PONE-D-22-22879Congenital diaphragmatic hernia in a middle-income country: persistent high lethality during a 12-year period.PLOS ONE

Dear Dr. SCAVACINI MARINONIO,

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PLOS ONE

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Additional Editor Comments:

Abstract

1. Line 26 of page 2, I strongly suggest that the incidence of CDH should be modified to birth prevalence of CDH throughout the manuscript. It is very difficult to estimate the incidence of birth defects.

2. Line 42 of page 2, The results showed that the median time of CDH-associated neonatal deaths was 24 hours after birth, so I think the statement 'most deaths occurred within the first day after birth' is not exactly, '50% deaths occurred within the first day after birth' might be more sound.

Introduction

1. Line 51 of page 4, the contents of reference 1 is about prevalence, not incidence.

2. Line 54 of page 4, birth prevalence of CDH is preferred.

3. Line 72 of page 4, please clarify the age group of lethality rate, in neonatal period or in infancy, or others?

Methods

1. I think more details about death certificates and live birth certificates should be given in the methods section, such as who, when and how collect death certificates, as well live birth certificates; the process of birth defect ascertainment; the quality measures of the two dataset.

2. Line 102, The definition and classification of CDH are shown in Table 1. Why are the diagnostic ICD-10 codes, such as K44, classified as CDH? So It's important to clarify the ascertainment time of CDH. Besides, if babies are diagnosed as CDH, will all cases undergo further chromosome examination? This is important to access the trend of prevalence of CDH associated with non-chromosome abnormality.

3. I would like to see the results about survival curve for newborns affected with CDH. That will give the readers more information.

Results

1. Line 138 of Page 8, please check the number '35.8%'. Also, please check all the data shown in Supplementary Table 1. The order of ' Other chromosomal anomalies' and 'Other trisomy' should be inter-changed.

2. Line 147-150 of page 9, could you please show 95%CI of birth prevalence of CDH in the main text.

3. Line 152 of page 9, the abbreviated 'CI' need to be defined earlier.

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Reviewers' comments:

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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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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: No

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: This is an important contribution to the knowledge on CDH. The authors have presented the data clearly, pointing out the limitations of the data. My once comment relates to the use of the term incidence. Incidence is not used to report the occurrence of congenital anomalies, as the total number of conceptions cannot be measured. Instead, birth prevalence is used. This correction may be made throughout the manuscript.

Reviewer #2: The authors have presented a really nice review of population based data on CDH births, mortality, and lethality in the Sao Paulo State of Brazil. The introduction and methodology of the manuscript are sound. I also thought that the results are presented clearly and succinctly for the limited data available on the topic. The discussion was thorough, but it seemed to go on for a little too long. I would recommend that the authors work to cut some of the discussion wording to make it a quicker and more streamlined read. Otherwise, I think it is worthy of publication and adds to the worldwide education about the status of CDH care in this middle-income country.

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Reviewer #1: Yes: Anita Kar

Reviewer #2: No

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Congenital diaphragmatic hernia in a middle-income country: persistent high lethality during a 12-year period.

PONE-D-22-22879R1

Dear Dr. SCAVACINI MARINONIO,

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.

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Kind regards,

Xiaohong Li

Academic Editor

PLOS ONE

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