Dear Dr. Hansen,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Hany Mahmoud Abo-Haded, MD

Academic Editor

PLOS ONE

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[The Project is supported by The Novo Nordisk Foundation grant NNFSA170030576].

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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: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: The manuscript addresses an important and clinically relevant topic: neurodevelopmental outcomes in preschool children with surgically corrected congenital heart defects (CHD), assessed with the Ages & Stages Questionnaire (ASQ). The study is well-designed, based on nationwide data, and uses appropriate methodology. My comments are as following:

The exclusion criteria may have inadvertently omitted critical cases, particularly those admitted to the neonatal ICU. Moreover, the outcomes may also depend on the surgical success rate; please provide more detailed information on this aspect.

The methodology related to the use of the ASQ requires further clarification and justification, as the current description is not sufficient.

The follow-up period is relatively short, which limits the ability to assess long-term neurodevelopmental outcomes.

Reviewer #2: Congratulations on the good job.

1. Abstract

i. Excellent summary

ii. Proper inference

2. Framing – disclosures, funding and ethical issues

a. Excellent

3. Introduction, methods, results and conclusion

a. The response rate amongst controls is 36.5%. Such may mean skewed result. Kindly relook the impact on the results.

b. Discussion section shouldn’t take a lot of explanations to convince readers the methodology was proper. You better remove it and can drop some points at the methods section if you wish.

c. Prevalence of congenital heart diseases and screening isn’t a target, and doesn’t need discussion. Was better finalized on the introduction. It took a content here.

d. The subgroup analysis had created minimal sample sizes, which remained to be a limitation.

e. Long – term neurodevelopmental outcomes

f. Term of astonishment like surprisingly better is avoided

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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.

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Reviewer #1: No

Reviewer #2: Yes: Abraha Gebreegziabher Hailu, MD

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Neurodevelopmental Outcomes in Preschool Children with Congenital Heart Defects: A Case-Control Study using Ages&Stages Questionnaire

PONE-D-25-33159R1

Dear Dr. Hansen,

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.

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Kind regards,

Hany Mahmoud Abo-Haded, MD

Academic Editor

PLOS One

Additional Editor Comments (optional):

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

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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

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Reviewer #1: As a peer reviewer, I have carefully evaluated the submitted manuscript for its scientific validity, methodology, data analysis, and clarity of presentation. The study addresses a clinically relevant topic and is based on appropriate study design and analytical methods. The authors have adequately addressed all comments raised during the review process and have revised the manuscript accordingly. After thorough reassessment of the revised version, I confirm that the manuscript meets the required academic and ethical standards and has successfully passed the peer-review process.

Reviewer #2: (No Response)

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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: No

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