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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?

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

Reviewer #1: Yes

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: This is an automated report for PONE-D-25-54861. This report was solicited by the PLOS One editorial team and provided by ScreenIT.

ScreenIT is an independent group of scientists developing automated tools that analyze academic papers. A set of automated tools screened your submitted manuscript and provided the report below. Each tool was created by your academic colleagues with the goal of helping authors. The tools look for factors that are important for transparency, rigor and reproducibility, and we hope that the report might help you to improve reporting in your manuscript. Within the report you will find links to more information about the items that the tools check. These links include helpful papers, websites, or videos that explain why the item is important. While our screening tools aim to improve and maintain quality standards they may, on occasion, miss nuances specific to your study type or flag something incorrectly. Each tool has limitations that are described on the ScreenIT website. The tools screen the main file for the paper; they are not able to screen supplements stored in separate files. Please note that the Academic Editor had access to these comments while making a decision on your manuscript. The Academic Editor may ask that issues flagged in this report be addressed. If you would like to provide feedback on the ScreenIT tool, please email the team at ScreenIt@bih-charite.de. If you have questions or concerns about the review process, please contact the PLOS One office at plosone@plos.org.

Reviewer #2: Manuscript title: "Trophic Feeding Initiation and its Predictors in Preterm Neonates Admitted to Neonatal Intensive Care Units

� Preterm enteral nutrition feeding is an important topic with significant variability despite multiple recommendations. I applaud the authors’ efforts to analyze trophic feeding initiation.

Abstract:

� Introduction: in the abstract should be a short convictive statement showing the identified gap.

� Conclusion: which factors are risk and which are preventive should be concluded. Make the conclusion sound with specific recommendations.

� AIM and primary outcomes not defined

� Ethics: is written informed consent waved or is it signed? it should clearly be stated. If signed who signed the consent?

Introduction:

� The introduction appears vague and extensive. It should focus on what is known of the problem and what gaps this study looks to evaluate and solve.

� Line 62-67-paraphrase the idea

� Please describe, in a succinct way, the presence of feeding protocols at the hospitals

� Please summarize line 120-123 including reference citations

� The manuscript from line 129 -134 is not convective to conduct this study. Please revise it. What gaps were identified and what was your study’s main aim?

� What other studies found regarding your topic and what is left should be explained.

� Generally, introduction section should focus more on reasoning’s why providers do not start trophic feeds early despite the evidence available. Also, state how this manuscript will contribute to the evidence available regarding this topic.

Method:

� Please define pre-diagnosed Stage II or III NEC, Stage III asphyxia and why is this an exclusion criterion

� The Methods and materials section does not provide adequate information to replicate the study.

� Simple definitions are not included, like: how are TF provided?

� Line 227: Survival time is a confusing name for the time to start TF

� Line 234-246 the idea on this text should be clear and summarized: and also please specify/clarify the purpose of the questionnaire; to whom it was administered? This goes accordingly with my comment regarding lack of clarity about the execution of the study.

� Please omit line 274-278

Result:

Line 295-310 un-necessary redundant information since the information is provided with Table 1

Line 350-351 “Kaplan-Meier curves constructed to compare the overall survival patterns over time ‘’for’’ between different groups”. Please omit ‘’for’’

Discussion:

The discussion is focused on comparing the findings with those noticed in other studies. However, are the findings aligned with international literature?

Overall the discussion section needs major revision; does not clearly synthesize your findings and the implication of these findings.

The limitation section should be paraphrased

Regarding language: there are English grammatical and syntaxis errors in the whole document. Please ensure that, before resubmission, a person proficient in written English edits the manuscript.

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Reviewer #1: No

Reviewer #2: Yes: Mekonen Adimasu Kebede

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Attachments

Attachment

Submitted filename: report_10.1101+2025.10.13.25337936.pdf

Attachment

Submitted filename: Comments to authors.docx

<p>Time to initiate trophic feeding and predictors among preterm neonates admitted at General Hospitals in Tigray, 2025.

PONE-D-25-54861R1

Dear Dr. Teklebrhan welderufael kidane,

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,

Yusuke Hoshino

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments: