https://orcid.org/0000-0002-2108-7980
Peer Review History
| Original SubmissionJanuary 25, 2021 |
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PONE-D-21-02629 The impact of COVID-19 pandemic on neonatal admission: an interrupted time-series study PLOS ONE Dear Dr. Ziyu Hua, 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. I am returning your manuscript with three reviews. Please pay attention to the following reviewer suggestions and give them due consideration. Please take the following points particularly into account:
Please submit your revised manuscript within fourty five days od the date of this decision. 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:
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, Maria Moitinho de Almeida Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 2. In your ethics statement in the manuscript and in the online submission form, please ensure that you have discussed whether all data/samples were fully anonymized before you accessed them and/or whether the IRB or ethics committee waived the requirement for informed consent. If patients' guardians provided informed written consent to have data/samples from their medical records used in research, please include this information. 3. In the ethics statement in the manuscript and in the online submission form, please provide additional information about the patient records/samples used in your retrospective study, including the date range (month and year) during which patients' medical records/samples were accessed. 4. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. [Note: HTML markup is below. Please do not edit.] 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: Partly Reviewer #2: Yes Reviewer #3: Yes ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ********** 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: No Reviewer #2: Yes Reviewer #3: No ********** 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 Reviewer #2: Yes Reviewer #3: Yes ********** 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: This is a study reporting trends in admission rates, source of admission and diagnostic categories for babies admitted to a large tertiary newborn care unit in Southern China. Data have been derived from routine hospital data systems. Authors have used a time series analysis to compare two time periods: (i) pre-covid pandemic non pharmaceutical intervention implementation and (ii) covid pandemic non pharmaceutical interventions. Trends in hospital use, particularly those relating to newborns as a result of the pandemic have not frequently been reported. Clear drop in admission rates are demonstrated following the implementation of lockdown and other associated measures. Reductions were also seen in proportion of babies transferred in from neighbouring hospitals. Major comments These represent interesting descriptive data, however would be much richer if measures such as neonatal mortality, gestational age, birth weight and diagnosis of neonatal encephalopathy were included. It would be unusual for these measures, in particular mortality, not to be available from routine hospital data and therefore it seems odd not to have reported these. For instance the authors comment in the discussion that medical complexity and severity increased in those admitted in the second time period – but provide no data with which to show this. Tantalisingly they also comment that rates of therapeutic cooling increase but do not comment on diagnostic rates of neonatal encephalopathy (a sentinel marker of quality of perinatal maternal care). Please clearly state available measures from the HIS and why you have chosen the ones you have chosen. Authors need to rewrite sections of the methods to describe more clearly the setting. They should not assume understanding or prior knowledge of this region, especially as lockdown and infection rates have been vastly different across the globe. I think this paper could be improved enormously with inclusion of broader measures of newborn diagnosis and outcomes. Methods need to set the scene much more clearly – for example, what is the population size covered by this unit (which from the description of newborn interventions provided would not be described as low resource). What is the usual care fatality rate for this unit? How premature are the babies who are cared for? What is the newborn birth rate within the hospital? It is not clear at all what admissions from outpatients refers to – please describe this more clearly. Anecdotally from my own work in Hong Kong a number of babies with prolonged jaundice and poor weight gain were admitted via outpatients to the NICU – not typical of UK settings. Is this similar in your hospital? Methods shound be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Also authors need to set the scene in the methods describing what policies were put in place by the local hospital systems due to COVID – for example, were hospitals told to reduce transfers? What were the pathways to admit from a referring hospital? Do you have isolation rooms etc? what lockdown/ NPIs were put in place and how did these change over time after the 24th? What are the staffing levels in the unit? How many ventilated beds/cots do you have? Did that change during the lockdown period? Results comment around proportion of emergency and inter-hospital transfers increasing (lines 132) is confusing. Would be easier to understand if the methods included a brief description of where babies can be admitted from, eg. “babies can be admitted to this neonatal unit from 3 sources: labour ward/maternity care (inborn), outborn (transfers in from other hospitals) and outpatients (outborn).” Univariate analysis appear to have been unnecessarily repeated – eg table 1 – chi2 should be conducted for one group of categorical outcomes rather than for each individual one. Please only present a single p value therefore for the group. Would have been useful to present % increase or decrease by week of admission rates for example. Results – major concern is exclusion of case fatality rate data and diagnosis of neonatal encephalopathy. More detail can be given to jaundice- were these increases in pathological early jaundice, physiological jaundice or prolonged jaundice? Discussion needs editing to explore data in more detail. For example what could the impact of this been on the wider health economy? did more babies die? What is the projected change in admissions like over time? When do you expect to reach previous levels? Or will you? Has the healthcare delivery in other settings/ home improved? Were some of the previous admissions inappropriate/unnecessary? More thought needs to be given to potential generalisability eg lines 201-202 – this is simply not true of the typical newborn population and likely related to the fact you are a tertiary surgical centre. Discussion needs considerable rewriting to revisit some of the statements that are not evidenced through the data presented here. Line 219 – I would argue that this is the most interesting data from this paper and least explored. As discussed above – what were the rates of neonatal encephalopathy diagnosis/ of deaths? Can you comment on reduced ventilated babies – is this because there were fewer premature babies (something reported in other countries) – can you test that within your data by looking at gestational age on admission? Lines 223-224 – what is your evidence to back this statement up?> how have medical resources been more efficiently allocated? Might you want to continue this efficient allocation in the future (assuming you can evidence this statement). How has this allocation of resources impacted upon neonatal mortality and morbidity and on parental experience of healthcare? And on maternal outcomes? Were you able to measure and report on stillbirth rates for example? Lines 224-225 – you don’t present any data to back this statement up in this paper. I have no doubt that has happened but it appears outkeeping with the data. Lines 227-230 – you do not present any evidence to back this statement up at all. Lines 231-232 – this is likely true, but how do your data help with this? Admission rates alone are not sufficient measure (and in fact one could argue an extremely poor measure) of efficacy of the healthcare system. Lines 232-233 – this is also undoubtedly true – but how does this relate to your data? Lines 238-239 – arguably this is a moderately well resourced unit – more detail needs ot be provided to allow the reader to compare resource of this unit to other settings. Lines 241-243 – not really, you don’t show change in newborn behaviour. Need to explore the what next? What additional data would be useful here with which to explore some of these hypotheses? For example from the wider health economy/ qualitative data from parents/ healthcare workers? Conclusion – poorly written General comments Newborns arguably are unable to behave in any particular way – rather the healthcare systems and their parents/carers/ maternity services vary. Please rephrase “newborn healthcare behaviour” (used throughout the paper). Ensure term pandemic rather than epidemic is used throughout Minor comments • Long and short title need to state location Abstract • background –needs to state where this study has been conducted • methods – needs to include the time periods and which lockdown interventions and when • methods - Define what the pre-COVID and COVID-impacted periods are. Seems pre-COVID period is very short • conclusion – insufficient – needs to comment on fact that admissions reduced dramatically, these data only capture a small part of the picture – what happened to the non-admitted babies – did overall infant mortality rate increase for example? Introduction More information on background literature needs to be included here. For example a modelling study of this threat predicted between 250000-1.1 million extra neonatal deaths as a result of decreased service provision and access in LMICs. https://www.medrxiv.org/content/10.1101/2021.01.06.21249322v1 Methods: Do HIS statistics capture all neonatal admissions for the region –and which region, how big, what population covered. Statistical methods do not match Introduction Line 51 – “in” not “since” Line 55 – “caused” not “causes” Line 60 – consider abbreviation for NPI – non pharmaceutical interventions and then use this raterh than lockdown throughout Line 63 “describing .. changes in newborn care” rather than “on the..” Line 66 – see comment re phrase newborn medical behaviour being in appropriate for this age group Methods Line 71 – do you mean 10,000 babies per year over the last 5 years? Or 10,000 over the last 5 years? Unclear, please edit for sense. Line 74 – no need for “besdies” Line 91 – see comment re phrase newborn medical behaviour being in appropriate for this age group Line 112 – I would not reloy on differentiating btween p values 0.05 or 0.01. Methods- please describe how and when the diagnoses were given to the babies and by whom. Results Line 123 – replace visits with admissions Lines 121-127 – please use phrase admissions per week (if this is what you are referring to) and edit this section for sense. For example – phrase “then it was reduced to a nadir of 108 people…” is not clear – do you mean it reduced to an admission rate of 108 babies/ week or that there were only 108 babies resident on the unit for that particular week? figure 1 – please include dates on x axis, and also edit y axis to more accurately represent this measure (which I think is admissions per week) figure 1 – annotate the figure to include what the dotted line indicates rather than just including this in the footnotes line 132 – pandemic, not epidemic line 132 – do not jump to causality here. Lines 155-156 do not make sense Lines 156-157 – when did a relatively high propotion of babies present with jaundice related conditions? Figure 2 – please clarify and annotate as per figure 1 Discussion Lines 177-178 edit for sense. Also highlight that these other cohorts do not include newborn data Line 182 – pandemic not epidemic Line 182 – edit to read admissions rather than entries Line 195 – please include this detail in the methods Line 206 – be more specific here between physiological/ pathological jaundice Line 217 – how might you have measured degree of severity? Line 218 – pandemic not epidemic Reviewer #2: The authors conducted a rigorous ITS analysis of changes in NICU encounters pre- and post-COVID19 at a major children's hospital. The changes in encounter volume are generally in line with other observed decreases across the world. The stratified analyses are probably useful (though this reviewer is not an expert in NICU volume/demand). While the study is statistically impeccable and the writing is very clear, more discussion of the negative impact on infant outcomes seems warranted. Similarly, if there has not been a commensurate increase in negative outcomes does that suggest many NICU admissions are unnecessary? The decrease in volume by itself is not that interesting. One approach might be a parallel ITS of negative outcomes with the same interruptions specified. Reviewer #3: The topic of this article is interesting and relevant to the public most especially at this period. However, there are few issues that could use some improvement. In the abstract the authors stated that “Overall, 13,540 infants were admitted to the NICU during the pre-COVID period (n= 12082) and COVID-impacted period (n=4558).” The figures provided in line 34 – 35 do not add up and the statement is not clear on the disparity between the 13,540 and the figures provided in parentheses. It is also not clear what NICU means at this stage. In line 64 it seems that the impact of lockdown measures ( such as curfew, opening and closing hours of business, who and where one could travel to ) on neonatal admissions and disease spectrum are to be studied. However, that seems not to be the case. The analysis and results presented seem to have studied if there is changes in neonatal admission and diseases spectrum pre-COIVD and during the COVID period. Or are the authors referring to the period of lockdown as the “lockdown measures”? This should be clarified in the manuscript. In line 77 it was stated the “clinical and demographics information were collected…” while in line 78 though attempt was made to list the clinical information but the lists provided in line 79 does not differentiate between clinical and demographic information. The authors should consider formatting the date on line 84 and 85 to commonly used time format for example (yyyy/m/d – yyyy/m/d). In the manuscript in line 87 to 91 the outcomes and dependent variables were not clearly stated. Clarity is needed for the readers. The use of interrupted time-series and the choice of break point seem appropriate. However, the authors should consider a change point analysis to detect a change in the data generating process. This might as well provide the basis for choosing or confirming the choice of the break point used in this analysis. In addition, time series analyses may be confounded by seasonal effects and there is no discussion in the manuscript if it is an issues and how it was addressed. In line 108, the mean should be reported with the standard deviation or the median and the interquartile range. In lines 134 – 138 of the manuscript, the medians and not the means were reported. Please ensure consistency with line 108. In line 139 table 1. The table needs formatting to ensure clarity. Are the values for neonatal transport part of the Admission group ( the values under the category admission did add up to the total). It is not obvious from the table, which values neonatal transport, and Treatment falls under or how they each sum to the total? In line 181 “… decreased by -68% and -45%,…” should be corrected to “… decreased by 68% and 45%,…” Inline 181 do the authors mean “… slowly improving….”? The sentence should be revised for easy understanding. ********** 6. 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 Reviewer #2: Yes: Robert. B. Penfold Reviewer #3: 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.
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| Revision 1 |
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PONE-D-21-02629R1 The impact of the COVID-19 pandemic on neonatal admissions: an interrupted time-series study PLOS ONE Dear Dr. Hua, 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 answer, all the comments of the reviewers. As they highlight, there are several points that need to be addressed mainly in the data description and results interpretation. The results (for example, table 1) would be easier to be interpreted if presented as rate per week. Otherwise, the values by disease groups, treatment, mortality and others produce confusion. Besides, to observe the variation in neonatal mortality the change in case fatality rate/ week over time should be added. Please submit your revised manuscript by Sep 23 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:
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. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Juan F. Orueta, MD, PhD Academic Editor PLOS ONE 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: (No Response) Reviewer #2: All comments have been addressed Reviewer #3: All comments have been addressed ********** 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: No Reviewer #2: (No Response) Reviewer #3: (No Response) ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: (No Response) Reviewer #3: 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: No Reviewer #2: (No Response) Reviewer #3: (No Response) ********** 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: No Reviewer #2: (No Response) Reviewer #3: 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: Whilst I thank the authors for their efforts to address my comments, I do not believe they have sufficiently addressed my concerns/comments nor do they describe the data sufficiently well – either in their analysis or in their interpretation and discussion. For example, they should look to describe change in case fatality rate/ week over time to show how that varies before and after introduction of NPIs. Of note, the figures show drops in admissions from all causes, with recovery only apparent from pathological jaundice. Other comments: Please state where this study is conducted in both the long and short title – not addressed. • Long and short title need to state location eg The impact of the COVID-19 pandemic on neonatal admissions to a tertiary surgical neonatal unit, Southwest-central China: an interrupted time-series study Please rephrase “newborn medical behaviours” throughout (not addressed) • “newborn medical behaviors” – please use a better phrase to describe the delivery of newborn care following the pandemic and/or parental care seeking behaviours. As noted previously, newborns do not seek care – their parents/ the healthcare system behaviour determines their care. Babies do not seek consultations, their parents/ caregivers seek medical review. Abstract, • Background – state “China” in location as many will not know where Chongqing Medical University is. • Results section appear to be contradictory and confusing – please edit for sense. This section does not make sense “There was no decline in the volume of admissions of newborns suffering from respiratory system diseases, infectious diseases, and gastrointestinal diseases immediately after the COVID-impacted period (p =0.08, p =0.11, p =0.06, respectively). There was an immediate decline in the volume of patients complaining about pathological jaundice-related disease conditions” – however table 1 and figures show casing the data suggests falls in all of these admissions. Setting • It appears this neonatal unit does not accept direct referrals from a maternity unit/ labour ward? Is this correct? Please clarify and add this detail to the methods. What does the emergency category pertain to? • What proportion of the admissions are usually from out of province? Results • “The patients seeking consultations in the COVID-impacted period were younger than those seeking consultations in the pre-COVID period 159 (median age 5 days vs. 6 days, p<0.05).” – this is likely because those admitted via outpatients were reduced – if you compare against age in those admitted from interhospital transfers only is there a difference in age? • Where is the p value for the mortality rate in table 1? Please present rate not percentage for a mortality rate (typically presented as case fatality rate of X babies per 1000 admitted babies) – here table 1 suggests a change from 10.3 per 1000 to 11.2 per 1000 – a 10% increase in mortality (not a 0.09% increase). Please clarify this on page 26 line 189-190. • Data should be presented as weekly rates – for example in the text include average weekly admission rates of 220/week pre COVID and 147/week post COVID; average weekly admissions for respiratory disorders pre and post decreased from 76/wk to 48/wk; admissions for neonatal encephalopathy from 4/wk to 2.5/wk – of those admitted with NE – 23% required therapeutic hypothermia compared to 56% post covid – suggesting those babes were sicker on admission. • Weekly rates of pathological jaundice admissions dropped from 59/week to 46/week – but that drop was not as substantial as other disorders, therefore relatively speaking the proportion of admissions attributable to jaundice increased, but the absolute number reduced. Discussion • Needs discussion on change in mortality rate • This statement “This is partly because gastrointestinal disorders are relatively more common in newborns due to inborn anomalies (e.g., megacolon, esophageal atresia, pyloric hypertrophic obstruction)[19]” is not correct. It may be that in your surgical unit these disorders are relatively more common, however in the typical neonatal population these are most certainly NOT more common than respiratory disorders/ infections. • This statement is not true “Almost all newborns develop pathological hyperbilirubinemia[20, 21]” furthermore references 20 and 21 relate to clinical assessment of jaundice rather than rates of pathological jaundice. • Need to consider impact on entire health economy – eg did more mother’s deliver at home? What was the change in stillbirth rate? The change in mortality rates in the secondary care units? The discussion presents a far too simplistic discussion around potential explanations for the changes in rates and diagnosis documented. • Discussion of change in therapeutic hypothermia focuses entirely on antenatal access – by mothers – not at all on availability of these services due to health service changes nor to potential discussion of quality of care available during the perinatal period – this needs to be addressed as it does not adequately address potential factors involved in resultant NE, but instead focuses on maternal factors in their behaviour of accessing health services. • Lines 242-245 – the data don’t reflect this. Too much weight is placed on parent behaviours. • Limitations are not sufficiently well described – of note this is a surgical tertiary referral unit that doesn’t appear (from the description) to admit directly from maternity services – extremely unusual for most neonatal units across the globe. Reviewer #2: All of my concerns have been addressed. ........................................................... Reviewer #3: Dear authors, I am happy that my points were taken into considerations and I appreciate the authors for the overall improvement of the manuscript. However, I have minor suggestions that might be useful for both the author and research community. In line 144 – 145, the author cited the R software, from the citation (I assume that the package used were R based package), if the packages are not “R base” the author should fully cite the packages if not shipped as part of R base functions. The citation of the packages acknowledges the effort and time spent by the people that created these tools and help in reproducibility of the results. All citation should also appear in the reference list. For example, using and citing RStudio and lme4 package assuming both are the 18th and 19th cited materials: All computations were conducted in RStudios 1.0.44 (18) … with lme4 v.xxx (19)…. While in the reference list the citation for lme4 should appear as: Douglas Bates, Martin Maechler, Ben Bolker, Steve Walker (2015). Fitting Linear Mixed-Effects Models Using lme4. Journal of Statistical Software, 67(1), 1-48. doi:10.18637/jss.v067.i01. R Core TEAM(2014). R. A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL http://www.R-project.org/ Table 1, in line 165 need a little adjustment. The section for weeks + day, require addition information. For instance 201(1.65), does it represent mean(sd) or median(IQR). Please let it be consistent like the section on Birth weight(gram), median(IQR), and the section on Age which has median (IQR) etc. ********** 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 Reviewer #2: Yes: Robert B. Penfold Reviewer #3: 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. |
| Revision 2 |
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PONE-D-21-02629R2Impact of the COVID-19 Pandemic on neonatal admissions in a tertiary Children's Hospital in Southwest China: an interrupted time-series studyPLOS ONE Dear Dr. Hua, 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 Dec 06 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:
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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Simone Lolli Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments (if provided): The manuscript is ready for publication after taking into consideration the minor changes pointed out by the reviewers. [Note: HTML markup is below. Please do not edit.] 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 Reviewer #3: All comments have been addressed ********** 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 Reviewer #3: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #3: 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: No Reviewer #3: 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 Reviewer #3: 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: Thank-you for addressing the comments. The paper is much clearer and the results and discussion sections in particular are improved. I have only one minor comments: please ensure the phrase "COVID-impacted period" is used throughout to describe the second time period. In places (eg abstract methods and discussion) it is described as "after covid" or post-covid. Reviewer #3: I thank the authors for accepting the suggestions and I appreciate how much they greatly improved the manuscript. I have very few minor comments on editing for the authors to take a second a look at: Line 124 – stated that is “experiment was designed” or do the author meant that “this study was conducted…”, because I don’t think an experiment was designed in the real sense of it. In line 155 “…. 147/week post-COVID”, do the authors meant COVID-period ? Lines 250 – 251 “It is more likely that changes in illness severity, health-seeking 251 behavior of parents/caregivers, and inadequate medical resources factors.” , seems incomplete. Lines 253, 275, 262 “…post COVID…” or do you mean COVID-impacted period ? ********** 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: Yes: Dr. Michelle Heys Reviewer #3: 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. 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| Revision 3 |
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Impact of the COVID-19 Pandemic on neonatal admissions in a tertiary Children's Hospital in Southwest China: an interrupted time-series study PONE-D-21-02629R3 Dear Dr. Hua, 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. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Simone Lolli Academic Editor PLOS ONE Additional Editor Comments (optional): 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 ********** 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: No ********** 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: Thank-you for addressing all my reviewer comments. I have no additional comments for you to address. ********** 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: Yes: Dr Michelle Heys |
| Formally Accepted |
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PONE-D-21-02629R3 Impact of the COVID-19 Pandemic on neonatal admissions in a tertiary Children's Hospital in Southwest China: an interrupted time-series study Dear Dr. Hua: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Simone Lolli Academic Editor PLOS ONE |
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