Predictors of time to death among preterm neonates admitted to neonatal intensive care units at public hospitals in southern Ethiopia: A cohort study

Alo Edin Huka; Lemessa Oljira; Adisu Birhanu Weldesenbet; Abdulmalik Abdela Bushra; Ibsa Abdusemed Ahmed; Abera Kenay Tura; Angefa Ayele Tuluka

doi:10.1371/journal.pone.0283143

Peer Review History

Original SubmissionOctober 5, 2022
12 Dec 2022 Decision Letter - Ammal Mokhtar Metwally, Editor PONE-D-22-26735Predictors of time to death among preterm neonates admitted to neonatal intensive care units at public hospitals in southern Ethiopia: A cohort studyPLOS ONE Dear Dr. Huka, 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 Jan 26 2023 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. 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There is consensus agreement that the idea of the article is interesting. Meanwhile, some of the reviewers identified important problems in your submission and provided copious comments that should be considered . Please note that further language improvement is indicated. Consider revising the spelling, grammar, diction, and syntax throughout the manuscript for increased clarity. [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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: 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: Yes Reviewer #2: Yes ****** 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 ****** 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: Using a retrospective cohort study, the authors estimate the time to death and its predictors among preterm neonates admitted to NIC units at public hospitals in southern Ethiopia. The paper reports an overall incidence of neonatal mortality of 47.7 per 1000 neonate-days, with lack of antenatal care, pregnancy complication, resuscitation at birth, and not using skin-to-skin mother care method being the predictors identified. First of all, this topic is of importance, given the number of newborn baby deaths, especially in sub-Saharan Africa. Such studies may aid in developing a roadmap towards achieving the SDGs by 2030. With that in mind, this reviewer has the following to remark: 1. The text appears to be in need of some editorial attention to improve readability. 2. It is recommended that the authors note the criteria used with respect to the inclusion of variables in cox regression analyses. 3. Did the authors calculate the maximum number of variables to include in the study? 4. I wonder if the authors thought of categorizing their variables into fixed versus time-dependent covariates. 5. In the results section, it is stated that “in the bi-variable cox regression analysis, maternal residence, antenatal care follow up, complication during last pregnancy, previous bad obstetrics history, place of birth, mode of delivery, preeclampsia, diabetic mellitus, gestational age, weight for gestational age, neonate cried immediately at birth, bag and mask resuscitation at birth, perinatal asphyxia at birth, neonate diagnosed with respiratory distress, hypoglycemia, neonatal sepsis, phototherapy, nasal continuous positive airway pressure, not receiving kangaroo mother care and radiant warmer were predictors of mortality at p<0.25.” The abstract mentions that “Cox-Proportional Hazards model was used to identify significant predictors of time to death at p<0.05.” To avoid potential confusion, it is recommended that the authors share briefly the rationale behind calling the above factors “predictors of mortality” when statistical significance wasn’t observed at the 5% level. 6. Did the authors assess the presence of interaction or effect modification? 7. A last point involves the limitations mentioned at the end of the discussion section. They are not sufficient. This paper would be stronger if it includes other obvious limitations. I hope this review is helpful and wish the authors the very best with their research! Reviewer #2: Title: "Predictors of time to death among preterm neonates admitted to neonatal intensive care units at public hospitals in southern Ethiopia: A cohort study." Summary comments: Generally well written manuscript. The subject of the paper, neonatal mortality is an important subject of public health importance. Few comments below mainly related to typos should be addressed by the authors Introduction Line 46: Authors wrote “Preterm birth, defined as a live birth before 37 completed weeks of pregnancy(1) and remains one of the common causes of hospitalization……..” They may either capture the sentence as “Preterm birth, defined as a live birth before 37 completed weeks of pregnancy(1) remains one of the common causes of hospitalization…….. ” Or “Preterm birth is defined as a live birth before 37 completed weeks of pregnancy(1) and remains one of the common causes of hospitalization ……… ” Line 49-51. The authors should review the tenses used. For instance, they state “Globally, the sub-Saharan Africa had the highest newborn mortality rate 27 deaths per 1,000 live births, followed by Central and Southern Asia (25 deaths per 1,000 live births) (3). ” They should clarify whether they mean, Globally, sub-saharan Africa has… or they meant ‘’had’’ in which case it will be good to know what the current NMR is sub-Saharan Africa is. Line 56-57: The sentence below is incomplete, please rephrase into a complete sentence: “Despite the national goal of reducing the NMR from 57 28 to 11 per 1000 by 2020 as part of the national newborn and child survival strategy (2015-2020) 58 (6).” Line 54-58. Question: Why do we have differences in the national Health Sector Transformation Plan (HSTP-I) target of reducing NMR to 10 deaths per 1,000 live births by 2020 and the national goal of reducing the NMR from 28 to 11 per 1000 by 2020. Are they different agencies? Line 62: “Ethiopia's neonatal mortality rate unacceptably high” It should rather read “Ethiopia's neonatal mortality rate is unacceptably high” Methods Lines 76 and 80, please remove duplication of sentence as captured below: Line 76: neonatology ward accommodate 16beds in including 8 total beds from NICU ward. Line 80: there is 16 beds in neonatology ward including 8 total beds from NICU ward. Comment: Repetition of sentence Line 97 to 99: “The checklist for this study was adapted from the similar literatures, neonates’ medical card and 99 logbook and modified after reviewing of other related literatures.” This may read better as “The checklist for this study was adapted from neonates’ medical card and logbook with modifications based on literature review.” Avoid use of the term “literatures”. Literature can be used as plural. Line 99: “A checklist consisted of the…” Please use “The checklist consisted of the…..” Line 97 to 104: In summary, the section on data collection can be better organized. See suggestion below based on what the authors been wrote: “The data were extracted from each individual neonate’s medical card and logbook using a structured checklist. The checklist consisted of information on maternal and neonatal socio demographic factors, neonatal related factors, maternal medical and obstetric-related factors. Since the data was collected from neonates’ medical card, the data collectors were trained on how to extract appropriate data and there was close daily monitoring and supervision at the data collection site.” Results: Line 153: “Four hundred and five neonates (79%) were cried immediately” Comment; Please remove “were” Discussion: Line 276-277: “This study revealed that 9-fold increase in hazard to mortality among preterm neonates who had not received KMC compared to those who were received KMC during hospital stay.” Rephrase: “This study revealed 9-fold increase in hazard to mortality among preterm neonates who had not received KMC compared to those who received KMC during hospital stay.” The manuscript will benefit from a conclusion paragraph that summarizes the findings and way forward. The conclusion at the abstract section is appropriate and can be used or adapted for this section. See conclusion of abstract below: “Conclusion: Despite admission to NICU for advanced care and follow up, mortality of preterm neonates was found to be high in the study settings. Addressing major intrapartum complications is required to improve survival of neonates admitted to NICU.” ****** 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: Dr. Richard Akuffo ******** [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: Manuscript review.docx https://doi.org/10.1371/journal.pone.0283143.r001
Revision 1
25 Jan 2023 Author Response Dear Ammal Mokhtar Metwally, Ph.D (MD), Academic Editor PLOS ONE Dear Editor, this is regarding the manuscript PONE-D-22-26735 entitled as “Predictors of time to death among preterm neonates admitted to neonatal intensive care units at public hospitals in southern Ethiopia: A cohort study.” submitted to PLOS ONE. Thank you for the opportunity to respond to the constructive reviews provided to our submission to PLOS One. We are grateful that reviewers 1 partly and 2 agree that this is a technically sound piece of research and hope we have satisfied both reviewers concerns about the rigor of the statistical assessment. We appreciate that both reviewers agree we have been transparent with provision of the data on which our conclusions are based and have presented the results in intelligible language. We have addressed all reviewer comments in the revised manuscript now respectfully submitted as both marked (Revised Manuscript with Track Changes) and unmarked (Manuscript) versions. We have made every effort to comply with the PLOS One Style requirements in accord with journal templates. Before addressing the specific reviewer comments point-by-point below, we would like to respond to your editorial request as follow:- 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 https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Response: Dear academic editor, Thank you so much for your suggestion. We have carefully considered and it has been done in the revised version. 2. Thank you for stating the following financial disclosure: “AEH received fund from Minster of Education, Ethiopia The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. Response: Dear academic editor, Thank you so much for your suggestion. We apologize for first funding statement that was submitted as “Minster of Science and Higher Education “Funded this study and again We apologize for any inconvenience this has caused. However, as per funding statement, we would like to confirm that the following statement is accurate. “AEH received fund from Haramaya University, Ethiopia. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." 3. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. Response: We have uploaded our supplementary information, including the full data set, as Supporting Information files (Supporting information, Line 326, S3 Data set). And under Data Availability statement we have modified as “All necessary information were included with the manuscript and its Supporting Information files” 4. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. Response: Thank you very much for your suggestion. We have removed ethical statement from other part of the manuscript except in Methods section. Additional Editor Comments: Please note that your manuscript was reviewed by 6 experts in the field. There is consensus agreement that the idea of the article is interesting. Meanwhile, some of the reviewers identified important problems in your submission and provided copious comments that should be considered Please note that further language improvement is indicated. Consider revising the spelling, grammar, diction, and syntax throughout the manuscript for increased clarity. Response: Dear academic editor, we are thankful for your important comment and we have tried to edit the grammatical flaws throughout the manuscript in its revised version. We have edited the spelling, grammatical errors, diction, and syntax throughout the manuscript. Now we believe that the revised version is clean and clear enough to the readers. 5. Review Comments to the Author Reviewer #1: Using a retrospective cohort study, the authors estimate the time to death and its predictors among preterm neonates admitted to NIC units at public hospitals in southern Ethiopia. The paper reports an overall incidence of neonatal mortality of 47.7 per 1000 neonate-days, with lack of antenatal care, pregnancy complication, resuscitation at birth, and not using skin-to-skin mother care method being the predictors identified. First of all, this topic is of importance, given the number of newborn baby deaths, especially in sub-Saharan Africa. Such studies may aid in developing a roadmap towards achieving the SDGs by 2030. With that in mind, this reviewer has the following to remark: 1. The text appears to be in need of some editorial attention to improve readability. Response: Dear reviewer, we are thankful for your important comment and we have tried to edit the grammatical flaws throughout the manuscript in its revised version. We have edited the spelling, grammatical errors, incomplete and poorly structured sentences throughout the manuscript. Now we believe that the revised version is clean and clear enough to the readers. 2. It is recommended that the authors note the criteria used with respect to the inclusion of variables in cox regression analyses. Response: Thank you Dear reviewer, the authors used following criteria for inclusion of variables in cox regression analyses. First, in Bivariable analysis, variables with p value < 0.25 were considered as candidate for multivariable model and included in the final Cox-regression analysis and We set a lower threshold for the p value (< 0.25) and giving priority to clinical reasoning in selecting variables, along with statistical significance, perhaps we would have allowed more important variables to be entered into the model. Any statistical test is considered significant at p-value < 0.05 (Data processing and analysis, Line 113-116) 3. Did the authors calculate the maximum number of variables to include in the study? Response: Dear Reviewer, thank you very much for your time and consideration. We didn’t calculate the maximum number of the variables initially, but, at design stage the authors have reviewed all relevant literature and clinical experiences based on this, we have included all potential independent variables. Similarly, at the analysis level first we have conducted crude analysis to identify candidate variable using cut off p value < 0.25 for multivariable analysis model. Accordingly, we have conducted adjusted analysis to determine significant predictors of time to death at p-value < 0.05. 4. I wonder if the authors thought of categorizing their variables into fixed versus time-dependent covariates. Response: Dear Reviewer, we found this comment is relevant. It is good to categorize the variables into fixed and time-dependent covariates in the longitudinal data analysis. But, in this study all time dependent covariates like age, weight and the like were assessed at the base line. 5. In the results section, it is stated that “in the bi-variable cox regression analysis, maternal residence, antenatal care follow up, complication during last pregnancy, previous bad obstetrics history, place of birth, mode of delivery, preeclampsia, diabetic mellitus, gestational age, weight for gestational age, neonate cried immediately at birth, bag and mask resuscitation at birth, perinatal asphyxia at birth, neonate diagnosed with respiratory distress, hypoglycemia, neonatal sepsis, phototherapy, nasal continuous positive airway pressure, not receiving kangaroo mother care and radiant warmer were predictors of mortality at p<0.25.” The abstract mentions that “Cox-Proportional Hazards model was used to identify significant predictors of time to death at p<0.05.” To avoid potential confusion, it is recommended that the authors share briefly the rationale behind calling the above factors “predictors of mortality” when statistical significance wasn’t observed at the 5% level. Response: Thank you Dear Reviewer, just this is to mean that these variables were significant predictors of time to death at p<0.05 in bivariable cox regression analysis. We have modified the sentence to “… at p<0.05..”) in the revised manuscript. 6. Did the authors assess the presence of interaction or effect modification? Response: Thank you Dear Reviewer, We appreciate your suggestion of assessing effect modification. Yes, it was assessed. First, we have conducted a crude analysis of the relationship between the exposure variables and the event of interest. Next, we conducted a stratified analysis that separates the crude data according to levels of the effect modifiers. Effect measure modification was evaluated by examining the stratum-specific estimates. Therefore, based on this we did not identify effect modifiers in our findings. 7. A last point involves the limitations mentioned at the end of the discussion section. They are not sufficient. This paper would be stronger if it includes other obvious limitations. Response: We thank the reviewer for the comment on limitations. We have recognized these things in the revised manuscript, on study limitations with the statement (Line 294-297) “Selection bias is possibly introduced during secondary data collection because patients with incomplete records were excluded so that the incidence of death may be underestimated….” and we have added the limitation due to “…data was collected retrospectively from secondary sources might also have an effect on the quality of the study...” Reviewer #2: Title: "Predictors of time to death among preterm neonates admitted to neonatal intensive care units at public hospitals in southern Ethiopia: A cohort study." Summary comments: Generally well written manuscript. The subject of the paper, neonatal mortality is an important subject of public health importance. Few comments below mainly related to typos should be addressed by the authors Introduction Line 46: Authors wrote “Preterm birth, defined as a live birth before 37 completed weeks of pregnancy(1) and remains one of the common causes of hospitalization……..” They may either capture the sentence as “Preterm birth, defined as a live birth before 37 completed weeks of pregnancy(1) remains one of the common causes of hospitalization…….. ” Or “Preterm birth is defined as a live birth before 37 completed weeks of pregnancy(1) and remains one of the common causes of hospitalization ………” Response: Dear Reviewer, thank you very much for your time and consideration in editing and reviewing our manuscript. We have carefully read your comments and corrected inline of reviewer’s comments and suggestions. All comments raised were edited and incorporated in the main manuscript. The changes were highlighted with yellow color in the manuscript. Line 49-51. The authors should review the tenses used. For instance, they state “Globally, the sub-Saharan Africa had the highest newborn mortality rate 27 deaths per 1,000 live births, followed by Central and Southern Asia (25 deaths per 1,000 live births) (3).” They should clarify whether they mean, Globally, sub-saharan Africa has… or they meant ‘’had’’ in which case it will be good to know what the current NMR is sub-Saharan Africa is. Response: We appreciate that the reviewer asked for more accurate wording regarding had. We have substituted “had” by “has” which is appropriate verb to state the current status of NMR in sub-Saharan Africa. Line 56-57: The sentence below is incomplete, please rephrase into a complete sentence: “Despite the national goal of reducing the NMR from 57 28 to 11 per 1000 by 2020 as part of the national newborn and child survival strategy (2015-2020) 58 (6).” Response: Thank you Dear reviewer, we have paraphrased this sentence to”… Neonatal mortality in Ethiopia is still high despite the country's goal of reducing it from 28 to 11 per 1000 by 2020 as part of the national newborn and child survival strategy (2015-2020) … Line 54-58. Question: Why do we have differences in the national Health Sector Transformation Plan (HSTP-I) target of reducing NMR to 10 deaths per 1,000 live births by 2020 and the national goal of reducing the NMR from 28 to 11 per 1000 by 2020. Are they different agencies? Response: Dear reviewer, thank you very much for your time and consideration. They are all part of the Ethiopian Ministry of Health sectors, but each has its own set of goals for reducing newborn mortality in accordance with other global targets. These sectors are: First is “Ministry of Health. Health Sector Transformation Plan I (HSTP-I) 2015/16- 2019/20. MOH, 2015” with target of reducing NMR to 10 deaths per 1,000 live births by 2020. Second is “Ministry of Health. National Newborn and Child Survival Strategy 2015/16-2019/20. MOH, 2015” with goal of reducing the NMR from 28 to 11 per 1000 by 2020. However, in both contests, Ethiopia is far behind achieving these national and international targets. Line 62: “Ethiopia's neonatal mortality rate unacceptably high” It should rather read “Ethiopia's neonatal mortality rate is unacceptably high” Response: Thank you Dear reviewer, we have paraphrased this sentence to “Ethiopia's neonatal mortality rate is unacceptably high”. Methods Lines 76 and 80, please remove duplication of sentence as captured below: Line 76: neonatology ward accommodate 16beds in including 8 total beds from NICU ward. Line 80: there is 16 beds in neonatology ward including 8 total beds from NICU ward. Comment: Repetition of sentence Response: Thank you dear, we have removed duplicated sentence and it is corrected. Line 97 to 99: “The checklist for this study was adapted from the similar literatures, neonates’ medical card and 99 logbook and modified after reviewing of other related literatures.” This may read better as “The checklist for this study was adapted from neonates’ medical card and logbook with modifications based on literature review.” Avoid use of the term “literatures”. Literature can be used as plural. Line 99: “A checklist consisted of the…” Please use “The checklist consisted of the…..” Response: Thank you so much for your suggestion. We have accepted your comment in the revised manuscript. Line 97 to 104: In summary, the section on data collection can be better organized. See suggestion below based on what the authors been wrote: “The data were extracted from each individual neonate’s medical card and logbook using a structured checklist. The checklist consisted of information on maternal and neonatal socio demographic factors, neonatal related factors, maternal medical and obstetric-related factors. Since the data was collected from neonates’ medical card, the data collectors were trained on how to extract appropriate data and there was close daily monitoring and supervision at the data collection site.” Response: Dear reviewer, we found this comment is relevant and we have corrected all as per suggestion. Results: Line 153: “Four hundred and five neonates (79%) were cried immediately” Comment; Please remove “were” Response: Thank you for this correction and the comment is accepted. Discussion: Line 276-277: “This study revealed that 9-fold increase in hazard to mortality among preterm neonates who had not received KMC compared to those who were received KMC during hospital stay.” Rephrase: “This study revealed 9-fold increase in hazard to mortality among preterm neonates who had not received KMC compared to those who received KMC during hospital stay.” Response: Dear reviewer, we found this comment is relevant and we have corrected all as per comment. We have incorporated all editorial and reviewer comments. The manuscript will benefit from a conclusion paragraph that summarizes the findings and way forward. The conclusion at the abstract section is appropriate and can be used or adapted for this section. See conclusion of abstract below: “Conclusion: Despite admission to NICU for advanced care and follow up, mortality of preterm neonates was found to be high in the study settings. Addressing major intrapartum complications is required to improve survival of neonates admitted to NICU.” Response: Thank you Dear reviewer, we have accepted your comment in the revised manuscript. We thank again all editors and reviewers for their helpful guidance, and critiques that have strengthened this research report Attachments Attachment Submitted filename: Response Reviewers.docx https://doi.org/10.1371/journal.pone.0283143.r002
3 Mar 2023 Decision Letter - Ammal Mokhtar Metwally, Editor Predictors of time to death among preterm neonates admitted to neonatal intensive care units at public hospitals in southern Ethiopia: A cohort study PONE-D-22-26735R1 Dear Dr. Huka, 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, Ammal Mokhtar Metwally, Ph.D (MD) Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. 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Reviewer #1: (No Response) Reviewer #2: 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 Response) Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? 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Formally Accepted
4 Oct 2023 Acceptance Letter - Ammal Mokhtar Metwally, Editor PONE-D-22-26735R1 Predictors of time to death among preterm neonates admitted to neonatal intensive care units at public hospitals in southern Ethiopia: A cohort study Dear Dr. Huka: 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 Professor Ammal Mokhtar Metwally Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0283143.r004

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