PONE-D-23-33081Asymptomatic hypoglycemia among preterm newborns: a cross-sectional analysis.PLOS ONE

Dear Dr. Leshabari,

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #2: Yes

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Reviewer #1: Re: Asymptomatic hypoglycemia among preterm newborns: a cross-sectional analysis.

Thanks for allowing me to review this work. Find below my comments

Short title:

“neonatal hypoglycemia” changes to hypoglycemia in preterm newborns.

Keywords:

“Dar es Salaam” delete, replace with preterm

Abstract

‘There is a growing body of evidence that links the causes of early neonatal mortality to neonatal hypoglycemia in Tanzania’ Replace with another statement, this is a well-established fact globally.

“Written informed consent was sought from each mother prior to inclusion of their babies into the study” delete

“Breastfeeding within 1st hour post-delivery was the only factor significantly associated with neonatal hypoglycemia (OR; 0.123, 95%-CI; 0.052-0.287).” Kindly rephrase to avoid ambiguity. Your odds ratio is less than.

“Nearly half of all asymptomatic newborns were in hypoglycemic range” You can not conclude with findings not in the results section, this is appearing out of no where

“Preterm neonates maybe the risky group worth considering for continuous glycemic screening at hospital protocols” Your abstract failed to support this statement and thus, you can not make this recommendation

Introduction

“They consider their argument on possible evolutionary basis for its occurrence within the first 24-hours of extra-uterine life. They justified their thinking on the nosology to be based on symptoms and signs (clinical aspects),” replace the word “they” and avoid third person pronoun in a scientific writing

“Some studies have shown perinatal hypoxia, small for gestational age and maternal hypertension to be factors associated with hypoglycemia in preterm newborns (4, 5) However, the exact mechanisms behind the observations are yet to be identified by neonatologists/endocrinologists to date. Yet still, it is not clear whether the suggested risks are generalized or specific to a certain neonatal cohort alone” move up to the paragraph before..

“This study gives findings from a cross-sectional sample of preterm neonates who presented with asymptomatic hypoglycemia in typical neonatal set ups” delete

Methods:

“Otherwise, Tanzania is a nation state situated on the East African coast. It is a former German colony, that accidentally fell under British protectorate after the World War II, up to her political independence. Most of her existing infrastructure in health, especially the study settings are post-independence initiatives on health. Tanzania is among the fastest growing nation states in Africa. She is rich in demographic sects, as evidenced by different population sub-structure ranging from Bantus to Afro-Asiatic population groups, especially in Dar es Salaam.” Delete, this is a manuscript and not a dissertation or thesis.

“Thus, the study population was considered to be representative of African demographic sects for all practical and clinical purposes” This is incorrect, kindly delete

“Nutritional status was assessed using growth charts” Mentioned the growth chart name

“Random (venous) blood glucose of the preterm newborns screened using Glucoplus blood glucose monitors (Glucoplus™ Inc. 2004, Canada)” has this been validated among the neonates?

“Data was triple entered under” who do you mean by triple entered? Why?

“(hypoglycemia – coded as 1- if random glucose value was ≥ 2.6 mmol/L and 0 – if random glycaemia was < 2.6 mmol/L).” kindly cross-check, your desired outcome is hypoglycemia and should have been coded 1.

Results:

Apgar score, and weight are appearing here for the first time, how were they assessed and it should be part of the methods. Also, birth asphyxia, respiratory distress, MAS

“TABLE 2: multivariate analysis” it should be bivariate or multivariable binary logistic regression

No mention of how many has hypoglycemia

Discussion

“In this study, we found almost half of all preterm babies to have been in quantitative hypoglycemic ran.” This is not mentioned in your results

”The current findings are comparable to others in similar settings (7-10) For instance, Sultan and his colleagues found out 73% of all babies born prematurely in South-Eastern Tanzania to had been in hypoglycemic range” This statement contradict your earlier assertion that no study has been done in Tanzania (At present, there is no evidence from available/retrievable published databases of any findings on factors associated with neonatal hypoglycemia among preterm babies in Tanzania).

“To what extent do these findings translate to prevalent double burden of morbidity and mortality indices among under-five year population in Tanzania and beyond, is still a matter of speculation (25, 26). However, the fact that there is solid evidence for under-fives population to be in ill-state in Tanzania (22) calls for urgent considerations for more analytical, possibly longitudinal designs in ascertaining the long-term effects ofasymptomatic hypoglycemia in newborns. Besides, these findings call for urgent and reliable estimates of morbidity and mortality statistics of special groups in the population pyramid. At present, there are potential indications that shows certain segments of the Tanzania’s population are left out in most reported morbidity and mortality statistics (25, 26). There are potential clues that chronic ill-states in childhood may result to miserable later life years both in Africa and elsewhere (23, 24). As we are advancing medical sciences on ageing cascades, even among humans (19, 24), we wish to consider that as a treasure hunt at least for now.” Delete, irrelevant.

Reviewer #2: The work is important in it's field. It has a logical flow and would be important in the setting that it was conducted. The authors need to present the work better especially the statistical work for factors associated in Table 2. They also need to discuss their work in more depth other than the simplistic discussion they have presented. There are many factors that are associated with hypoglycemia but these have not been studied at all or even mentioned as limitations like maternal medical conditions like HIV, BMI of mother, use of drugs that could cause hypoglycemia , critical illness; did they only enrol stable infants? Was this also the best design for such a study given the resources they had?

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Reviewer #1: Yes: Olayinka Ibrahim

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Re hypoglycemia study.pdf

Attachment

Submitted filename: Hypoglycemia in Preterms.docx

PONE-D-23-33081R1Asymptomatic hypoglycemia among preterm newborns: a cross-sectional analysis.PLOS ONE

Dear Dr. Leshabari,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

==============================

Please submit your revised manuscript by Mar 15 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

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

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: 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,

Kazumichi Fujioka

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:

Both reviewers requires response comment letter point by point.

PONE-D-23-33081R1

Asymptomatic hypoglycemia among preterm newborns: a cross-sectional analysis.

Dr Kelvin Melkizedeck Leshabari

Dear Editor,

I can not access the comments from the author or the response from the reviewers.

Thank you

PONE-D-23-33081R1

Asymptomatic hypoglycemia among preterm newborns: a cross-sectional analysis.

Dr Kelvin Melkizedeck Leshabari

Dear Editor,

Thank you for asking to review the revised manuscript. I observed that there was no cover letter or point-to-point response to my earlier comments. Besides, I hardly see track changes in the revised manuscript.

I wish these issues to be resolved before proceeding with review.

Best wishes

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[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.

Asymptomatic hypoglycemia among preterm newborns: a cross-sectional analysis.

PONE-D-23-33081R2

Dear Dr. Leshabari,

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,

Kazumichi Fujioka

Academic Editor

PLOS ONE

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