Dear Dr. Nantale,

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 address all comments from both reviewers, separately, as described below.In addition, please address the following:https://safri.org/the-baby-saver/

Please submit your revised manuscript by Aug 07 2025 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.

• 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 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,

Alan Richard Horn, MD, DCH, FCPaed, Cert. Neonatology, PhD

Academic Editor

PLOS ONE

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

2. Please include a complete copy of PLOS’ questionnaire on inclusivity in global research in your revised manuscript. Our policy for research in this area aims to improve transparency in the reporting of research performed outside of researchers’ own country or community. The policy applies to researchers who have travelled to a different country to conduct research, research with Indigenous populations or their lands, and research on cultural artefacts. The questionnaire can also be requested at the journal’s discretion for any other submissions, even if these conditions are not met.  Please find more information on the policy and a link to download a blank copy of the questionnaire here: https://journals.plos.org/plosone/s/best-practices-in-research-reporting. Please upload a completed version of your questionnaire as Supporting Information when you resubmit your manuscript.”

3. Thank you for stating in your Funding Statement:

[This study was supported through the Saving Lives at Birth program in Low and Middle Income Countries under the Laerdal Foundation (#REF:2022-0264) The funding sources had no role in the study design, data collection, data analysis, data interpretation, the manuscript's writing, or the decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding sources.].

Please provide an amended statement that declares *all* the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now.  Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement.

Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf.

4. We notice that your supplementary tables are included in the manuscript file. Please remove them and upload them with the file type 'Supporting Information'. Please ensure that each Supporting Information file has a legend listed in the manuscript after the references list.

5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information.

6. 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.

[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?

Reviewer #1: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

Reviewer #1: Title: Feasibility and acceptability of using the BabySaver resuscitation platform and NeoBeat together for neonatal resuscitation in a low-resource setting: A pre-post implementation study

Author: Ritah Nantale

Summary: In this article the author(s) examined the feasibility of introducing the bedside neonatal resuscitation practice using the portable BabySaver resuscitation platform alongside the NeoBeat heart rate monitor, arguing that when combined, resulted in prompt initiation of neonatal resuscitation, a shorter duration to successful resuscitation with improved neonatal outcomes. The author(s) also explored the lived experiences of the healthcare workers performing the resuscitations and the mothers of respective infants and demonstrated the feasibility, ease of use and acceptability of this low cost intervention which fostered trust and satisfaction from the mothers. The article concludes that the use of BabySaver and NeoBeat intervention increased bedside resuscitation rates and significantly reduced neonatal morbidity .

Analysis: The article effectively illustrated that with pre-intervention training and incorporation of the new interventions into the SOPs, bedside resuscitation was easily adopted and implemented especially in a one-man resuscitation. It encompassed a much needed heart rate monitor to give ongoing feedback during the resuscitation, which was previously not readily available.The strength of this study lies in the quasi experimental approach where the authors demonstrated the outcomes of interest using the standard of care at baseline and compared the same outcomes post intervention. The uptake of bedside resuscitation was significantly higher which allowed the authors to demonstrate a relative improvement in the neonatal resuscitation process and which decreased neonatal morbidity and the need for admission. The buy-in by both healthcare workers and mothers is a cue for fostering sustainability

However, the article could benefit from some clarification on

1. How they arrived at a sample size estimation of 150 observations, and the entry point thereof.

2. How much power these 15 observations afforded to the study.

3. From the Figure 1, flow chart the entry point is the total neonatal resuscitations during each phase, of whom 150 consented in both the pre and post arms; and only 75 of each were included in the final analysis. So, how did the authors select the specific 75 observations in each arm out of the 150

Insights

This article illustrates the empowerment of healthcare workers in adopting bedside neonatal resuscitation using low cost interventions that significantly improve neonatal outcomes in LMICs. These findings were enhanced by a feedback loop from the qualitative context of the healthcare workers' and mothers' experiences. The study also dispelled some myths and misconceptions serving as potential barriers for the adoption of the intervention. Future research might explore a country-wide scale up of this intervention to determine its sustainability whilst incorporating suggested modifications.

Conclusion:

Overall the article provides a valuable contribution to the improvement of neonatal resuscitation outcomes using feasible and acceptable low cost intervention strategies in limited resource settings. Future research can explore the country-wide scale up of the intervention with incorporation of the suggested modifications which can be life saving.

This article meets the criteria to be considered for publication and will contribute to a gap in knowledge on neonatal resuscitation applicable in low resource settings. However, there is need for some minor corrections and clarifications as follows

Abstract : Is well written and concise

Background :

The narrative in the background did not allude to the fact that bedside resuscitation was already in practice pre- implementation as we find later in the results. Was this contributed by previous interventions or was this part of the standard of care?

It would be worthy to cite (Ditai J et al, 2021) who developed the BabySaver in the same hospital and inform the reader if its use had been adopted or not and what were the concerns and how have these been addressed in the current study? or if this is the first feasibility study on the BabySaver?

Grammar : Paragraph line 8 .... This practice prevents the practice of delyaed cord clamping............ The double use of practice in the same sentence can be improved

Problem statement and Objectives: Were well stated

Paragraph 4 in the Background section

Justification: This can be enhanced by citations that show the potential benefits of beside resuscitation in terms of morbidity indicators (early initiation, improved Apgars, decreased neonatal morbidity) and not just the delayed cord clamping benefits [ REF 13-15].

Methods

Study setting:

Line 5..... The hospital has one labour ward theatre ....... this phrase can be changed to an obstetric theatre a terminology which will resonate with most readers.

Sample size estimation and sampling needs clarification as mentioned in the above summary

Variables

Paragraph 2. ........A clarification between the baseline socio-demographic characteristics versus the independent and dependent variables is warranted to be able to interpret the tables correctly. Table 3 variables are dependent on whether a pre or post implementation approach was adopted and not the reverse.

Data collection: Was well elaborated

Data analysis For both phases was done well, using the appropriate/relevant statistical methods for the study design

Ethical consideration for intrapartum research was duly followed and clearance was obtained through the right pathways.

Results Overall the results were well presented

Study profile

Line 5 . in the post intervention arm only 152 mother-infant dyads were eligible not 155 and shown in Figure 1

Table 4 Comparison of the ...... birth outcomes pre and post implementation of the bedside neonatal resuscitation did not show any difference in the condition of the neonate at 24 and 48 hours. This was not discussed by the authors. Is there any explanation for this? Does it call for long-term follow up research ?

The qualitative findings were well presented and the use of an existing theoretical framework was ideal in streamlining the interpretations of the arising themes, although there was some overlap in the some constructs.

The suggested modifications added great value to the qualitative findings allowing the end user to contribute towards the quality improvement of the intervention

Discussion: Was brief but concise and focused on the responding to the main objective.

Typo ........

Paragraph 1 Line .5...... fewer babies needed further care post resuscitation

Paragraph 2 Line 16......Several studies including systematic reviews

Limitations: The use of the same researchers for the IDI may indeed have biased the participants. Is there a reason different research assistants were not allocated for this phase? If so, how was the potential for bias mitigated?

Conclusions and recommendations : We appropriate and derived from the study findings.

References: These were appropriately selected but it would help to know what reference style the authors used to assess for consistency?

Reviewer #2: This is a well written and important work. I believe the conclusions are sound and based on the research which is well described. I have a few important queries/observations, and then a number of less important minor issues.

I think the issues around the sample size need to be better clarified. What is the potential change in outcome that was used to calculate the sample size? Improved resuscitation at the bedside? And if so, where does the assumption of a 50% change come from? What alpha/power was used ?

I find the graph documenting differences in temperature very interesting. I am not clear whether the initial temperature is at the time of birth or at 1 minute. It would seem odd for there to be a difference in temperature at the time of birth. But – before intervention- it seems the initial temperature ( ? at 1 min) was 33 degrees? That seems noteworthy and I wonder if it is accurate?

It is reported that the duration of resuscitation was shorter post intervention. Were there specific objective criteria to determine when resuscitation stopped? Should these be listed?

I have a few questions around table 4. The footnotes all say “ adjusted for antepartum haemorrhage and malpresentation”. I suspect this is a typo. Perhaps the correct footnotes may answer some of my questions.

Under outcomes of “ the resuscitation process” it mentions early neonatal death. This seems less than the number of deaths at 24 h- does this line refer to babies who died in the resuscitation process? That should be made clear. And there were infact an increase in the number of deaths- albeit a small one from 0 to 3. But no p value given- I would think this is important, from my calculatiosn using a Fischers exact I get 0.244. I think this is worth mentioning in the text, even if it is not significant. I am also wondering why the total number of babies in the 24 h and 48h intervals does not add up to 75.

The rest of my comments are more minor and a matter of style.

In the methods section there seems to a semi- repetition of a sentence around the use of a phenomenological method.

There is mention of a resuscitation checklist in the methods- and then in the data it is mentioned that the liveborn LGH tool is used- if these are the same, I may mention the LGH tool in the methods.

In the table about characteristics of the mothers , some are classified as housewives and others as unemployed. What was the distinction used to separate these two categories?

I was often intrigued by what the products may look like- is there a possibility to show a photo of them, ideally in use? Or set up for use?

In the qualitative section, it is mentioned that 63% of the mothers had secondary education, but for the group as a whole I see it was more like 40%- should this be mentioned?

I also feel that the slightly different training for staff in the pre and post intervention period may have had some impact on the outcomes ( ie not just the gadgets themselves) and I think that might need to be mentioned.

**********

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:  Alexander G. Stevenson

**********

[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

Dear Dr. Nantale,

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 respond to the remaining issues raised by the reviewers, including the point raised by reviewer one, as a proviso to their acceptance.Please also update the response to conflict of interest section of the submission, which should be "Yes" there is  a potential conflict which must be stated as: 

"ADW holds no personal rights to the IP, but there is a royalty sharing scheme at UoL whereby any future royalties would be shared with him." In addition the amount and/or terms of those royalties needs to be transparently stated.

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

Please submit your revised manuscript by Sep 22 2025 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.

• 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 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,

Alan Richard Horn, MD, DCH, FCPaed, Cert. Neonatology, PhD

Academic Editor

PLOS ONE

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 

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.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

Reviewer #1: Thank you , the author(s) have addressed the comments stipulated and they have cleared out the sample size and sampling queries which were previously confusing. Similarly the revision of Table 4 was a crucial step in clarifying the key outcomes,

1, one minor comment in the background line 81 .................. This practice hinders delayed cord-clamping and may also cause mother anxiety and denial CHANGE TO..........to maternal anxiety

2. In the results , Line 311-312, the narrative on the lack of a difference in outcome at 24 hours and 48 hours should still be documented. This has been rightfully included in the discussion, though it is my opinion that HIE is an evolving condition and the outcome at 24 and 48 hours may be influenced by affection of other organ systems and the management thereof; and is not limited to the initial resuscitation results.

In conclusion

The authors have produced a good manuscript with important scientific evidence and have addressed the major concerning issues

Reviewer #2: Thank you for addressing my previous comments.

I still feel the claim that baby's axillary temperature at 1 min was 33.5 degrees warrants a comment in the discussion. I strongly suspect this was a measuring error. Even babies who are actively cooled with icepacks take 30 min to drop their temperature that far. I find it hard to accept that a baby no more than 1 min old, who presumably had a normal temperature 1 min ago, could drop their temperature to 33 degrees in 1 minute.

**********

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:  alexander g stevenson

**********

[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

Dear Dr. Nantale,

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 address the following remaining aspects in your final revision:

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.

• 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 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,

Alan Richard Horn, MD, DCH, FCPaed, Cert. Neonatology, PhD

Academic Editor

PLOS ONE

Journal Requirements:

1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 

2. 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.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

Reviewer #1:  Greetings

Thank you for working on the previous comments which have added great clarity to your work thus far.

I have very minor comments which you can consider for your final version.

Few corrections

Abstract

Line 45: the median time to successful resuscitation was shorter 8 versus 5 minutes, [I think should be the reverse '5 versus 8 minutes]'

Background

Line 66: hindered by a lack of training and suitable and functional equipment [ 'and suitable or functional resuscitation equipment '] may be used to avoid the double and in the sentence

Study population

Line 116 admitted to the neonatal unit ['for'] assessment and ongoing management... the word for is missing

Study procedures

Lines 122 and 136 ['obstetric theatre'] rather than labour ward theatre

One inquiry

Background

Line 85 :Just wanted clarity why it is said the Babysaver has not been clinically tested whilst it had undergone phase 1 and 11 clinical testing and part of this was done in Uganda?

Otherwise, my previous comments have been addressed

Good luck

Reviewer #2:  all issues have been addressed, there are no further comments and the submission is ready for publication as it is.

**********

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:  alexander g stevenson

**********

[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

Dear Dr. Nantale,

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 correct the competing interests section on page 5 of  PONE-D-25-16948R3 still reads, "The authors have declared that no competing interests exist." Please correct this to align with the statement in the manuscript which reads, 

"ADW was one of the co-inventors of the BabySaver tray. The intellectual property is held by

his employer, the University of Liverpool, but the rights for Africa were sold to the Sanyu

Africa Research Institute for £1 in 2019 so that they could take forward its development and

distribution in Africa. ADW holds no personal rights to the IP, but there is a royalty sharing

scheme at UoL whereby any future royalties would be shared with him."

Please submit your revised manuscript by Nov 26 2025 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.

• 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 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,

Alan Richard Horn, MD, DCH, FCPaed, Cert. Neonatology, PhD

Academic Editor

PLOS ONE

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 

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.

[Note: HTML markup is below. Please do not edit.]

[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.

Feasibility and acceptability of using the BabySaver resuscitation platform and NeoBeat together for neonatal resuscitation in a low-resource setting: A pre-post implementation study

PONE-D-25-16948R4

Dear Dr. Nantale,

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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support .

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,

Alan Richard Horn, MD, DCH, FCPaed, Cert. Neonatology, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: