PONE-D-21-32465

The Time To Initiate Trophic Feeding And Its Predictors Among Preterm Neonate Admitted To Neonatal Intensive Care Unit, Multicenter study, Northwest Ethiopia, 2020.

PLOS ONE

Dear Dr. Belay,

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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

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: 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

Reviewer #2: 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

Reviewer #2: 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: Your manuscript entitled "The Time To Initiate Trophic Feeding And Its Predictors Among Preterm Neonate

Admitted To Neonatal Intensive Care Unit, Multicenter study, Northwest Ethiopia, 2020" has the potential to be published...

The standard of English language was suitable. It described a technically sound piece of scientific research with data that supports the conclusions.

Reviewer #2: Comment 1: Title and aim of the study should be revisited. In Abstract (Line 40), it was mentioned that aim of the study to assess the time to initiate the TF, In background (Line 116): The aim of the study to estimate the time of initiate the TF. The Title should suggest predictors of early initiation of TF or survival of neonates who have been initiated TF early?

Background Section:

Comment 2: Line 111: The initiation, mode, and rate of advancement of TF remained a topic of controversy. Revise the sentence with a more suitable word other than "controversy."

Comment 3: Line 135: Kindly revise or define the word " health professional mixes."

Comment 4: Line 137 and 139 Extend the short name when authors use it the first time. kangaroo mother care (KMC) and continuous positive airway pressure (CPAP)

Comment 5: Use the proper way to write the date: Line 139. Write November 30, 2020 instead of November 30/2020.

Methodology Section:

The methodology needs revision.

Comment 6: Revisit the flow: Line 140 & 141 should be placed after inclusion and exclusion criteria or during the description - sample selection. Here, it creates duplications.

Comment 7: Inclusion and Exclusion Criteria: Does the study include or exclude neonates given TF at previously admitted hospitals? Does the study include the neonate who had hemodynamic instability or any other complications after initiating the TF?

Comment 8: Revisit line 158." Neonates that don't fulfill eligibility criteria were recruited from respective study hospitals": Why did the study recruit the non-eligible study samples?

Comment 9: Line 160: Check the English grammar and describe: was it a simple random sampling method or a different randomization method?

Comment 10: Revisit the Data collection method: Mention the variables included in the checklists, brief on the contents of the semi-structured questionnaire and who has undertaken the data collection for both.

Comment 11: The study also assigned the NICU nurses as data collectors and supervisors. Kindly explain - How the data collection process was not biased despite assigning NICU working nurses & supervisors for data collection? Who checked the completeness of the data? (Authors or Supervisors?) What steps had been taken to avoid it?

Comment 12: Line 179: "The outcomes of study participants were dichotomized into (code '1') as a failure and (code '0') as a censor." What was the outcome assigned to the study participants?

Result Section: Required to maintain the flow of the results based on objectives and planned analysis.

Comment 13: Check the grammar in lines 212 (278 preterms) and 213 (of these, 48..)

Comment 14: Line 228: Referred to study hospitals (outborn) or referred to other centers from study hospitals.? Please clarify.

Comment 15: Line 234: The cumulative probabilities of starting or the cumulative proportions?

Comment 16: Line 240: Describe the survival estimates to build the flow for model of predictors.

Comment 17: Defined all categorical variables in methodology. (line 243-244)

Comments 18: Revisit the line 255, 256

Comment 19:

median survival time of the neonates would have higher impact on the data variables. Here, I recommend to reframe the results. In Table 3; Mention that the survival (time to initiate the feeding) time (hours)

The variables in Cox hazard and Kaplan-Meier survival model, the most appropriate subset of these predictors are to be selected in the multivariable model based on their contribution to the maximized log partial likelihood of the model (−2LL).

The interpretations based on further analysis and translate the findings. The other important step is considering variables that are nonsignificant at univariable analysis but it could be confounders. The effect of adding each of the variables should be checked with −2LL(). It was undertaken here. but this should be outlined in the methodology and in result section with title of the statical model.

At the final step, the Wald test is to be used to assess the significance of reasonable and possible interactions if possible.

Discussion :

Remove duplication of the results. Reduce number of words.

Comment 20: Line 300. To assess or to estimate.

Comment 21: Line 301, English Grammar- study hospitals

Comment 22: Line 323: Reframe the sentence

Comment: 23 Discussion should also mention the neonates were not started TF and reasons.

Conclusion:

Outline the specific recommendations revealed out from the study. in the conclusion section, it is not clear to the reader what are the specific recommendations for the hospitals. Clear 'Action points' need to be described accordingly.

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Reviewer #1: Yes: Shooka Mohammadi

Reviewer #2: Yes: Dr Harsh Shah

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The Time To Initiate Trophic Feeding And Its Predictors Among Preterm Neonate Admitted To Neonatal Intensive Care Unit, Multicenter study, Northwest Ethiopia.

PONE-D-21-32465R1

Dear Dr. Belay,

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,

Harsh Shah, MD

Guest 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

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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: our manuscript entitled "The Time To Initiate Trophic Feeding And Its Predictors Among Preterm Neonate

Admitted To Neonatal Intensive Care Unit, Multicenter study, Northwest Ethiopia, 2020" has the potential to be published...

It described a technically sound piece of scientific research with data that supports the conclusions.

**********

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. Shooka Mohammadi

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