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Authors have carried out changes and improved presentation
Ok
Ok
Nil specific
As you can see from the reviews, you need to perform an additional edit for readability; making sure sections are in the right place in the manuscript; editing for incomplete or hanging sentences and so on
Please address these issues.
Clear and unambiguous, professional English used throughout.
Original primary research within Aims and Scope of the journal.
Impact and novelty not assessed. Meaningful replication encouraged where rationale & benefit to literature is clearly stated.
Authors have modified the presentation. However, it requires further improvement.
Ok. This is a retrospective study
Ok
Authors need to revise the results section. Statistical tests used to be given under methods and not under results. There are multiple subheadings under results. One should only givr important findings under results.
Much improved from original state but still need structure and grammatical editing to improve flow, understanding and ease of reading
no comments
improved from original but will benefit from grammatical review
This version is much improved from the original but will benefit from further structural review to enhance the flow and ease of reading.
Please address the comments of the reviewers in a comprehensive revision
The article should be revised, my suggestions are attached.
The article should be revised, my suggestions are attached.
Appropriate
The introduction part of the article should be revised, the method should be strengthened with references, the findings should be discussed mainly in the discussion, the conclusion part is not appropriate.
1. Language requires major editing
2.Tables are lengthy and can be improved
3.How duration of hypothermia becomes a risk factor for hypothermia ?
4.Severity grading of hypothermia is not as per standard definitions available. (Mild between 34-36. moderate 32-24 and severe <32)
This is a retrospective study. Methods used appears to be Ok
As per the data, ,79.17% infants had hypothermia. This appears to be high compared to earlier published data cited by the authors. Did the authors take any corrective steps to prevent hypothermia?. If yes, those steps can be highlighted. Since the severity of hypothermia classification used by authors is not as per the standard definitions, either they can re-analyse or just give the ranges of temperature.
Manuscript requires major revision especially with regard to language. Some of the references listed are not as per the guidelines providded by the journal..
This is a great contribution to an important topic. I applaud the authors for their hard work and attempt to contribute to what is known in the field of pediatrics and neonatology surrounding this issue. While I find the discussion and conclusion clear and easy to follow, the Abstract, introduction and results could be clearer and more pointed for clarity.
The method section under abstract should be rephased for clarity and understanding. An example of a good way to introduce this study would be
A retrospective single center study was conducted and 648 subjects who had surgery performed under general anesthesia were enrolled and demographic, perioperative and intraoperative data gathered.
The research question is not well defined although the data collected and presented is quite compelling.
The abstract suggests and rightfully so that the study is a retrospective study designed to evaluate the characteristic patterns of intraop temperature fluctuations and risk factors for severe hypothermia. However, line 101 to 102 suggest this study was performed on neonates who received operations from 1st January 2021 to 28th February 2024. Line 118 states data gathering process was tested in October 2023.
By definition a retrospective study is done after the events have occurred. The authors received ethics committee approval to in July 2023 to collect data on neonates who have had surgery up to the dates of their approval. Authors need to clarify what exactly study duration is and if study was truly retrospective or had a prospective phase.
I suspect these are errors and can be clarified easily. However, if there was a prospective aspect or period of the study, it needs to be included and described fully. A prospective aspect will influence intraoperative nursing and anesthesiology practices that will impact results.
The authors did not include a paragraph or two on the inherent limitations of the study including: single center study, the retrospective nature of the study and approximately 50% enrollment rate (small number of subjects enrolled) from large number eligible. Although the inclusion and exclusion criteria are well laid out, 50% exclusion rate is high and can skew the results.
The authors failed to describe the location of the operating room in relation to the newborn nursery, intensive care or pediatric floor where the patients are housed prior to surgery. The paper also does not describe transport to the operating room or where surgeries are performed. All these factors could affect temperature regulation and cold exposure which will impact reproducibility of this study in other centers.
The results section can be better laid out to show case the major findings indicating that gestational age, chronologic age and weight impact severity of hypothermia
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