PONE-D-19-33770

A study on the association between eye movements and regular mouthing movements (RMMs) in normal fetuses between 24 to 39 weeks of gestation

PLOS ONE

Dear Morokuma,

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PLOS ONE

Additional Editor Comments:

It seems to be interesting, and may have information for readers of the Plos One. My concern about this manuscript is the subjective assessments of mouthing movement and eye movement in this study. Authors should clarify this subject. 

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Reviewers' comments:

Reviewer's Responses to Questions

Reviewer #1: General comments

This paper seems to be interesting, and may have information for readers of the PROS ONE. However, I think that significant major revisions are needed to accept this manuscript in the PROS ONE. My big concern is the subjective assessments of mouthing movement and eye movement in this study. How about the inter-observer reproducibility? Authors should address this issue. Authors should clearly state the new points in this study. Authors should also explain the cause for difference in fetal mouthing movements between their study and previous studies.

Specific comments

1. How did fetal movements affect the 2D sonographic observations of the fetal face? I think that authors could not observe fetal face during fetal movements.

2. Authors should state that they used two-dimensional sonography.

3. How about the frequency of the probe.

Reviewer #2: There is a minor typo in the abstract (line 24; 'sacking').

This is a well written manuscript with a clear and concise aim. I do feel that there likely to be a rather loose association between the value of sucking movements as a neurological marker, and that there is too much emphasis placed on the (temporal) association with cortical or synaptic maturation.

There is considerable data emerging on behaviour patterns that involve a much greater integration of the neurological axis, such as the so-called 'General Movements' or behavioural state analysis, which themselves are not the most robust marker of neurological integrity.

Nevertheless, a detailed analysis of individual behavioural parameters as presented in this study certainly do have their place in the literature. I commend the authors for their diligent work.

Reviewer #3: The authors report their experience with evaluation of eye and regular mouthing movements in 2nd and 3rd trimester. They have previously published another article on the same topic. My major concern regards the sonographic methodology employed. In particular, there are at least two issues which should be clarified. 1) reading the paper, it seems that there was no movement whatsoever of any fetus leading to failure of recording the eye and mouth movements in the whole series; 2) in advanced gestation it is rather unusual for the fetuses to lie in such a position that the reference view employed in the study - ie coronal view and contemporary observation of lips and eyes (lenses) - is visible. These two factors should be clarified and explained. From my experience, it is virtually impossible that over 60 uninterrupted minutes of observation the fetuses do not show at least some breathing or major trunk (or limb) movements which will hamper or at least interrupt the continuous observation of the fetal face. And the authors have neither reported any failure in the recording nor acknowledged this in the limitations to the study. furthermore, the single paper (published by the same group) cited to account for reproducibilty is cited as ref n.33, but the reference list stops at 31...

Finally, all the figures attached should report the titles of the axes ON the image and not only in the caption.

In summary, I appreciate the long and tiring work of the authors, but I have doubts about the complete absence or reported failures in the recordings.

To improve the manuscript, this major flaw should be addressed in the discussion and in the presentation of data, and a figure /clip illustrating the sonographic approach should be included

Reviewer #4: This study is well-written and appropriate statistics have been performed. However, can the authors make a comment on the pregnant women characteristics including maternal data; presence of preeclampsia, maternal disease, chorioamnionitis and etc. Were the mothers have these kind of problems, or all were heakthy pregnant women?

The authors explained the limitations of the study. Can they comment on the clinical practical use of these data on both antenatal and postnatal evaluation in both fetuses and infants, respectively?

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PONE-D-19-33770R1

A study on the association between eye movements and regular mouthing movements (RMMs) in normal fetuses between 24 to 39 weeks of gestation

PLOS ONE

Dear Morokuma,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

We would appreciate receiving your revised manuscript by May 23 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.

We look forward to receiving your revised manuscript.

Kind regards,

Mehmet Yekta Oncel, M.D.

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

I think the comments of the referees should be reviewed by the authors. There are some unanswered questions.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

Reviewer #4: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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Reviewer #1: General comments

The revised manuscript is significantly improved. However, I think that one minor revision is needed to accept this manuscript in the PROS ONE.

Specific comments

1. The frequency of the probe means 3-MHz, 3,5-MHz, or 5-MHz, etc. Authors should state the frequency of the probe in the text.

Reviewer #2: The authors have made a good effort to address the comments from all the reviewers, and I am happy to support the publication

Reviewer #3: The authors have submitted a new version of the manuscript, apparently revised according to the comments of the reviewers which they claim were "fully considered and included in the revised version". However, at least for the points I raised, they only reported a very generic sentence "Cases where such observation was not possible or time during which observation was not possible were not included". The authors did neither mention the number of cases in which the recording had started and then aborted nor their incidence by weeks of pregnancy. In addition, they did not include a sonographic image to show the technique, nor a clip to this extent.

Since the former was my major criticism, because it is quite clear tha major head and trunk movements do occur quite frequently in the 3rd trimester of pregnancy, I do not think my comments were adequately dealt for. Therefore, I would recommend rejection of the paper, due to possible selection bias and failure to comply with reviewers' suggestions

Reviewer #4: Thank you for the revisions

The authors made all the changes that have been recommended by the reviewers

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Attachments

Attachment

Submitted filename: PONE-D-19-33770R1-(3-27-20).doc

A study on the association between eye movements and regular mouthing movements (RMMs) in normal fetuses between 24 to 39 weeks of gestation

PONE-D-19-33770R2

Dear Dr. Morokuma,

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Guest Editor

PLOS ONE

Additional Editor Comments (optional):

The authors made all the changes that have been recommended by the all reviewers.

Reviewers' comments:

Reviewer's Responses to Questions

Reviewer #3: Now eventually also my comments have been addressed. Thanks. In particular, a picture showing the reference view of the fetal face has been added. And the number of cases discarded because of fetal movements too, even though in my experience these should have been much higher...