PONE-D-19-16940

Umbilical cord separation time, predictors and healing complications in newborns with dry care

PLOS ONE

Dear Dr. María Dolores López Medina,

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Reviewers' comments:

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: I Don't Know

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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5. Review Comments to the Author

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Reviewer #1: This manuscript prospectively studies the separation time of umbilical cord stump and risk for infection with routine soap and water/dry cord care. The current standard of care and recommendation from major clinical centers (NIH and AAP) supports soap and water/dry cord care, but parents still use antiseptic treatments because of lack of confidence with these recommendations. The authors chose to study this issue prospectively and compare their rates of infection and other complications. This topic has been extensively investigated before by other groups but this group effectively describe their concerns about parental refusal to believe these recommendations. Studying this issue in their region could help the doctors in that region families to follow the stated guidelines.

The manuscript is written well, easy to read, the English is excellent. The authors represent the time of separation is different ways in the abstract vs manuscript which was a bit confusing (I would recommend using days rather than seconds).

Overall, on first read this didn't appear to add more to the literature given that the evidence for the stated guidelines is strong, but perhaps the study using regional factors will help guide care and improve understanding of the mistrust of families of their study population.

Reviewer #2: There are several areas that require revision for minor grammatical errors. For example, the World Health Organization is written as both the World Health Organization and the World Health Organisation. In addition, some of the phrasing is a little awkward, especially when using passive voice.

In the introduction, there is a nice argument to support the importance of this research due to the large public health concern of neonatal infection. In particular, omphalitis can have considerable morbidity and mortality, a risk that increases if the umbilical cord remains attached and theoretically is then reduced if the umbilical cord detaches more quickly. This is seen in line 66 and 67. Consider including the reference for this statement that connects the time of umbilical cord attachment and increased risk of omphalitis, especially if there is any statistical information where a particular length of time increases the risk of omphalitis by a known amount. This would help further support the overall clinical importance of this research because even though the time of cord separation was statistically different in some cases this might not result in a clinically significant length of time to the neonate. For example, though there is a clear statistical difference of about 2 days between the groups of neonates whose umbilical cords became wet 0-4 times vs. >5 times, does 2 days make a clinical significance to these children? However, if the aim was merely to show that the clean and dry method is both safe and financially sound then the current information provided would be sufficient.

Please discuss the training or role of the researcher who is taking the measurements for the umbilical cord and providing a clinical assessment/ possible diagnosis of omphalitis. Are they a physician? Nurse?

In line 151, please provide the definition that the paper uses for late separation of the umbilical cord.

On page 8, within the socio-demographic and clinical newborn variables, please list gestational age as a length of weeks and days. For example, 40 weeks and 0 days instead of 280 days.

Finally, please state clearly that the umbilical cord separation time of interest in your research is the time when the umbilical cord naturally separates from the infant. This will clear up any questions that the reader might have when reading the title or abstract and wondering if the authors meant the time of clamping the cord from the mother at birth (delayed cord clamping) or something even more extreme such as the lotus birth where the placenta is never clamped and remains attached to the infant for several days.

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Reviewer #1: No

Reviewer #2: No

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Umbilical cord separation time, predictors and healing complications in newborns with dry care

PONE-D-19-16940R1

Dear Dr. López Medina,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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With kind regards,

Anna Palatnik, M.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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