PONE-D-20-15401

NEONATAL HYPOTHERMIA AND ADHERENCE TO WORLD HEALTH ORGANISATION THERMAL CARE GUIDELINES AMONG NEWBORNS AT MOI TEACHING AND REFERRAL HOSPITAL, KENYA

PLOS ONE

Dear Dr. Lubuya,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Barbara Wilson Engelhardt, MD

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

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

Reviewer #1: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Nyandiko, et al. report on adherence to WHO thermal care guidelines for newborns cared for at the a hospital in Kenya. They report on 372 newborns and find that 73.9% were hypothermic upon admission. Not surprisingly, mortality rates were increased in this group. The conclusion was that adherence to WHO thermal care guidelines was extremely low.

My comments on each section of the paper.

Introduction -This section provides a nice review of previous work done in this area and summarizes WHO guidelines. I think an additional paragraph describing the setting of this hospital, problems in this setting, and the attempts at instituting the guidelines would help the reader.

Materials and Methods - Well written and clear. Ethical approval was obtained from local committee. How was the adherence to warm chain steps collected? Was an unbiased observer present or was this based on nursing memory of what happened?

Results - Demographics are listed, but it would be interesting to know what proportion of neonates with hypothermia had an underlying disease process like sepsis, etc.?

All other data and statistical tests appear to be accurate and appropriate for this type of report.

Discussion - Clear and again a good review of previous studies with integration of the data from this report to support conclusions.

Errors to correct.

page 12, line 179: "There was sub-optimal adherence to the warm chain..."

page 13, line 202: "2500g had a four-fold...."

Conclusion - Although conclusions are usually short, I do think this one could be expounded upon a little. I like the fact that the authors point to the fact that quality improvement strategies are needed to address the use of the warm chain. I think this is key and I hope a QI paper is forthcoming. Since the data from this study was collected in 2016, I hope this has taken place. Could you add a sentence or two addressing what might be implemented to prevent hypothermia?

Overall, the information in this report further contributes to the knowledge that hypothermia leads to poor outcomes and that this early step is critical to the success of caring for newborns. It provides country specific information at a large, university hospital and identifies three factors that led to increased day one mortality. It also provides a good starting point for a QI project and report that can hopefully benefit other hospitals in a similar setting.

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Reviewer #1: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: Due to difficulty engaging another reviewer.docx

PONE-D-20-15401R1

NEONATAL HYPOTHERMIA AND ADHERENCE TO WORLD HEALTH ORGANISATION THERMAL CARE GUIDELINES AMONG NEWBORNS AT MOI TEACHING AND REFERRAL HOSPITAL, KENYA

PLOS ONE

Dear Dr. Lubuya,

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.

Please submit your revised manuscript by Mar 22 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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.

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). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

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

We look forward to receiving your revised manuscript.

Kind regards,

Orvalho Augusto, MD, MPH

Academic Editor

PLOS ONE

Journal Requirements:

Additional Editor Comments (if provided):

This is a very important report for neonatal care in Kenya and sub-Saharan Africa where such account is rare. Nyandiko, et al. report on adherence to WHO thermal care guidelines for newborns cared for at the a hospital in Kenya. They report on 372 newborns and find that 73.9% were hypothermic upon admission.

Few minor comments:

1. This is scientific report. Pleas add the aims in the introduction. The abstract has it. But it is lacking in the introduction.

2. In the statistical section please correct the "Pearson chi-square" to "Pearson's chi-squared". That is in on the abstract, the methods and the results.

3. Table 1

- Below the tables or somewhere put the meaning of the abbreviations. It needs to be a sort of clinician in English to understand and remember these abbreviations such MTRH, NBMS etc etc...

4. Table 2

- we do not need the "No(%)" column. I would recommend to remove this.

5. Table 5:

There is seems to be very small cells there. The best chi-squared here should be the Fisher's exact.

6. Table 6 is unnecessary. If the authors want keep it move to supplements.

7. Figure 2 -

- Remove the no hypothermia [we can compute it by doing 100 - Hypothermia]

- It would be nice to have below the table the amount of babies remaining like in Kapplan-Meier

8. Figure 3: I would not call it "cummulative". Strictly speaking "cummulative" plots are monotonic up i.e they grow or stay constant. Use the x-axis title "number of warn chain steps adhered to" or something similar.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

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

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors adequately addressed all of my corrections, comments, questions, and suggestions. I did note a couple of very minor grammatical errors and would recommend it is read through again to correct these and any others that might exist.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

NEONATAL HYPOTHERMIA AND ADHERENCE TO WORLD HEALTH ORGANISATION THERMAL CARE GUIDELINES AMONG NEWBORNS AT MOI TEACHING AND REFERRAL HOSPITAL, KENYA

PONE-D-20-15401R2

Dear Dr. Lubuya,

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

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Orvalho Augusto, MD, MPH

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

This is important work. It documents the challenges of newborn care in one typical reference public health facility in many sub-Saharan countries.

One new minor thing remaining:

- Add below the table 1 how the gestational age was measured.

Reviewers' comments: