. Tool II: Neonatal clinical outcome: Measures for humanized care It was used to assess physiological parameters for both the study and control groups on the first and seventh days after nursing intervention. Regarding both routine care and humanized nursing care of neonates with hyperbilirubinemia. It included the following: Bilirubin level: Total serum bilirubin & direct serum bilirubin. Clinical efficacy: Time of jaundice regression & duration of phototherapy. Using a pulse oximeter to measure oxygen saturation (the higher oxygen indicates good prognosis). Milk intake: An increased milk intake indicates a good prognosis. Method Two tools (I, II) were developed by the researcher after reviewing recent literature ( 17 , 27 ) . To measure the study tools' use, visibility, and clarity, a pilot study was conducted on ten neonates (10% of the sample). After the necessary modifications were made, those neonates were excluded from the study's total sample. Phases of the study: The study was carried out in four phases: 1. Assessment phase: Baseline data on neonates were extracted from their hospital records on the first day of admission for the two groups (control & study) before intervention to select neonates who fulfilled the inclusion criteria of the present research (Tool I). The data were initially gathered from the control group and then from the group receiving humanized care to prevent the subjects from contaminating. 2. Planning phase For the control group , neonates only received routine care for hyperbilirubinemia, including incubator care, eye care, skin care, genitalia care, phototherapy care (covering eyes, positioning, hydration, monitoring serum bilirubin, and side effects of phototherapy) and care of the peripheral intravenous line care. For the study group : humanized nursing care began on the first day; the neonate received phototherapy and continued through the seventh day. It included the following items: feeding strategies , which include the type of feeding, frequency, digestive capacity, and amount of milk. Gentle stroking : the researcher massaged the neonates' entire body, from head to toe. Kinesthetic stimulation included passive motion of the limbs singly and then together in the following order: right arm, left arm, right leg, and left leg. For the bird’s nest care , the bath towel was rolled and folded around the newborn to promote security for the neonate. 3. Implementation phase: (For the study) group: During the first stage: The neonate was placed in the supine position and gently stroked in the following sequence: Gentle stroking technique: Stroking was performed once in the morning, once at midnight and once in the evening from the first day to the seventh day for 15 minutes. Hands were carefully washed; the room temperature was maintained between 24 and 28°C, and pressure was applied to the newborn’s skin with warm and bare hands. The periorbital and cheek regions of the face were first massaged gently with the two thumbs. It then moved to the chest by moving the two hands alternately from the lower edge of the chest to the higher edge. It then moved to the abdomen by gently pushing in a half-circle that matched the structure of the colon. After that, the outside of the upper and lower limbs was massaged with moderate pressure. Finally, the neonate was massaged from the vertebra to the sides of the neck and buttocks with both hands was performed. The massage was stopped and restarted after everything returned to normal if the newborn cried or defecated during the massage. During the second stage: The neonate was positioned in the supine position, and six passive motions of the limbs were performed singly and then together. Each of the movements lasted for approximately 10 seconds in the following order: passive motion of the right arm with fixation along the collarbone, then the left, then the arms together; passive motion of the left arm with fixation along the collarbone, then the left, then the arms together. Passive motion of the right leg involved fixing along the pelvic bones while holding the ankle joint; passive motion of the left leg; simultaneous movements of the legs; and finally bending and straightening the two legs together. During phototherapy, the neonate was placed into the nest in the incubator (preheated to 33–34°C) with the neck stretched and both hands and legs curved relative to the middle of the body. The bath towel was folded into an oval shape similar to a roller (a U shape). 4. Evaluation phase: Neonatal clinical outcomes, including total serum bilirubin, direct serum bilirubin, oxygen saturation, amount of daily milk intake, time of jaundice regression and duration of phototherapy, were evaluated on the 1st and 7th days after routine care and humanized nursing care (Tool II). 5. Statistical analysis: Using SPSS software, the collected data were arranged, tabulated, and statistically evaluated. The range, mean, and standard deviation were computed for quantitative data. When comparing qualitative data between two groups, among other comparisons, the chi-square test was used to compare more than two means of parametric data. A P value of 0.05 was used as the significance level for interpreting the findings of the significance tests. Results Table (1): No statistically significant differences were observed between the study and control groups for gestational age, current age, feeding type and current weight. As shown in Table 2, highly statistically significant differences were found between the study and control groups on the seventh day regarding total serum bilirubin (P 2 = 0.0001) and direct serum bilirubin (P 2 = 0.0001), despite the nonsignificant difference between the two groups on the 1st day. Table (3): It was obvious that jaundice regression was better in the study group than in the control group, with a mean of (3.966 ± 1.09) (4.66 ± 1.29) days, respectively, with a statistically significant difference (P = 0.028) between the two groups. Additionally, the duration of phototherapy was significantly shorter in the study group (mean = 1.83 ± 0.73 days), than in the control group (2.41 ± 1.01; P = 0.014). As presented in Table 4, it was shown that oxygen saturation increased significantly on the 7th day in the study group compared to the control group, with statistically significant differences (P < 5.455 and P < 0.020) in terms of percentage and mean, respectively. Additionally, the amount of daily milk intake increased on the 7th day of intervention when compared to that in the study group and the control group, with a mean (752.8 ± 262.9 ml) (600.76 ± 290.31 ml), respectively, with a statistically significant difference between the two groups (P = 0.026). Table (5) No statistically significant correlations were observed between neonatal biosocial characteristics and clinical outcomes before intervention in the study or control group. The correlations between neonatal clinical outcomes and their biosocial characteristics after intervention are illustrated in Table 6. A highly significant positive correlation was found between the type of feeding and the amount of daily milk intake in the study group (P = 0.004). Significant positive correlations were also found between current weight, direct serum bilirubin, oxygen saturation and amount of milk (P = 0.032, 0.022 & 0.049), respectively, after intervention. Additionally, a significant positive correlation between treatment modality and oxygen saturation after intervention was found in the study group (P = 0.046). No statistically significant correlation was found between variables in the control group. Discussion Neonatal hyperbilirubinemia is a life-threatening condition that can lead to severe jaundice and hospital readmissions. Neonatal morbidity and mortality are caused by untreated neonatal jaundice and kernicterus ( Olusanya et al., 2018) ( 25 ) . The most common type of treatment for hyperbilirubinemia is phototherapy because it is effective and noninvasive. However, it is associated with severe adverse effects such as dehydration, retinal damage, and bronzy baby syndrome. As a result, it makes sense to use adjuvant interventions, such as humanized care, can improve neonatal recovery by enhancing nutritional, circulatory, mood, and vagal excitability for bilirubin elimination (Yan 2021, Ahmed Y 2019 ) ( 17 , 28 ) . The present study was conducted to evaluate the effect of the use of humanized nursing care on the clinical outcomes of neonates with hyperbilirubinemia. According to the biosocial sociodemographic characteristics of the studied neonates, the results of the current study showed that more than half of them had gestational ages of 37 weeks or older, and more than two-thirds of them had a normal weight at the time of the study. This could be attributed to the fact that half of the neonates in the present study were born at term. These results were comparable to those of Demis et al. (2021) , ( 29 ) who discovered that more than half of the neonates under study were between 37- and 42-weeks gestational age. Furthermore, Saeedi et al. (2020) ( 30 ) found that almost the same percentage of the subjects' weight ranged from 2.500 to 4,000 kg in their study to evaluate neonatal jaundice on the first day of life, as in the present study. In addition, the results of the present study are compatible with the findings of the study conducted by Eta et al. (2023) ( 31 ) , who mentioned that the majority of the neonates in their study had LBW less than 2500 g. Additionally, the current study revealed that more than three-quarters of the participants in the study and control groups’ ages ranged from 1 to 7 days, which may be related to neonatal jaundice, which is frequent during the first week of life. These findings were consistent with those of Ahmed A et al. (2022) , ( 32 ), who reported that more than two-thirds of the neonates were now between three and seven days old. Regarding the type of feeding, the current study indicated that more than half of the study and control groups received artificial feed, which was similar to the findings of Kiros et al. (2023) ( 33 ) , who found that more than two-thirds of LBW infants were fed artificial milk. Concerning treatment modalities, the current study showed that all studied neonates were receiving phototherapy. This may be justified by the importance of phototherapy as a widely used worldwide modality for treating neonatal jaundice. The findings of a study by Mukherjee et al. (2018) ( 34 ), supported this result and revealed that the majority of the neonates in the study were receiving phototherapy. Additionally, these results agreed with those of Al Gameel (2023) and Asefa et al. (2020) ( 35 , 36 ) , who reported that more than three-quarters and approximately two-thirds of neonates, respectively, were treated with phototherapy. The current study demonstrated improvements in neonatal clinical outcome measures after the implementation of humanized care. There were highly significance differences in total and direct serum bilirubin between the neonates in the study and the control group. Total and direct serum bilirubin levels were significantly lower in the study group than in the control group on the seventh day. These results might be explained scientifically by the fact that gentle stroking and kinesthetic stimulation stimulate lymphatic blood flow and circulation, which accelerate gastrointestinal motility and result in more frequent stools with high bilirubin content. In addition, increased milk consumption results in more frequent bowel movements, which will reduce the enterohepatic circulation of bilirubin and improve bilirubin excretion ( 37 , 38 ) . These findings are consistent with those of Jalalodini et al. (2016) ( 39 ) , who found that tactile-kinesthetic stimulation can impact the reduction of bilirubin in neonates. Additionally, these improvements are in line with those of Wang et al. (2020) ( 40 ) , who used a variety of nursing interventions to treat neonatal hemolytic disease and discovered that the mean bilirubin level in the intervention group on the seventh day of treatment was significantly lower than that in the control group. Furthermore, the findings of the present study were also supported by the findings of Korkmaz et al. (2020) ( 41 ), who evaluated the effects of massage therapy on indirect hyperbilirubinemia in newborns receiving phototherapy and reported that the total serum bilirubin level was significantly lower in the intervention group than in the control group. The present study reported that the time of jaundice regression in the study group was significantly shorter than that in the control group. This result was congruent with the findings of Wei et al. (2017) and Dai et al. (2021) ( 42 , 43 ), as they reported a considerably short duration of jaundice regression in the study group in the neonates who received comprehensive nursing intervention for neonatal hyperbilirubinemia. Additionally, the current study showed that the duration of phototherapy was significantly shorter in the study group than in the control group. This could be explained by the way in which humanized nursing care, such as feeding techniques, gentle touching, kinesthetic stimulation, and bird's nest care, increases the comfort and health of neonates. This shortens the course of phototherapy, shortens hospital stays, and lowers hospital expenses. Consequently, the use of humanized nursing care results in more desirable nursing impacts. This result was consistent with a study by Kenari et al. (2020) ( 44 ), who reported that the duration of phototherapy and hospital stay were much shorter in the intervention group than in the control group. According to the current findings, on the seventh day, there was a statistically significant difference between the study and control groups in terms of oxygen saturation, but on the first day, there was no such difference. The scientific explanation for these findings is that gentle strokes and kinesthetic stimulation increase epinephrine production, affect beta-adrenergic receptors in the airways, increase their diameter, and hence increase alveolar ventilation. Finally, this procedure increases the mean oxygen saturation. Additionally, the neonates breathed better and were calmer due to the bird’s nest technique, which increased oxygenation ( 45 ) . This result was supported by Ramezani et al. (2017) and Jazayeri et al. (2021) ( 46 , 47 ), who reported that there was a significant increase in oxygen saturation after intervention compared to before intervention. Concerning the amount of daily milk intake, the present study revealed that it was significantly higher in the study group than in the control group on the seventh day. This may be attributed to the influence of humanized care on easier environmental adaptation, which made the newborns calmer and more comfortable and increased milk intake, which improved digestive function by promoting the digestion and absorption of food and increasing body weight. This finding was in agreement with Jiao (2023 ) ( 48 ), who reported that comfort care significantly increases milk intake and causes neonates to gain weight more quickly in the study group than in the control group. In addition, the study results were congruent with those of Rashwan et al. (2023) ( 49 ) , who found that the intervention bundle successfully decreased the blood bilirubin level, increased the percentage of consumed milk, increased weight gain, and shortened the duration of phototherapy. Regarding the correlation between neonatal biosocial characteristics and their clinical outcome measures after intervention, the current study showed that there were significant positive correlations between type of feeding, current weight, and amount of daily milk intake after intervention. Significant positive correlations were also found between current weight, treatment modalities, and oxygen saturation after intervention, while there was a significant negative correlation between current weight and total bilirubin level after intervention. These findings are similar to those of Paulsamy et al. in 2021 ( 50 ), who investigated the impact of massage with or without kinesthetic stimulation on weight gain in preterm neonates and discovered that gentle stroking combined with kinesthetic stimulation had a favorable impact on weight gain and neonatal outcomes. In the study group following the intervention, there was a strong positive correlation between the amount of milk consumed daily, the type of feeding, and the current weight. Conclusion Based on the findings of the present study, it can be concluded that humanized nursing care had a positive effect on improving neonatal clinical outcomes when the study group was compared to the control group by increasing the amount of daily milk intake and weight, increasing oxygen saturation, decreasing bilirubin levels, and finally decreasing the duration of phototherapy. Recommendations The application of humanized nursing care should be endorsed as a part of routine care for neonates with hyperbilirubinemia to improve their clinical outcomes. Educational and training programs must be provided to pediatric and neonatal nurses to apply humanized care in their practice. Using Humanized care for different newborns to examine its' effect and clinical outcome for other diagnosis. Declarations Acknowledgment: The authors would like to acknowledge all neonates' guardians who participated in this study and appreciate the collaboration of the entire NICU staff of Tanta main university hospital for their cooperation and tolerance during the study period. Authors’ contributions: EG, SE selected the research idea, suggested the design of the study, assigned the study tool. EG, HE, NM,SE wrote the introduction. EG collected the data. EG, SE analyzed data, wrote the results, and revised the final manuscript. EG, HE, NM, SE wrote discussion and revised the manuscript. The authors read and approved the final manuscript. Funding The authors did not receive any funding for this study. Ethics approval and consent to participate: The dean of Tanta University's Faculty of Nursing gave formal approval for collecting the data. Their approval was then directed to the managers responsible for the Neonatal Intensive Care Unit (NICU) at Tanta Main University Hospital to secure their cooperation and permission to conduct this study. Ethical approval was obtained before conducting the study, code no. (9/2021-34926/9/21). The nature of the study did not cause any harm or pain to the entire sample. The privacy of the neonates was maintained during the implementation of the study. Consent for publication: Not applicable. Competing interests : The authors declare that they have no competing interests. Author details 1 Faculty of Nursing, Department of Pediatric Nursing, Tanta University, Gharbia Governorate, Tanta, Egypt. 2 Faculty of Medicine, Department of Pediatric Medicine, Tanta University, Gharbia Governorate, Tanta, Egypt. 3 Faculty of Nursing, Department of Pediatric Nursing, Tanta University, Gharbia Governorate, Tanta, Egypt. 4 Faculty of Nursing, Department of Pediatric Nursing, Tanta University, Gharbia Governorate, Tanta, Egypt. Corresponding author: Eman Salah Elmetwaly References Khan R, Houlihan D, Newsome P. Investigation of jaundice. Med (United Kingdom). 2015;43(10):573–6. Salia S, Afaya A, Wuni A, Ayanore M, Salia E, Kporvi D, Adatara P, Yakong V, Eduah-Quansah S, Quarshie S, Dey E, Akolga D, Alhassan R. Knowledge, attitudes and practices regarding neonatal jaundice among caregivers in a tertiary health facility in Ghana. PLoS ONE. 2021;16(6):1–20. Graham J, Paul S, Mulholland S, Tran S, Butler C, Mankiewitz R, Beech G. 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Demis A, Getie A, Wondmieneh A, Alemnew B, Gedefaw G. Knowledge on neonatal jaundice and its associated factors among mothers in northern Ethiopia: a facility-based crosssectional study. BMJ Open. 2021;11(1):1–8. Saeedi Z, Mosayeb Z, Movahedian A, Kavian Z, Movahedian H. Evaluation of Neonatal Jaundice in the First Day of Life. J Res Med Dent Sci. 2020;8(5):63–7. Eta E, Awuembom A, Ngek E. Prevalence, associated factors and management of neonatal jaundice by midwives and nurses of selected health facilities in Fako Division, Cameroon. Pediatr Neonatal Nurs Open J. 2023;9(1):1–7. Ahmed A, Nazeer M, Bakri A. Evaluation of using agar combined with phototherapy in management of neonatal unconjugated hyperbilirubinemia. IJMS.2022;5(1):325 – 30. Kiros B, Fisseha G, Gebreslassie A, Gufue Z,Ebuy H, Belew MRG. Neonatal Jaundice: Its Determinants Among Neonates Admitted to Neonatal Intensive Care Units of Tigray Region General Hospitals, Northern Ethiopia. Global Pediatr Health. 2032;10(1):1–11. Mukherjee D, Coffey M, Maisels J. Frequency and duration of phototherapy in preterm infants < 35 weeks gestation. J Perinatol. 2018;38(9):1246–51. Al Gameel A, El-Sherbiny, Mohamed W. Amin. Assessment of Knowledge and Practices of Health Care Providers about Neonatal Jaundice in Primary Health Care Units in Fayoum Governorate. Fayoum Univ Med J. 2020;6(1):84–92. Asefa G, Gebrewahid T, Nuguse H, Gebremichael M, Birhane M, Zereabruk K, Zemichael T, Heilay A, Abrha W, Hadera S. Determinants of Neonatal Jaundice among Neonates Admitted to Neonatal Intensive Care Unit in Public General Hospitals of Central Zone, Tigray, Northern Ethiopia: A Case–Control Study. Biomed Res Int. 2020;81(3):1–8. Abo El-Magd A, Dabash S, El-Guindy S, Masoed E, Elhouchi S. Effect of massage on health status of neonates with hyperbilirubinemia. IMPACT: Int J Res Appl Nat Social Sci. 2017;5(5):33–44. Zhang M, Wang L, Wang Y, Tang J. The influence of massage on neonatal hyperbilirubinemia: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med. 2019;32(18):3109–114. Jalalodini A, Nourian M, Goodarzvand L, Jahantigh M, Amin M, Poor M. The Effect of Tactile-Kinesthetic Massage on Transcutaneous Bilirubin in Term Neonates with Hyperbilirubinemia Care with Phototherapy. Iran Nurs Sci Association. 2016;11(5):13–8. Wang W, Tang C, Ji Q, Xiu H, Shao H, Yu X. Use of multiple nursing interventions (cluster nursing) in ABO hemolytic disease of neonates and evaluation of its effect. J Int Med Res. 2020;48(1):1–7. Korkmaz G, Esenay F. Effects of Massage Therapy on Indirect Hyperbilirubinemia in Newborns Who Receive Phototherapy. J Obstet Gynecol Neonatal Nurs. 2020;49(1):91–100. Wei W, Dan Z, Chun Z. Effect of comprehensive nursing intervention on neonatal hyperbilirubinemia and its effect on prognosis. J Clin Med Pract. 2017;21(6):156–58. Dai J, Xu Y, Yin Q, Chen J, Shi H, Li Y. Effect of Systematic Holistic Nursing Combined with the MDT Teaching Method in the Nursing of Neonatal Jaundice and Its Impact on the Recovery of the Newborns' Physiological Function. J Health Eng. 2021;7(1):1–7. Kenari R, Aziznejadroshan P, Mojaveri M, Tilaki K. Comparing the effect of kangaroo mother care and field massage on serum bilirubin level of term neonates with hyperbilirubinemia under phototherapy in the neonatal ward. Casp J Intern Med. 2020 Winter;11(1):34–40. Abd el-fatah Y, Mahmoud R. Effect of Simulative Heartbeat Nest on Improving Physiological Parameters, Comfort and Pain of Preterm Neonates at Neonatal Intensive Care Unit. J Nurs Sci Benha Univ. 2023;4(1):1244–61. Ramezani T, Baniasadi H, Baneshi M. The Effects of Massage on Oxygen Saturation of Infants with Respiratory Distress Syndrome Treated with Nasal Continuous Positive Airway Pressure. Br J Pharm Res. 2017;16(5):1–7. Jazayeri Z, Sajadi M, Dalvand H, Zolfaghari M. Comparison of the effect of foot reflexology and body massage on physiological indicators and bilirubin levels in neonates under phototherapy. Complementary Therapies in Medicine.2021; 59(2021):1–5. Jiao J. Effects of comfort care combined with blue-light phototherapy on neonatal jaundice and total bilirubin and high-sensitivity C-reactive protein levels. J King Saud Univ. 2023;35(2):1–11. Rashwan Z, Abohadida R, Khonji L, Saleh S. Bundling gentle body massage along with regular position change under phototherapy among full-term neonates with hyperbilirubinemia. J Neonatal Nurs. 2023;29(3):464–70. Paulsamy B, Venkatesan K, Qureshi A, Sethuraj P. Effects of massage with or without kinesthetic stimulation on weight gain on preterm neonate. Int J Nurs Healthc Res. 2021;5(1):41–5. Tables Table (1): Percentage distribution of the studied neonates according to bio sociodemographic characteristics Bio sociodemographic data Study group (n=60) Control group (n=60) c 2 P No. % No. % Gestational age (weeks) 35 – 36 37 and more 22 38 36.7 63.3 28 32 46.7 53.3 0.617 0.432 Mean ± SD 37.43 ± 1.794 36.83 ± 1.510 t test= 1.401 P = 0.166 Current age 1 – 7 days 50 83.3 24 73.3 0.884 0.347 8 – 15 days 10 16.7 16 26.7 Type of feeding Bottle feeding 32 53.3 30 50.0 0.067 0.796 Gavage feeding 28 46.7 30 50.0 Current weight Less than 2.500 gm 20 33.3 20 33.3 0.000 1.000 2.500 - 4,000 gm 40 66.7 40 66.7 Mean ± SD 2.680 ± 0.368 2.540 ± 0.561 t test= 1.142 P= 0.259 Table ( 2): Percentage distribution of neonatal clinical outcome measures regarding bilirubin levels on the first and seventh days after intervention Bilirubin level First day (n=60) P1 Seventh day (n=60) P2 Study group (n=30) Control group (n=30) Study group (n=30) Control group (n=30) No. % No. % No. % No. % Total serum bilirubin ˂ 7 mg/dl 4 6.7 0 0.0 2.069 58 96.7 8 13.3 42.088 ≥ 7 mg/dl 56 93.3 60 100.0 0.150 2 3.3 52 87.7 0.0001** 1.705 13.209 Mean ± SD 9.20 ± 2.08 10.01 ± 1.58 P 1= 0.093 4.03 ± 1.48 10.21 ± 2.08 P2 = 0.0001** Direct serum bilirubin ˂ 1 mg/dl 28 46.7 22 36.7 0.617 60 100.0 24 40.0 25.714 0.0001** ≥ 1 mg/dl 32 53.3 38 63.3 0.432 0 0.0 36 60.0 0.5 – 2.3 1.204 9.121 P2= 0.0001** Mean ± SD 0.94 ± 0.29 1.04 ± 0.38 P1= 0.233 0.35 ± 0.12 1.01 ± 0.45 * Difference that is statistically significant at P<0.05 **Statistically significantly different at (P<.0001), highly significant P1= Statistically significant difference between the study and the control group on the first day P2 = Statistically significant difference between the study group and the control group on the seventh day Table (3): Percentage distribution of neonatal clinical outcomes regarding jaundice regression and duration of phototherapy after intervention Variables Study group (n=60) Control group (n=60) c 2 P No. % No. % Time of jaundice regression (Day) ≤ 3 24 23.3 10 16.7 4.022 0.045* ˃ 3 – 6 36 76.7 50 83.3 Mean ± SD 3.966 ± 1.09 4.66 ± 1.29 t test= 0.028* 2.258 Duration of phototherapy (Day) ≤ 2 46 76.7 34 56.7 2.700 0.001** ˃ 2 – 4 14 23.3 26 43.3 Mean ± SD 1.83 ± 0.73 2.41 ± 1.01 t test= 2.545 0.014* * Difference that is statistically significant at P<0.05 **Statistically significantly different at (P<.0001), highly significant Table (4): Percentage distribution of neonatal clinical outcomes regarding oxygen saturation and amount of daily milk intake on the first and seventh days after intervention. Variables First day (n=60) P 1 Seventh day (n=60) P 2 Study group (n=60) Control group (n=60) Study group (n=60) Control group (n=60) No. % No. % No. % No. % Oxygen saturation 92- 100%. 50 83.3 46 76.7 0.417 60 100.0 50 83.3 5.455 Less than 92%. 10 16.7 14 23.3 0.519 0 0.0 10 16.7 0.020* Amount of daily milk intake (ml/kg) ˂ 500 22 36.7 28 46.7 0.617 0.432 10 16.7 22 36.7 7.276 0.026* 500 - ˂ 1000 38 63.3 32 53.3 40 66.6 38 63.3 ≥ 1000 0 0.0 0 0.0 10 16.7 0 0.0 Mean ± SD 485.7 ± 267.4 456.4 ± 246.1 t test 0.440 P1=0.660 752.8 ± 262.9 600.76 ± 290.31 t test 2.285 P2= 0.026* * Difference that is statistically significant at P<0.05 **Statistically significantly different at (P<.0001), highly significant P1= Statistically significant difference between the study and control groups on the first day P2 = Statistically significant difference between the study group and the control group on the seventh day Table (5): Correlation between neonatal biosocial characteristics and their clinical outcome measures before intervention Biosocial characteristics data Total serum bilirubin Direct serum bilirubin Oxygen saturation Amount of daily milk intake (ml/kg) r P R P R P r P Gestational age (weeks) Study group 0.273 0.145 0.041 0.830 0.008 0.965 0.078 0.683 Control group 0.138 0.468 0.261 0.163 0.165 0.384 0.322 0.227 Current age Study group 0.097 0.609 0.163 0.389 0.116 0.540 0.143 0.452 Control group 0.070 0.711 0.091 0.631 0.208 0.270 0.245 0.191 Type of feeding Study group 0.078 0.682 0.074 0.696 0.188 0.319 0.065 0.731 Control group 0.206 0.274 0.089 0.640 0.050 0.795 0.101 0.594 Current weight Study group 0.165 0.383 0.117 0.537 0.065 0.733 0.079 0.679 Control group 0.002 0.991 0.105 0.580 0.237 0.207 0.184 0.330 Treatment modalities Study group 0.065 0.731 0.062 0.744 0.273 0.145 0.140 0.459 Control group 0.126 0.505 0.142 0.454 0.040 0.834 0.247 0.189 Table (6): Correlation between neonatal biosocial characteristics and their clinical outcome measures for the study and control groups after intervention Biosocial characteristics data Total serum bilirubin Direct serum bilirubin Oxygen saturation Amount of daily milk intake (ml/kg) r P R P r P r P Gestational age (weeks) Study group 0.225 0.233 0.086 0.650 0.435 0.554 0.280 0.134 Control group 0.125 0.511 0.224 0.234 0.137 0.469 0.211 0.263 Current age Study group 0.276 0.140 0.054 0.777 0.326 0.321 0.230 0.221 Control group 0.002 0.992 0.036 0.850 0.224 0.229 0.270 0.149 Type of feeding Study group 0.149 0.431 0.012 0.951 0.712 0.621 0.514 0.004** Control group 0.259 0.166 0.052 0.784 0.227 0.227 0.129 0.495 Current weight Study group 0.220 0.243 0.867 0.032* 0.438 0.022* 0.362 0.049* Control group 0.037 0.846 0.081 0.672 0.150 0.428 0.107 0.575 Treatment modalities Study group 0.011 0.953 0.037 0.846 0.365 0.046* 0.148 0.437 Control group 0.040 0.834 0.139 0.464 0.932 0.932 0.218 0.248 * Difference that is statistically significant at P<0.05 **Statistically significantly different at (P<.0001), highly significant Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 08 Feb, 2025 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 06 Feb, 2024 Reviews received at journal 25 Jan, 2024 Reviewers agreed at journal 25 Jan, 2024 Reviewers invited by journal 25 Jan, 2024 Editor invited by journal 16 Jan, 2024 Editor assigned by journal 10 Jan, 2024 Submission checks completed at journal 10 Jan, 2024 First submitted to journal 25 Dec, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3805640","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":266243469,"identity":"0ef48c71-fea1-48aa-832d-f9e028821e4e","order_by":0,"name":"Eman Salah Elmetwaly Galalah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYPACCwY+Bh7GBwkVQDYzcwMxWiQY2Bh4mA0enAFpYSReC5vkwzYQh4AWfrHDzx5+qZGQZ2M/e0wicV5tNH87UMuPim04tUjOTjM3ljkmYdjGk5dskbjteO6Mw4wNjD1nbuPUYnA7wUxagk2CsY0hx/BG4rZjuQ1ALcyMbbi12N9O/yYt8U/Cvo3/jYFE4pxjufMJaTGQzjGT/NgmkdgmkWMkkdhQk7uBkBaJ2zll0ox9EsltEm+MDRKOHcjdCNRyEJ9f+Genb5P88c3Gtp8/x/Dhj5q63HnnDx988KMCtxYQYOZBsA+DyQN41QMB4w8Eu46Q4lEwCkbBKBiBAABCqFkvA4PbjAAAAABJRU5ErkJggg==","orcid":"","institution":"Faculty of Nursing, Department of Pediatric Nursing, Tanta University,Gharbia Governorate","correspondingAuthor":true,"prefix":"","firstName":"Eman","middleName":"Salah Elmetwaly","lastName":"Galalah","suffix":""},{"id":266243470,"identity":"ab0d7b8f-df7d-4cc0-a42e-928765165e34","order_by":1,"name":"Heba Saied Mohamed El-mahdy","email":"","orcid":"","institution":"Faculty of Medicine, Department of Pediatric Medicine, Tanta University,Gharbia Governorate","correspondingAuthor":false,"prefix":"","firstName":"Heba","middleName":"Saied Mohamed","lastName":"El-mahdy","suffix":""},{"id":266243471,"identity":"71a7f8e3-e569-4646-ae4a-44647da39490","order_by":2,"name":"Nagafa Hafez farag Mahdy","email":"","orcid":"","institution":"Faculty of Nursing, Department of Pediatric Nursing, Tanta University,Gharbia Governorate","correspondingAuthor":false,"prefix":"","firstName":"Nagafa","middleName":"Hafez farag","lastName":"Mahdy","suffix":""},{"id":266243472,"identity":"c638c826-d03d-4fe4-bbd6-c932aeeda4b6","order_by":3,"name":"Sahar Mahmoud Elkhedr Abdelgawad","email":"","orcid":"","institution":"Faculty of Nursing, Department of Pediatric Nursing, Tanta University,Gharbia Governorate","correspondingAuthor":false,"prefix":"","firstName":"Sahar","middleName":"Mahmoud Elkhedr","lastName":"Abdelgawad","suffix":""}],"badges":[],"createdAt":"2023-12-25 22:29:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3805640/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3805640/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-025-02772-z","type":"published","date":"2025-02-08T15:57:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":75930399,"identity":"b0dcd368-a957-4b75-a985-f693e0031add","added_by":"auto","created_at":"2025-02-10 16:11:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2474051,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3805640/v1/7311e4a7-eb0f-44e0-a9f0-d671ef0e8ef8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of the Application of Humanized Nursing Care on the Clinical Outcomes of Neonates with Hyperbilirubinemia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNeonatal hyperbilirubinemia is the most common reason for hospitalization in the first week of life worldwide. It may have an effect on 60% and 80% of term and preterm neonates, respectively. \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e Neonatal jaundice is characterized by yellowish staining of a newborn's skin and other membranes, which indicates elevated levels of unconjugated bilirubin in the blood. \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e When a newborn's total blood bilirubin level exceeds 5 mg/dl, jaundice becomes clinically evident. Newborns may experience both pathological and physiological types of jaundice. The main causes of pathological jaundice are abnormalities in bile acid production, liver metabolism, and excessive bilirubin secretion. \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e Physiological jaundice usually disappears on its own, while pathologic jaundice frequently needs therapeutic intervention. \u003csup\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eExcessive amounts of bilirubin accumulate in the bloodstream and affect the brain, possibly leading to mental retardation, hearing loss, vision impairments, or even death. When jaundice is not treated, kernicterus starts to develop, which can lead to serious problems, such as permanent brain impairment. Therefore, early diagnosis and prompt treatment to reduce bilirubin levels are essential for prevention. \u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCurrently, there are numerous methods for treating hyperbilirubinemia, including medication, phototherapy, and blood exchange transfusion. However, phototherapy is used as the primary mode of treatment \u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e. Phototherapy involves the application of fluorescent light to newborn naked skin to facilitate bilirubin excretion through photoisomerization, which converts bilirubin's chemical structure from one that is insoluble to one that is soluble for easy excretion. \u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe environment inside neonatal intensive care units (NICUs) is characterized by high stress due to different factors, such as mechanical noise from equipment, movement of people, parallel and loud conversations, and handling of neonates. Therefore, these NICUs have been seeking ways to improve their environment, creating a more humanized environment and reducing stressful factors \u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHumanization practices have increasingly stood out in the healthcare field, especially when present in situations in which the environment is a stressful factor for the neonate, directly impacting his/her treatment. These humanization practices include nonpharmacological treatments and noninvasive procedures that can alleviate pain, anxiety, or even fear, increase well-being and even improve neonatal clinical outcomes. \u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe World Health Organization (WHO) describes \"humanized care\" as the act of human interaction and cooperation. It makes an effort to enhance and appreciate the essential spirit of life. \u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e It has significant potential for physical and emotional intimacy between neonates and professionals, as well as between neonates and their families, from the perspective of health care intervention. \u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e Feeding techniques, gentle stroking, kinesthetic stimulation, and bird nest care are the major components of humanized nursing care \u003csup\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFeeding not only provides a proper supply of essential nutrients but also promotes the recovery of gastrointestinal function and a normal frequency of defecation for neonatal jaundice patients. Feeding strategies include breast feeding or artificial feeding, such as formula milk (oral or nasogastric tube) and parenteral nutrition. Adequate breastfeeding promotes normal intestinal flora establishment in newborns as well as physical growth and development, all of which help fight against physiological jaundice. \u003csup\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eConsequently, most of the care given in NICUs is provided by neonatal nurses, who have the ability to modify feeding schedules to enhance feeding tolerance, assist mothers in starting and maintaining a milk supply, and facilitate the expression, handling, and storage of milk. To support the newborn's normal, healthy physical, psychological, and emotional development, nurses can also learn strategies and techniques for feeding the neonates, providing oral care and skin-to-skin care (also known as Kangaroo care), and creating opportunities for fostering parent-child interactions. \u003csup\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAdditionally, nurses attach the nasogastric (NG) feeding tubes to neonates who are unable to receive oral feeding, maintain feeding tubes, provide neonates with appropriate nutrients, and avoid complications. The newborns were encouraged to sleep on their right side to reduce the possibility that they would spit up after eating. Finally, the type, amount of milk, residual volume, and any complications were recorded. \u003csup\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNeonatal massage and kinesthetic stimulation are recognized as noninvasive, supplemental treatments that do not need specialized equipment and are safe for neonates older than 31 weeks. Daily massage can enhance physiological development, improve a infant's respiration and heart rate, and improve communication between nurses and neonates. It can also alleviate colic and abdominal bloating. Moreover, massage can increase meconium elimination and prevent bilirubin from re-entering the circulatory system through the portal system, which lowers blood bilirubin levels. \u003csup\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e Hence, pediatric nurses should frequently stroke the whole body of neonates from top to bottom after disinfecting their hands and applying kinesthetic stimuli, such as active range-of-motion movements in the lower and upper extremities that involve changing the newborn's position between supine and prone. \u003csup\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNesting care is a sort of developmental care that is well liked in the NICU due to its ease of application, accessibility of materials, and absence of size restrictions. It can maintain the newborn's curved limb position, minimize unexpected movement and excessive limb extension, and improve the comfort and sleep quality of the newborn by establishing boundaries around them. \u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eSignificance of the study\u003c/h2\u003e \u003cp\u003e Despite evidence-based guidelines for monitoring and treating hyperbilirubinemia, failure to prevent and manage neonatal hyperbilirubinemia results in permanent disability and even death. The humanization of care is a broad and inclusive program that includes and values excellence in the quality of care. Since it can prevent the onset of certain sequalae that affect newborns. Jean Watson supports the idea that, nurses in all settings, especially critical care units, should strengthen their humanistic role throughout the hospitalization process. Humanized care should not simply remain a theoretical concept, but rather be implemented through the recognition of the importance of the human touch and the individuality that are essential in NICUs. \u003csup\u003e(\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/sup\u003e. However, studies of the combination between feeding strategies, gent stroking and kinesthetic stimulation and bird\u0026rsquo;s nest care as a humanized nursing care for neonates with hyperbilirubinemia are limited. Hence, this study was designed to evaluate the effect of the application of humanized nursing care on the clinical outcomes of neonates with hyperbilirubinemia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAim of the study\u003c/h2\u003e \u003cp\u003eThis study was conducted to evaluate the effect of the application of humanized nursing care on the clinical outcomes of neonates with hyperbilirubinemia.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eResearch hypothesis\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eneonatal clinical outcomes are expected to be improved after applying humanized nursing care for neonates with hyperbilirubinemia.\u003c/p\u003e\u003cp\u003e \u003cb\u003eOperational definition\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eHumanized care\u003c/b\u003e is a comprehensive strategy that promotes the discharge of newborns and attends to the nutritional, therapeutic, psychological, and hygienic aspects of neonatal nursing. In the current study, humanized nursing care included feeding strategies, gentle stroking, kinesthetic stimulation and bird\u0026rsquo;s nest care.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eClinical outcomes\u003c/b\u003e: is a good outcome when the neonate improved after applying humanized nursing care such as reducing bilirubin level, decrease duration of phototherapy, improve oxygen saturation, and increase amount of daily milk intake.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Subjects And Methods","content":"\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the present study, a quasi-experimental research design was used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was performed in the Neonatal Intensive Care Unit (NICU), Tanta Main University Hospital, which is affiliated with the Ministry of Higher Education and Scientific Research.\u003c/p\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eSample:\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eUsing the following criteria, the Epi-Info computer calculated the sample size\u003c/strong\u003e:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eThe total number of neonates with hyperbilirubinemia is approximately 300/year.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eThe sample size calculation was found to be 120 neonates using the Epi-info software statistical package. This calculation is based on a type I error of 0.05 and a confidence level of 95%.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eThe inclusion criteria for the neonates included neonates with hyperbilirubinemia, both sexes, more than 35 weeks, who were from the first day to ten days undergoing phototherapy and in the same therapeutic plan and treatment modalities. Neonates who had severe infectious disease and severe cardiac, hepatic, and renal insufficiency were excluded.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eEligible neonates who fulfilled the inclusion criteria were divided into two groups. Each group consisted of 60 neonates. The study group received routine care as well as humanized nursing care, in contrast to the control group, while the control group received only routine care.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eTwo tools were used in the current study:\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eTool I: Biosocial characteristics of the studied neonates\u003c/strong\u003e: including gestational age, postnatal age, type of hyperbilirubinemia, weight, signs and symptoms of hyperbilirubinemia and treatment modalities.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eTool II: Neonatal clinical outcome: Measures for humanized care\u003c/h3\u003e\n\u003cp\u003eIt was used to assess physiological parameters for both the study and control groups on the first and seventh days after nursing intervention. Regarding both routine care and humanized nursing care of neonates with hyperbilirubinemia. It included the following:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eBilirubin level: Total serum bilirubin \u0026amp; direct serum bilirubin.\u003c/li\u003e\n \u003cli\u003eClinical efficacy: Time of jaundice regression \u0026amp; duration of phototherapy.\u003c/li\u003e\n \u003cli\u003eUsing a pulse oximeter to measure oxygen saturation (the higher oxygen indicates good prognosis).\u003c/li\u003e\n \u003cli\u003eMilk intake: An increased milk intake indicates a good prognosis.\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch2\u003eMethod\u003c/h2\u003e\n\u003cp\u003eTwo tools (I, II) were developed by the researcher after reviewing recent literature \u003csup\u003e(\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/sup\u003e. To measure the study tools\u0026apos; use, visibility, and clarity, a pilot study was conducted on ten neonates (10% of the sample). After the necessary modifications were made, those neonates were excluded from the study\u0026apos;s total sample.\u003c/p\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003ePhases of the study:\u003c/h2\u003e\n \u003cp\u003eThe study was carried out in four phases:\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e1. Assessment phase:\u003c/h2\u003e\n \u003cp\u003eBaseline data on neonates were extracted from their hospital records on the first day of admission for the two groups (control \u0026amp; study) before intervention to select neonates who fulfilled the inclusion criteria of the present research (Tool I). The data were initially gathered from the control group and then from the group receiving humanized care to prevent the subjects from contaminating.\u003c/p\u003e\n \u003ch2\u003e2. Planning phase\u003c/h2\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eFor the control group\u003c/strong\u003e, neonates only received routine care for hyperbilirubinemia, including incubator care, eye care, skin care, genitalia care, phototherapy care (covering eyes, positioning, hydration, monitoring serum bilirubin, and side effects of phototherapy) and care of the peripheral intravenous line care.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eFor the study group\u003c/strong\u003e: humanized nursing care began on the first day; the neonate received phototherapy and continued through the seventh day. It included the following items: \u003cstrong\u003efeeding strategies\u003c/strong\u003e, which include the type of feeding, frequency, digestive capacity, and amount of milk. \u003cstrong\u003eGentle stroking\u003c/strong\u003e: the researcher massaged the neonates\u0026apos; entire body, from head to toe. \u003cstrong\u003eKinesthetic stimulation\u003c/strong\u003e included passive motion of the limbs singly and then together in the following order: right arm, left arm, right leg, and left leg. For the \u003cstrong\u003ebird\u0026rsquo;s nest care\u003c/strong\u003e, the bath towel was rolled and folded around the newborn to promote security for the neonate.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e3. Implementation phase: (For the study) group:\u003c/h2\u003e\n \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\n \u003ch2\u003eDuring the first stage:\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eThe neonate was placed in the supine position and gently stroked in the following sequence:\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eGentle stroking technique:\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eStroking was performed once in the morning, once at midnight and once in the evening from the first day to the seventh day for 15 minutes. Hands were carefully washed; the room temperature was maintained between 24 and 28\u0026deg;C, and pressure was applied to the newborn\u0026rsquo;s skin with warm and bare hands. The periorbital and cheek regions of the face were first massaged gently with the two thumbs. It then moved to the chest by moving the two hands alternately from the lower edge of the chest to the higher edge. It then moved to the abdomen by gently pushing in a half-circle that matched the structure of the colon. After that, the outside of the upper and lower limbs was massaged with moderate pressure. Finally, the neonate was massaged from the vertebra to the sides of the neck and buttocks with both hands was performed. The massage was stopped and restarted after everything returned to normal if the newborn cried or defecated during the massage.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eDuring the second stage:\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eThe neonate was positioned in the supine position, and six passive motions of the limbs were performed singly and then together. Each of the movements lasted for approximately 10 seconds in the following order: passive motion of the right arm with fixation along the collarbone, then the left, then the arms together; passive motion of the left arm with fixation along the collarbone, then the left, then the arms together. Passive motion of the right leg involved fixing along the pelvic bones while holding the ankle joint; passive motion of the left leg; simultaneous movements of the legs; and finally bending and straightening the two legs together. During phototherapy, the neonate was placed into the nest in the incubator (preheated to 33\u0026ndash;34\u0026deg;C) with the neck stretched and both hands and legs curved relative to the middle of the body. The bath towel was folded into an oval shape similar to a roller (a U shape).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e4. Evaluation phase:\u003c/h2\u003e\n \u003cp\u003eNeonatal clinical outcomes, including total serum bilirubin, direct serum bilirubin, oxygen saturation, amount of daily milk intake, time of jaundice regression and duration of phototherapy, were evaluated on the 1st and 7th days after routine care and humanized nursing care (Tool II).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e5. Statistical analysis:\u003c/h2\u003e\n \u003cp\u003eUsing SPSS software, the collected data were arranged, tabulated, and statistically evaluated. The range, mean, and standard deviation were computed for quantitative data. When comparing qualitative data between two groups, among other comparisons, the chi-square test was used to compare more than two means of parametric data. A P value of 0.05 was used as the significance level for interpreting the findings of the significance tests.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eTable (1):\u0026nbsp;\u003c/strong\u003eNo statistically significant differences were observed between the study and control groups for gestational age, current age, feeding type and current weight.\u003c/p\u003e\n\u003cp\u003eAs shown in Table\u0026nbsp;2, highly statistically significant differences were found between the study and control groups on the seventh day regarding total serum bilirubin (P\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.0001) and direct serum bilirubin (P\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.0001), despite the nonsignificant difference between the two groups on the 1st day.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (3):\u0026nbsp;\u003c/strong\u003eIt was obvious that jaundice regression was better in the study group than in the control group, with a mean of (3.966\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09) (4.66\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29) days, respectively, with a statistically significant difference (P\u0026thinsp;=\u0026thinsp;0.028) between the two groups. Additionally, the duration of phototherapy was significantly shorter in the study group (mean\u0026thinsp;=\u0026thinsp;1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73 days), than in the control group (2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01; P\u0026thinsp;=\u0026thinsp;0.014).\u003c/p\u003e\n\u003cp\u003eAs presented in Table\u0026nbsp;4, it was shown that oxygen saturation increased significantly on the 7th day in the study group compared to the control group, with statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;5.455 and P\u0026thinsp;\u0026lt;\u0026thinsp;0.020) in terms of percentage and mean, respectively. Additionally, the amount of daily milk intake increased on the 7th day of intervention when compared to that in the study group and the control group, with a mean (752.8\u0026thinsp;\u0026plusmn;\u0026thinsp;262.9 ml) (600.76\u0026thinsp;\u0026plusmn;\u0026thinsp;290.31 ml), respectively, with a statistically significant difference between the two groups (P\u0026thinsp;=\u0026thinsp;0.026).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(5)\u003c/strong\u003e No statistically significant correlations were observed between neonatal biosocial characteristics and clinical outcomes before intervention in the study or control group.\u003c/p\u003e\n\u003cp\u003eThe correlations between neonatal clinical outcomes and their biosocial characteristics after intervention are illustrated in Table\u0026nbsp;6. A highly significant positive correlation was found between the type of feeding and the amount of daily milk intake in the study group (P\u0026thinsp;=\u0026thinsp;0.004). Significant positive correlations were also found between current weight, direct serum bilirubin, oxygen saturation and amount of milk (P\u0026thinsp;=\u0026thinsp;0.032, 0.022 \u0026amp; 0.049), respectively, after intervention. Additionally, a significant positive correlation between treatment modality and oxygen saturation after intervention was found in the study group (P\u0026thinsp;=\u0026thinsp;0.046). No statistically significant correlation was found between variables in the control group.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eNeonatal hyperbilirubinemia is a life-threatening condition that can lead to severe jaundice and hospital readmissions. Neonatal morbidity and mortality are caused by untreated neonatal jaundice and kernicterus (\u003cb\u003eOlusanya et al., 2018)\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/sup\u003e. The most common type of treatment for hyperbilirubinemia is phototherapy because it is effective and noninvasive. However, it is associated with severe adverse effects such as dehydration, retinal damage, and bronzy baby syndrome. As a result, it makes sense to use adjuvant interventions, such as humanized care, can improve neonatal recovery by enhancing nutritional, circulatory, mood, and vagal excitability for bilirubin elimination \u003cb\u003e(Yan 2021, Ahmed Y 2019\u003c/b\u003e) \u003csup\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe present study was conducted to evaluate the effect of the use of humanized nursing care on the clinical outcomes of neonates with hyperbilirubinemia. According to the biosocial sociodemographic characteristics of the studied neonates, the results of the current study showed that more than half of them had gestational ages of 37 weeks or older, and more than two-thirds of them had a normal weight at the time of the study. This could be attributed to the fact that half of the neonates in the present study were born at term. These results were comparable to those of \u003cb\u003eDemis et al. (2021)\u003c/b\u003e, \u003csup\u003e(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/sup\u003e who discovered that more than half of the neonates under study were between 37- and 42-weeks gestational age.\u003c/p\u003e \u003cp\u003eFurthermore, \u003cb\u003eSaeedi et al. (2020)\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/sup\u003e found that almost the same percentage of the subjects' weight ranged from 2.500 to 4,000 kg in their study to evaluate neonatal jaundice on the first day of life, as in the present study. In addition, the results of the present study are compatible with the findings of the study conducted by \u003cb\u003eEta et al. (2023)\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/sup\u003e, who mentioned that the majority of the neonates in their study had LBW less than 2500 g.\u003c/p\u003e \u003cp\u003eAdditionally, the current study revealed that more than three-quarters of the participants in the study and control groups\u0026rsquo; ages ranged from 1 to 7 days, which may be related to neonatal jaundice, which is frequent during the first week of life. These findings were consistent with those of \u003cb\u003eAhmed A et al. (2022)\u003c/b\u003e, \u003csup\u003e(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e),\u003c/sup\u003e who reported that more than two-thirds of the neonates were now between three and seven days old. Regarding the type of feeding, the current study indicated that more than half of the study and control groups received artificial feed, which was similar to the findings of \u003cb\u003eKiros et al. (2023)\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/sup\u003e, who found that more than two-thirds of LBW infants were fed artificial milk.\u003c/p\u003e \u003cp\u003eConcerning treatment modalities, the current study showed that all studied neonates were receiving phototherapy. This may be justified by the importance of phototherapy as a widely used worldwide modality for treating neonatal jaundice. The findings of a study by \u003cb\u003eMukherjee et al. (2018)\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e),\u003c/sup\u003e supported this result and revealed that the majority of the neonates in the study were receiving phototherapy. Additionally, these results agreed with those of \u003cb\u003eAl Gameel (2023) and Asefa et al. (2020)\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/sup\u003e, who reported that more than three-quarters and approximately two-thirds of neonates, respectively, were treated with phototherapy.\u003c/p\u003e \u003cp\u003e The current study demonstrated improvements in neonatal clinical outcome measures after the implementation of humanized care. There were highly significance differences in total and direct serum bilirubin between the neonates in the study and the control group. Total and direct serum bilirubin levels were significantly lower in the study group than in the control group on the seventh day.\u003c/p\u003e \u003cp\u003eThese results might be explained scientifically by the fact that gentle stroking and kinesthetic stimulation stimulate lymphatic blood flow and circulation, which accelerate gastrointestinal motility and result in more frequent stools with high bilirubin content. In addition, increased milk consumption results in more frequent bowel movements, which will reduce the enterohepatic circulation of bilirubin and improve bilirubin excretion \u003csup\u003e(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e)\u003c/sup\u003e. These findings are consistent with those of \u003cb\u003eJalalodini et al. (2016)\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)\u003c/sup\u003e, who found that tactile-kinesthetic stimulation can impact the reduction of bilirubin in neonates. Additionally, these improvements are in line with those of \u003cb\u003eWang et al. (2020)\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e)\u003c/sup\u003e, who used a variety of nursing interventions to treat neonatal hemolytic disease and discovered that the mean bilirubin level in the intervention group on the seventh day of treatment was significantly lower than that in the control group.\u003c/p\u003e \u003cp\u003eFurthermore, the findings of the present study were also supported by the findings of \u003cb\u003eKorkmaz et al. (2020)\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e),\u003c/sup\u003e who evaluated the effects of massage therapy on indirect hyperbilirubinemia in newborns receiving phototherapy and reported that the total serum bilirubin level was significantly lower in the intervention group than in the control group.\u003c/p\u003e \u003cp\u003eThe present study reported that the time of jaundice regression in the study group was significantly shorter than that in the control group. This result was congruent with the findings of \u003cb\u003eWei et al. (2017) and Dai et al. (2021)\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e),\u003c/sup\u003e as they reported a considerably short duration of jaundice regression in the study group in the neonates who received comprehensive nursing intervention for neonatal hyperbilirubinemia.\u003c/p\u003e \u003cp\u003eAdditionally, the current study showed that the duration of phototherapy was significantly shorter in the study group than in the control group. This could be explained by the way in which humanized nursing care, such as feeding techniques, gentle touching, kinesthetic stimulation, and bird's nest care, increases the comfort and health of neonates. This shortens the course of phototherapy, shortens hospital stays, and lowers hospital expenses. Consequently, the use of humanized nursing care results in more desirable nursing impacts. This result was consistent with a study by \u003cb\u003eKenari et al. (2020)\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e),\u003c/sup\u003e who reported that the duration of phototherapy and hospital stay were much shorter in the intervention group than in the control group.\u003c/p\u003e \u003cp\u003eAccording to the current findings, on the seventh day, there was a statistically significant difference between the study and control groups in terms of oxygen saturation, but on the first day, there was no such difference.\u003c/p\u003e \u003cp\u003eThe scientific explanation for these findings is that gentle strokes and kinesthetic stimulation increase epinephrine production, affect beta-adrenergic receptors in the airways, increase their diameter, and hence increase alveolar ventilation. Finally, this procedure increases the mean oxygen saturation. Additionally, the neonates breathed better and were calmer due to the bird\u0026rsquo;s nest technique, which increased oxygenation \u003csup\u003e(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e)\u003c/sup\u003e. This result was supported by \u003cb\u003eRamezani et al. (2017) and Jazayeri et al. (2021)\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e),\u003c/sup\u003e who reported that there was a significant increase in oxygen saturation after intervention compared to before intervention.\u003c/p\u003e \u003cp\u003eConcerning the amount of daily milk intake, the present study revealed that it was significantly higher in the study group than in the control group on the seventh day. This may be attributed to the influence of humanized care on easier environmental adaptation, which made the newborns calmer and more comfortable and increased milk intake, which improved digestive function by promoting the digestion and absorption of food and increasing body weight.\u003c/p\u003e \u003cp\u003eThis finding was in agreement with \u003cb\u003eJiao (2023\u003c/b\u003e) \u003csup\u003e(\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e),\u003c/sup\u003e who reported that comfort care significantly increases milk intake and causes neonates to gain weight more quickly in the study group than in the control group. In addition, the study results were congruent with those of \u003cb\u003eRashwan et al. (2023)\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e)\u003c/sup\u003e, who found that the intervention bundle successfully decreased the blood bilirubin level, increased the percentage of consumed milk, increased weight gain, and shortened the duration of phototherapy.\u003c/p\u003e \u003cp\u003eRegarding the correlation between neonatal biosocial characteristics and their clinical outcome measures after intervention, the current study showed that there were significant positive correlations between type of feeding, current weight, and amount of daily milk intake after intervention. Significant positive correlations were also found between current weight, treatment modalities, and oxygen saturation after intervention, while there was a significant negative correlation between current weight and total bilirubin level after intervention.\u003c/p\u003e \u003cp\u003eThese findings are similar to those of \u003cb\u003ePaulsamy et al. in 2021\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e),\u003c/sup\u003e who investigated the impact of massage with or without kinesthetic stimulation on weight gain in preterm neonates and discovered that gentle stroking combined with kinesthetic stimulation had a favorable impact on weight gain and neonatal outcomes. In the study group following the intervention, there was a strong positive correlation between the amount of milk consumed daily, the type of feeding, and the current weight.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBased on the findings of the present study, it can be concluded that humanized nursing care had a positive effect on improving neonatal clinical outcomes when the study group was compared to the control group by increasing the amount of daily milk intake and weight, increasing oxygen saturation, decreasing bilirubin levels, and finally decreasing the duration of phototherapy.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e"},{"header":"Recommendations","content":"\u003cul\u003e \u003cli\u003e \u003cp\u003eThe application of humanized nursing care should be endorsed as a part of routine care for neonates with hyperbilirubinemia to improve their clinical outcomes.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEducational and training programs must be provided to pediatric and neonatal nurses to apply humanized care in their practice.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eUsing Humanized care for different newborns to examine its' effect and clinical outcome for other diagnosis.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge all neonates\u0026apos; guardians who participated in this study and appreciate the collaboration of the entire NICU staff of Tanta main university hospital for their cooperation and tolerance during the study period.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEG, SE selected the research idea, suggested the design of the study, assigned the study tool. EG, HE, NM,SE wrote the introduction. EG collected the data. EG, SE analyzed data, wrote the results, and revised the final manuscript. EG, HE, NM, SE wrote discussion and revised the manuscript. The authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive any funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dean of Tanta University\u0026apos;s Faculty of Nursing gave formal approval for collecting the data. Their approval was then directed to the managers responsible for the Neonatal Intensive Care Unit (NICU) at Tanta Main University Hospital to secure their cooperation and permission to conduct this study. Ethical approval was obtained before conducting the study, code no. (9/2021-34926/9/21). The nature of the study did not cause any harm or pain to the entire sample. The privacy of the neonates was maintained during the implementation of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eFaculty of Nursing, Department of Pediatric Nursing, Tanta University, Gharbia Governorate, Tanta, Egypt. \u003csup\u003e2\u003c/sup\u003e Faculty of Medicine, Department of Pediatric Medicine, Tanta University, Gharbia Governorate, Tanta, Egypt. \u003csup\u003e3\u003c/sup\u003eFaculty of Nursing, Department of Pediatric Nursing, Tanta University, Gharbia Governorate, Tanta, Egypt. \u003csup\u003e4\u0026nbsp;\u003c/sup\u003eFaculty of Nursing, Department of Pediatric Nursing, Tanta University, Gharbia Governorate, Tanta, Egypt.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author:\u003c/strong\u003e Eman Salah Elmetwaly\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKhan R, Houlihan D, Newsome P. 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Effects of comfort care combined with blue-light phototherapy on neonatal jaundice and total bilirubin and high-sensitivity C-reactive protein levels. J King Saud Univ. 2023;35(2):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRashwan Z, Abohadida R, Khonji L, Saleh S. Bundling gentle body massage along with regular position change under phototherapy among full-term neonates with hyperbilirubinemia. J Neonatal Nurs. 2023;29(3):464\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaulsamy B, Venkatesan K, Qureshi A, Sethuraj P. Effects of massage with or without kinesthetic stimulation on weight gain on preterm neonate. Int J Nurs Healthc Res. 2021;5(1):41\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable (1):\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePercentage distribution of the studied neonates according to\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ebio sociodemographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"675\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.34421364985163%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eBio sociodemographic data\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.958456973293767%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eStudy group (n=60)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.73887240356083%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eControl group (n=60)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.534124629080118%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003ec\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e2\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.42433234421365%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.623376623376622%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eNo.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.948051948051948%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eNo.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eGestational age (weeks)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.34421364985163%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e35 \u0026ndash; 36\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e37 and more\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.166172106824925%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e38\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.792284866468842%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e36.7\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e63.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.31454005934718%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e28\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e32\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.42433234421365%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e46.7\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e53.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.534124629080118%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.617\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.42433234421365%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.432\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.34421364985163%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eMean \u0026plusmn; SD\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.958456973293767%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e37.43 \u0026plusmn; 1.794\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.73887240356083%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e36.83 \u0026plusmn; 1.510\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.958456973293767%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003et test=\u003c/span\u003e\u003c/strong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;1.401\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eP = 0.166\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eCurrent age\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.34421364985163%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e1 \u0026ndash; 7 days\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.166172106824925%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e50\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.792284866468842%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e83.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.31454005934718%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.42433234421365%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e73.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.534124629080118%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.884\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.42433234421365%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.347\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.444866920152094%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e8 \u0026ndash; 15 days\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.5893536121673%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.547528517110266%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e16.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.779467680608365%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e16\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.638783269961976%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e26.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eType of feeding\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.34421364985163%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eBottle feeding\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.166172106824925%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e32\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.792284866468842%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e53.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.31454005934718%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.42433234421365%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e50.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.534124629080118%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.067\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.42433234421365%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.796\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.444866920152094%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eGavage feeding\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.5893536121673%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e28\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.547528517110266%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e46.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.779467680608365%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.638783269961976%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e50.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eCurrent weight\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.34421364985163%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eLess than 2.500 gm\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.166172106824925%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.792284866468842%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e33.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.31454005934718%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.42433234421365%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e33.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.534124629080118%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.42433234421365%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e1.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.444866920152094%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e2.500 - 4,000 gm\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.5893536121673%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e40\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.547528517110266%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e66.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.779467680608365%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e40\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.638783269961976%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e66.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.34421364985163%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eMean \u0026plusmn; SD\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.958456973293767%\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e2.680 \u0026plusmn; 0.368\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.73887240356083%\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e2.540 \u0026plusmn; 0.561\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.958456973293767%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003et test=\u003c/span\u003e\u003c/strong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;1.142\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eP= 0.259\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eTable (\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e2): Percentage distribution of neonatal clinical outcome measures regarding\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003ebilirubin\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003elevels on the\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;first and seventh\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003edays\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;after intervention\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.049382716049383%\" rowspan=\"3\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eBilirubin level\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.47530864197531%\" colspan=\"4\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eFirst day (n=60)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\" rowspan=\"3\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eP1\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.395061728395063%\" colspan=\"4\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eSeventh day (n=60)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.117283950617283%\" rowspan=\"3\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eP2\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.866666666666667%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eStudy group (n=30)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.066666666666666%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eControl group (n=30)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.533333333333335%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eStudy group (n=30)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.533333333333335%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eControl group (n=30)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.266666666666667%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eNo.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.6%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.266666666666667%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eNo.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.8%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.733333333333333%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eNo.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.8%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.266666666666667%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eNo.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.266666666666667%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"11\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eTotal serum bilirubin\u003c/span\u003e\u003c/strong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.049382716049383%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e˂\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\"\u003e7 mg/dl\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.098765432098766%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.87037037037037%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e6.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.098765432098766%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.407407407407407%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e2.069\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.790123456790123%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e58\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.407407407407407%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e96.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.098765432098766%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.098765432098766%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e13.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.117283950617283%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e42.088\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.049382716049383%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026ge; 7 mg/dl\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.098765432098766%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e56\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.87037037037037%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e93.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.098765432098766%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e60\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.407407407407407%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e100.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.150\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.790123456790123%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.407407407407407%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e3.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.098765432098766%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e52\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.098765432098766%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e87.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.117283950617283%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e0.0001**\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.049382716049383%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.969135802469136%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.506172839506172%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e1.705\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.197530864197532%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.197530864197532%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.117283950617283%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e13.209\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.049382716049383%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eMean \u0026plusmn; SD\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.969135802469136%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e9.20 \u0026plusmn; 2.08\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.506172839506172%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e10.01 \u0026plusmn; 1.58\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eP 1=\u003c/span\u003e\u003c/strong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;0.093\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.197530864197532%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e4.03 \u0026plusmn; 1.48\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.197530864197532%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e10.21 \u0026plusmn; 2.08\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.117283950617283%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eP2 =\u003c/span\u003e\u003c/strong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003cstrong\u003e0.0001**\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"11\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eDirect serum bilirubin\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.049382716049383%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e˂\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\"\u003e1 mg/dl\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.098765432098766%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e28\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.87037037037037%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e46.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.098765432098766%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.407407407407407%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e36.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.617\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.790123456790123%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e60\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.407407407407407%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e100.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.098765432098766%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.098765432098766%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e40.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.117283950617283%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e25.714\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e0.0001**\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.47246891651865%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026ge;\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\"\u003e1\u003c/span\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;mg/dl\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.170515097690942%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e32\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.058614564831261%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e53.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.170515097690942%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e38\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.52575488454707%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e63.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.920071047957371%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.432\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.815275310834814%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.52575488454707%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.170515097690942%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e36\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.170515097690942%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e60.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.049382716049383%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.969135802469136%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.506172839506172%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e0.5 \u0026ndash; 2.3\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e1.204\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.197530864197532%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.197530864197532%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.117283950617283%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e9.121\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eP2=\u003c/span\u003e\u003c/strong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003cstrong\u003e0.0001**\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.47246891651865%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eMean \u0026plusmn; SD\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.2291296625222%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e0.94 \u0026plusmn; 0.29\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69626998223801%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e1.04 \u0026plusmn; 0.38\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.920071047957371%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eP1=\u003c/span\u003e\u003c/strong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;0.233\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.341030195381883%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e0.35 \u0026plusmn; 0.12\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.341030195381883%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e1.01 \u0026plusmn; 0.45\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e* Difference that is statistically significant at P\u0026lt;0.05\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e**Statistically significantly different at (P\u0026lt;.0001), highly significant\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eP1= Statistically significant difference between the study and the control group on the first\u003csup\u003e\u0026nbsp;\u003c/sup\u003eday\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eP2 = Statistically significant difference between the study group and the control group on the seventh day\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (3): Percentage distribution of neonatal clinical outcomes regarding jaundice regression and duration of phototherapy after intervention\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"662\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.444947209653094%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eVariables\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.96530920060332%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eStudy group (n=60)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.624434389140273%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eControl group (n=60)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.105580693815988%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003ec\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e2\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.85972850678733%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.643598615916954%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eNo.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.453287197231834%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.98961937716263%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eNo.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.913494809688583%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eTime of jaundice regression (Day)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.444947209653094%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026le; 3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.613876319758672%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.351432880844646%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e23.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.764705882352942%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.85972850678733%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e16.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.105580693815988%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e4.022\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.85972850678733%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e0.045*\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.847328244274806%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e˃ 3 \u0026ndash; 6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.694656488549619%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e36\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.83206106870229%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e76.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.885496183206106%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e50\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.740458015267176%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e83.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.444947209653094%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eMean \u0026plusmn; SD\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.96530920060332%\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e3.966 \u0026plusmn; 1.09\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.624434389140273%\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e4.66 \u0026plusmn; 1.29\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.105580693815988%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003et test=\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.85972850678733%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e0.028*\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e2.258\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eDuration of phototherapy (Day)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.444947209653094%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026le; 2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.613876319758672%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e46\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.351432880844646%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e76.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.764705882352942%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.85972850678733%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e56.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.105580693815988%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e2.700\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.85972850678733%\" rowspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e0.001**\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.847328244274806%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e˃ 2 \u0026ndash; 4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.694656488549619%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e14\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.83206106870229%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e23.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.885496183206106%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.740458015267176%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e43.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.444947209653094%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eMean \u0026plusmn; SD\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.96530920060332%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e1.83 \u0026plusmn; 0.73\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.624434389140273%\" colspan=\"2\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e2.41 \u0026plusmn; 1.01\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.105580693815988%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003et test=\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e2.545\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.85972850678733%\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e0.014*\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Difference that is statistically significant at P\u0026lt;0.05\u003c/p\u003e\n\u003cp\u003e**Statistically significantly different at (P\u0026lt;.0001), highly significant\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (4): Percentage distribution of neonatal clinical outcomes regarding oxygen saturation and amount of daily milk intake\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eon the\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;first and seventh\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edays\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;after intervention.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"706\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.198581560283689%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.354609929078013%\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst day (n=60)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.914893617021276%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eP 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.765957446808514%\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeventh day (n=60)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.76595744680851%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eP 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.318385650224215%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy group (n=60)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.663677130044842%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group (n=60)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.663677130044842%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy group (n=60)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.3542600896861%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group (n=60)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.659192825112108%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.659192825112108%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.659192825112108%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.004484304932735%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.538116591928251%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.125560538116591%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.31390134529148%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.04035874439462%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"11\"\u003e\n \u003cp\u003e\u003cstrong\u003eOxygen saturation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.181303116147308%\"\u003e\n \u003cp\u003e92- 100%.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.36543909348442%\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.36543909348442%\"\u003e\n \u003cp\u003e83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.36543909348442%\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.215297450424929%\"\u003e\n \u003cp\u003e76.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.898016997167138%\" valign=\"top\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.657223796033994%\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.923512747875353%\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.515580736543909%\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76487252124646%\"\u003e\n \u003cp\u003e83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.747875354107649%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.455\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.181303116147308%\"\u003e\n \u003cp\u003eLess than 92%.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.36543909348442%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.36543909348442%\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.36543909348442%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.215297450424929%\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.898016997167138%\" valign=\"top\"\u003e\n \u003cp\u003e0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.657223796033994%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.923512747875353%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.515580736543909%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76487252124646%\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.747875354107649%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.020*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"11\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmount of daily milk intake (ml/kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.181303116147308%\"\u003e\n \u003cp\u003e˂ 500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.36543909348442%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.36543909348442%\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.36543909348442%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.215297450424929%\"\u003e\n \u003cp\u003e46.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.898016997167138%\" rowspan=\"3\"\u003e\n \u003cp\u003e0.617\u003c/p\u003e\n \u003cp\u003e0.432\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.657223796033994%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.923512747875353%\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.515580736543909%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76487252124646%\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.747875354107649%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.276\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.026*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.165413533834588%\"\u003e\n \u003cp\u003e500 - ˂ 1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.774436090225564%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.774436090225564%\"\u003e\n \u003cp\u003e63.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.774436090225564%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.902255639097744%\"\u003e\n \u003cp\u003e53.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.834586466165414%\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.842105263157896%\"\u003e\n \u003cp\u003e66.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.646616541353383%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e63.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.165413533834588%\"\u003e\n \u003cp\u003e\u0026ge; 1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.774436090225564%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.774436090225564%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.774436090225564%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.902255639097744%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.834586466165414%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.842105263157896%\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.646616541353383%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.181303116147308%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.73087818696884%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e485.7 \u0026plusmn; 267.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.580736543909348%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e456.4\u003c/strong\u003e \u003cstrong\u003e\u0026plusmn; 246.1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.898016997167138%\"\u003e\n \u003cp\u003e\u003cstrong\u003et test\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.440\u003c/p\u003e\n \u003cp\u003eP1=0.660\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.580736543909348%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e752.8 \u0026plusmn; 262.9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.28045325779037%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e600.76 \u0026plusmn; 290.31\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.747875354107649%\"\u003e\n \u003cp\u003e\u003cstrong\u003et test\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2.285\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eP2=\u003cstrong\u003e0.026*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Difference that is statistically significant at P\u0026lt;0.05\u003c/p\u003e\n\u003cp\u003e**Statistically significantly different at (P\u0026lt;.0001), highly significant\u003c/p\u003e\n\u003cp\u003eP1= Statistically significant difference between the study and control groups on the first\u003csup\u003e\u0026nbsp;\u003c/sup\u003eday\u003c/p\u003e\n\u003cp\u003eP2 = Statistically significant difference between the study group and the control group on the seventh day\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (5): Correlation between neonatal\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ebiosocial\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;characteristics and their clinical outcome measures before intervention\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"627\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.203821656050955%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiosocial characteristics data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.515923566878982%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal serum bilirubin\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.515923566878982%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirect serum bilirubin\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.94904458598726%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eOxygen saturation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.81528662420382%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmount of daily milk intake (ml/kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.554621848739496%\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.554621848739496%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.554621848739496%\"\u003e\n \u003cp\u003e\u003cstrong\u003eR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.554621848739496%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.445378151260504%\"\u003e\n \u003cp\u003e\u003cstrong\u003eR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.554621848739496%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.554621848739496%\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.22689075630252%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age (weeks)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.203821656050955%\" valign=\"top\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.830\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\" valign=\"top\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.965\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.05732484076433%\" valign=\"top\"\u003e\n \u003cp\u003e0.683\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.203821656050955%\" valign=\"top\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.468\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\" valign=\"top\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.05732484076433%\" valign=\"top\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.203821656050955%\" valign=\"top\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\" valign=\"top\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.05732484076433%\" valign=\"top\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.203821656050955%\" valign=\"top\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.711\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\" valign=\"top\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.05732484076433%\" valign=\"top\"\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of feeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.203821656050955%\" valign=\"top\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\" valign=\"top\"\u003e\n \u003cp\u003e0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.05732484076433%\" valign=\"top\"\u003e\n \u003cp\u003e0.731\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.203821656050955%\" valign=\"top\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\" valign=\"top\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.05732484076433%\" valign=\"top\"\u003e\n \u003cp\u003e0.594\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent weight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.203821656050955%\" valign=\"top\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\" valign=\"top\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.05732484076433%\" valign=\"top\"\u003e\n \u003cp\u003e0.679\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.203821656050955%\" valign=\"top\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\" valign=\"top\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.05732484076433%\" valign=\"top\"\u003e\n \u003cp\u003e0.330\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.203821656050955%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment modalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.05732484076433%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.203821656050955%\" valign=\"top\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.731\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.744\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\" valign=\"top\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.05732484076433%\" valign=\"top\"\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.203821656050955%\" valign=\"top\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.505\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\" valign=\"top\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.834\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.757961783439491%\" valign=\"top\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.05732484076433%\" valign=\"top\"\u003e\n \u003cp\u003e0.189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (6): Correlation between neonatal\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ebiosocial\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;characteristics and their clinical outcome measures for\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ethe\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003estudy and control\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003egroups\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;after intervention\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"635\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.448818897637796%\" rowspan=\"2\" style=\"width: 24.8819%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiosocial characteristics data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.79527559055118%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal serum bilirubin\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.79527559055118%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirect serum bilirubin\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.37007874015748%\" colspan=\"2\" style=\"width: 18.7402%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOxygen saturation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.590551181102363%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmount of daily milk intake (ml/kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.666666666666666%\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.666666666666666%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.666666666666666%\"\u003e\n \u003cp\u003e\u003cstrong\u003eR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.666666666666666%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.666666666666666%\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.666666666666666%\" style=\"width: 7.0866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.666666666666666%\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.333333333333334%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age (weeks)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.356357927786497%\" style=\"width: 24.8819%;\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.361067503924646%\"\u003e\n \u003cp\u003e0.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\" style=\"width: 7.0866%;\"\u003e\n \u003cp\u003e0.554\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.593406593406593%\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.356357927786497%\" style=\"width: 24.8819%;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.361067503924646%\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\" style=\"width: 7.0866%;\"\u003e\n \u003cp\u003e0.469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.593406593406593%\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.356357927786497%\" style=\"width: 24.8819%;\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.361067503924646%\"\u003e\n \u003cp\u003e0.326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\" style=\"width: 7.0866%;\"\u003e\n \u003cp\u003e0.321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.593406593406593%\"\u003e\n \u003cp\u003e0.221\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.356357927786497%\" style=\"width: 24.8819%;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.361067503924646%\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\" style=\"width: 7.0866%;\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.593406593406593%\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of feeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.356357927786497%\" style=\"width: 24.8819%;\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.951\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.361067503924646%\"\u003e\n \u003cp\u003e0.712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\" style=\"width: 7.0866%;\"\u003e\n \u003cp\u003e0.621\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.514\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.593406593406593%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.356357927786497%\" style=\"width: 24.8819%;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.784\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.361067503924646%\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\" style=\"width: 7.0866%;\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.593406593406593%\"\u003e\n \u003cp\u003e0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent weight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.356357927786497%\" style=\"width: 24.8819%;\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.361067503924646%\"\u003e\n \u003cp\u003e0.438\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\" style=\"width: 7.0866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.022*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.593406593406593%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.049*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.356357927786497%\" style=\"width: 24.8819%;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.846\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.361067503924646%\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\" style=\"width: 7.0866%;\"\u003e\n \u003cp\u003e0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.593406593406593%\"\u003e\n \u003cp\u003e0.575\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.356357927786497%\" style=\"width: 24.8819%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment modalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.361067503924646%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\" style=\"width: 7.0866%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.593406593406593%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.356357927786497%\" style=\"width: 24.8819%;\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.953\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.846\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.361067503924646%\"\u003e\n \u003cp\u003e0.365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\" style=\"width: 7.0866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.046*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.593406593406593%\"\u003e\n \u003cp\u003e0.437\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.356357927786497%\" style=\"width: 24.8819%;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.834\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.464\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.361067503924646%\"\u003e\n \u003cp\u003e0.932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\" style=\"width: 7.0866%;\"\u003e\n \u003cp\u003e0.932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.593406593406593%\"\u003e\n \u003cp\u003e0.248\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Difference that is statistically significant at P\u0026lt;0.05\u003c/p\u003e\n\u003cp\u003e**Statistically significantly different at (P\u0026lt;.0001), highly significant\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Clinical, Humanized care, Hyperbilirubinemia, Outcomes, Neonates","lastPublishedDoi":"10.21203/rs.3.rs-3805640/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3805640/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNeonatal hyperbilirubinemia is a potentially fatal condition that has toxic effects on the brain and may have negative effects. Humanized care is a comprehensive approach that focuses on the nutritional, therapeutic and hygienic needs of neonates, which helps in the resolution of hyperbilirubinemia.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA quasi experimental design was utilized in this study to evaluate the effect of humanized nursing care application on the clinical outcomes of neonates with hyperbilirubinemia. It was carried out at the Neonatal Intensive Care Unit at Tanta Main University Hospital. A total of 120 neonates with hyperbilirubinemia who fit the inclusion criteria were blindly assigned to both the study and control groups. The data were collected using the biosocial-demographic characteristics of the studied neonates and neonatal clinical outcome measures for humanized care.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOn the seventh day after receiving humanized care, total bilirubin levels in the study group decreased to 4.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48 compared to 10.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08 in the control group; there was also a decline in the time of jaundice regression with a mean of 3.966\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09 in the study group compared to 4.66\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29. in the control group. The mean days of phototherapy were 1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73 in the study group and 2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01 in the control group. Additionally, oxygen saturation increased significantly on the 7th day in the study group compared to the control group; the mean amount of daily milk intake was 752.8\u0026thinsp;\u0026plusmn;\u0026thinsp;262.9 ml in the study group compared with 600.76\u0026thinsp;\u0026plusmn;\u0026thinsp;290.31 ml in the control group.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eApplying humanized care improved neonatal clinical outcomes, including O\u003csub\u003e2\u003c/sub\u003e saturation, jaundice regression, enhanced newborn feeding and decreased duration of phototherapy.\u003c/p\u003e","manuscriptTitle":"Effect of the Application of Humanized Nursing Care on the Clinical Outcomes of Neonates with Hyperbilirubinemia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-11 10:47:09","doi":"10.21203/rs.3.rs-3805640/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-02-06T06:08:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-01-25T15:06:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"48d8e524-c907-4387-96d0-586fb7f5e830","date":"2024-01-25T10:59:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-01-25T10:36:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-01-16T11:08:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-01-10T09:14:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-01-10T09:14:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2023-12-25T22:22:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"695bc385-edb9-4440-a57d-2af7cc47f370","owner":[],"postedDate":"January 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-10T16:01:52+00:00","versionOfRecord":{"articleIdentity":"rs-3805640","link":"https://doi.org/10.1186/s12912-025-02772-z","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-02-08 15:57:30","publishedOnDateReadable":"February 8th, 2025"},"versionCreatedAt":"2024-01-11 10:47:09","video":"","vorDoi":"10.1186/s12912-025-02772-z","vorDoiUrl":"https://doi.org/10.1186/s12912-025-02772-z","workflowStages":[]},"version":"v1","identity":"rs-3805640","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3805640","identity":"rs-3805640","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}