Rigor Reviewed

Rigor-Reviewed Manuscript

Non-invasive high frequency oscillatory ventilation for primary respiratory support in extremely preterm infants: multicentre randomised controlled trial

Name: Adcurare Rigor Record — Non-invasive high frequency oscillatory ventilation for primary respiratory support in extremely preterm infants: multicentre randomised controlled trial
Item: Non-invasive high frequency oscillatory ventilation for primary respiratory support in extremely preterm infants: multicentre randomised controlled trial
Rating: 100
Author: Adcurare

Li Y, Zhu X, Li LJ, Chen L, Yang Q, Xu L, Liang W, Lin X, Li C, Xue J, Liu L, Pan X, Ju R, Peng X, Tang W, Shi Y, NHFOV study group.

Paper source

Read full text (PMC)Journal

Embed this Rigor badge

Adcurare Rigor Review — 5★ (Exemplary), 0 critical, 2 high issues for “Non-invasive high frequency oscillatory ventilation for primary respiratory support in extremely preterm infants: multicentre randomised controlled trial”

Links back to this Rigor Record.

Adcurare Editorial

This rigor review was examined and confirmed by Adcurare Editorial · July 6, 2026

Adcurare Rigor Review

Rigor Reviewed

5 / 5

Exemplary — no material problems found

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — no deductions. Nothing the checks ran surfaced a material problem.

Model-reported confidence: highReviewer agreement: moderateEngine: 7.6.0Source: full text

No specific rigor problems surfaced by the checks that ran.

This Adcurare Rigor Review uses AI Rigor Reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

The manuscript presents a well-designed multicentre RCT with clear randomisation, masked outcome assessment, adequate power, and transparent reporting. Two minor but fixable gaps are identified: (1) the regulatory compliance statement does not explicitly cite the Declaration of Helsinki or ICH-GCP, and (2) the analysis code is only in supplemental files rather than a version-controlled public repository. No integrity or fabrication signals were detected.

Three independent rigor evaluations were synthesised; the reviewers agreed on 6 of 8 dimensions, with divergence on ethical approvals (2 pass, 1 warn) and data code availability (2 pass, 1 warn). The copyedit pass identified 8 minor issues. Citation verification found no retracted or missing references (37 checked). 6 statistics recomputed all consistent. The data link is live.

12 major claims checked against the paper's own evidence: all adequately supported.

Recomputed 6 tests: 6 consistent, 0 inconsistent, 6 via agent-written checks.

Reporting

Eight Dimensions8 pass

The introduction cites clinical guidelines and prior studies establishing NCPAP as first-line therapy but noting a high failure rate, and cites emerging evidence that NHFOV may be superior, highlighting the inconsistency in previous RCT results as the gap the trial is designed to fill. The specific hypothesis is stated. The paper explicitly discusses limitations of prior research in the Discussion section, including population differences, severity variability, and study power.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

The scientific premise is well-established with prior work cited, a clear rationale linking the premise to the study objectives, and limitations of prior research explicitly addressed.

Evidence

direct quote[Introduction, paragraphs 1-4]

“European consensus guidelines recommend nasal continuous positive airway pressure (NCPAP) as the preferred first line respiratory support strategy for respiratory distress syndrome. However, cumulative evidence has suggested that up to 40% of extremely preterm infants are prone to a high risk of NCPAP failure”

direct quote[Introduction, paragraph 5]

“We hypothesised that NHFOV would be more effective than NCPAP in reducing treatment failure within 72 hours after birth in a homogeneous population of Chinese extremely preterm infants.”

direct quote[Discussion, 'Comparison with other studies']

“Although Malakian and colleagues reported no significant reduction in intubation rates with NHFOV versus NCPAP, their study population differed critically from ours: it included more mature infants and had a smaller sample size.”

PASSReviewer 2· 95% conf

The paper clearly establishes the scientific premise with an extensive review of prior research and provides a logical rationale for the hypothesis. Limitations of prior studies are acknowledged and addressed by the study design.

Evidence

direct quote[Introduction, paragraphs 2-4]

“Several randomised controlled trials comparing NHFOV and NCPAP have reported inconsistent findings about their effectiveness in managing respiratory distress syndrome. To address this gap, we conducted a multicentre randomised controlled trial...”

direct quote[Introduction, paragraph 2]

“NHFOV may provide dual physiological advantages over NCPAP by maintaining lung recruitment while actively clearing carbon dioxide through oscillatory gas mixing—a mechanism particularly beneficial for non-uniformly diseased lungs.”

direct quote[Discussion, 'Strengths and limitations' subsection]

“This study possesses several key strengths: enrolment of a large cohort of extremely preterm infants; implementation of a rigorous, physiology targeted protocol with standardised ventilatory management...”

PASSReviewer 3· 95% conf

The paper establishes a clear scientific premise by citing prior research, providing a logical rationale for the hypothesis, and acknowledging limitations of previous studies.

Evidence

paraphrase[Introduction, paragraph 1-2]

“Paraphrase: The introduction cites European consensus guidelines recommending NCPAP and studies showing 40% NCPAP failure, and NHFOV's potential advantages from bench and clinical studies.”

direct quote[Introduction, paragraph 2]

“NHFOV may provide dual physiological advantages over NCPAP by maintaining lung recruitment while actively clearing carbon dioxide through oscillatory gas mixing”

direct quote[Introduction, paragraph 2]

“Several randomised controlled trials comparing NHFOV and NCPAP have reported inconsistent findings about their effectiveness in managing respiratory distress syndrome.”

Simple randomization using a computer-generated random number sequence with central allocation concealment is described. The unit of randomization is the infant. Outcome assessors were masked; caregiver blinding was not feasible and is justified. A sample size calculation was performed with alpha=0.05, power=90%, and a 15% absolute difference. Inclusion and exclusion criteria are explicit. Outcomes were analysed by intention-to-treat, handling the analysis population. Biological replicates are not applicable for a human RCT.

Sub-criteria

controlsN/A

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 92% conf

The study design is rigorous for a clinical trial: randomisation method and unit are clearly stated, the open-label design is justified, a power analysis is reported, inclusion/exclusion criteria are pre-specified, and the analysis population (ITT) is defined.

Evidence

direct quote[Methods, 'Randomisation and masking']

“Simple randomisation was performed using a computer generated random number sequence, which was securely posted on a dedicated, password protected website accessible 24/7.”

direct quote[Methods, 'Randomisation and masking']

“Owing to the nature of the intervention with the distinct characteristics of the ventilation modalities, masking of care givers was not feasible, and masking of patients was not applicable. However, outcome assessors were masked to the treatment allocation to minimise ascertainment bias.”

direct quote[Methods, 'Statistical analysis']

“With a significance level (α) of 0.05 and 90% power, a sample size of 170 newborns per group was required, leading to a total enrolment target of at least 340.”

PASSReviewer 2· 98% conf

The study design is rigorous and well-described, with adequate randomization, masking of outcome assessors, a power analysis, clear inclusion/exclusion criteria, and intention-to-treat analysis. Applicable sub-criteria are met for a human RCT.

Evidence

direct quote[Methods, 'Randomisation and masking' subsection]

“Simple randomisation was performed using a computer generated random number sequence, which was securely posted on a dedicated, password protected website accessible 24/7.”

direct quote[Methods, 'Randomisation and masking' subsection]

“However, outcome assessors were masked to the treatment allocation to minimise ascertainment bias.”

direct quote[Methods, 'Statistical analysis' subsection]

“With a significance level (α) of 0.05 and 90% power, a sample size of 170 newborns per group was required, leading to a total enrolment target of at least 340.”

PASSReviewer 3· 95% conf

The study design is robust and well-reported across applicable sub-criteria for a human RCT, with clear randomization, stratification, sample size calculation, inclusion/exclusion criteria, and masked outcome assessment.

Evidence

direct quote[Methods, Randomisation and masking]

“Simple randomisation was performed using a computer generated random number sequence, which was securely posted on a dedicated, password protected website accessible 24/7.”

direct quote[Methods, Statistical analysis]

“With a significance level (α) of 0.05 and 90% power, a sample size of 170 newborns per group was required”

direct quote[Methods, Randomisation and masking]

“However, outcome assessors were masked to the treatment allocation to minimise ascertainment bias.”

Table 1 reports sex (percentage female) and gestational age (median and IQR), birth weight, Apgar scores, and other relevant health indicators. Demographics such as multiple birth, mode of delivery, and prenatal treatments are provided. Sex is reported for both groups.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 85% conf

Key demographic and clinical variables for human subjects are reported adequately, including sex, gestational age, birth weight, and relevant clinical scores.

Evidence

direct quote[Table 1]

“Female | 74 (43.5) | 68 (39.5)”

direct quote[Table 1]

“Gestational age (weeks), median (IQR) | 27.0 (26.0-28.0) | 27.0 (26.0-28.0)”

direct quote[Table 1]

“Small for gestational age newborns | 15 (8.8) | 16 (9.3)”

PASSReviewer 2· 97% conf

Biological and demographic variables appropriate for a human neonatal trial are adequately reported, including sex, gestational age, birth weight, and clinical characteristics. Single-sex justification is not applicable as both sexes were included.

Evidence

direct quote[Table 1]

“Female 74 (43.5) ... Female 68 (39.5)”

direct quote[Table 1]

“Gestational age (weeks), median (IQR) | 27.0 (26.0-28.0) | 27.0 (26.0-28.0)”

direct quote[Table 1]

“Birth weight (g), median (IQR) | 990 (820-1100) | 970 (880-1090)”

PASSReviewer 3· 95% conf

Biological variables are well-reported for a human RCT: sex, gestational age, birth weight, and other demographics are provided in a baseline table.

Evidence

direct quote[Results, Table 1]

“Female | 74 (43.5) | 68 (39.5)”

direct quote[Results, Table 1]

“Gestational age (weeks), median (IQR) | 27.0 (26.0-28.0) | 27.0 (26.0-28.0)”

direct quote[Results, Table 1]

“Table 1 Baseline characteristics in NHFOV and NCPAP groups”

The paper reports approval by the Ethics Committee of the Children's Hospital of Chongqing Medical University (No 2019.161) and local IRBs. Written informed consent was obtained from parents. Regulatory compliance is stated via adherence to CONSORT guidelines and anonymisation per local regulations. All applicable sub-criteria are met for a human interventional trial.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 97% conf

Ethics approval is explicitly stated with a named ethics committee and protocol number; informed consent from parents is described; regulatory compliance with CONSORT and local regulations is stated.

Evidence

direct quote[Methods, 'Study design']

“The study was approved by the ethics committee of the Children's Hospital of Chongqing Medical University (No 2019.161)”

direct quote[Methods, 'Study design']

“Informed consent was obtained from parents or guardians antenatally or upon admission to the neonatal intensive care unit”

direct quote[Methods, 'Study design']

“The trial was conducted in compliance with CONSORT (consolidated standards of reporting trials) guidelines.”

WARNReviewer 2· 90% conf

Ethics approval and informed consent are explicitly reported and adequate. However, regulatory compliance is only stated with reference to local regulations and CONSORT guidelines, not to a named international ethical framework such as the Declaration of Helsinki or ICH-GCP, which is considered inadequate.

Evidence

direct quote[Ethics statements section]

“The protocol was approved by the Ethics Committee of the Children’s Hospital of Chongqing Medical University (No 2019.161) and local institutional review boards of the participating centres.”

direct quote[Ethics statements section]

“All parents or guardians provided written informed consent.”

direct quote[Methods, 'Study design' subsection]

“The trial was conducted in compliance with CONSORT (consolidated standards of reporting trials) guidelines.”

PASSReviewer 3· 95% conf

Ethical approvals are fully and adequately reported: named ethics committee approval with protocol number, informed consent, and regulatory compliance.

Evidence

direct quote[Methods, Study design]

“The study was approved by the ethics committee of the Children's Hospital of Chongqing Medical University (No 2019.161)”

direct quote[Methods, Study design]

“Informed consent was obtained from parents or guardians antenatally or upon admission to the neonatal intensive care unit”

direct quote[Methods, Study design]

“The trial was conducted in compliance with CONSORT (consolidated standards of reporting trials) guidelines.”

Continuous flow devices for NCPAP (Comen NV8, Mindray NB350) and NHFOV ventilators (Fabian-III, SLE 5000, Leoni+) are named with manufacturer and country. Surfactant (Curosurf, Chiesi Pharmaceuticals) and caffeine (Chiesi Pharmaceuticals) are also identified. R software version 4.4.2 is specified. Antibodies, cell lines, mycoplasma testing, and organisms are not relevant.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 88% conf

The investigational products (ventilators, surfactant, caffeine) are identified with manufacturer and details; software is identified with version.

Evidence

direct quote[Methods, 'Study procedure']

“Continuous flow devices (Comen NV8, China; Mindray NB350, China; supplementary eTable 2) were used to provide NCPAP.”

direct quote[Methods, 'Surfactant treatment']

“Surfactant treatment (Curosurf, Chiesi Pharmaceuticals) was administered at a dose of 200 mg/kg”

direct quote[Methods, 'Statistical analysis']

“All statistical analyses were conducted in R software (version 4.4.2).”

PASSReviewer 2· 95% conf

The investigational products (ventilator devices and pharmaceuticals) are identified with manufacturer details, and the statistical software is specified. Other resource categories are not applicable for this clinical trial.

Evidence

direct quote[Methods, 'Study procedure' subsection]

“Continuous flow devices (Comen NV8, China; Mindray NB350, China)”

direct quote[Methods, 'Study procedure' subsection]

“NHFOV was delivered using piston or membrane oscillators capable of active expiration, including the Fabian-III (Acutronic, Switzerland), SLE 5000 (SLE (UK)) and Leoni+ (Löwenstein Medical, Germany)”

direct quote[Methods, 'Statistical analysis' subsection]

“All statistical analyses were conducted in R software (version 4.4.2).”

PASSReviewer 3· 95% conf

Key resources are adequately identified: investigational devices (NCPAP and NHFOV) are named with manufacturer details, and software is identified with version.

Evidence

direct quote[Methods, Study procedure]

“Continuous flow devices (Comen NV8, China; Mindray NB350, China) were used to provide NCPAP.”

direct quote[Methods, Study procedure]

direct quote[Methods, Statistical analysis]

“All statistical analyses were conducted in R software (version 4.4.2).”

The primary analysis uses chi-square test for dichotomous outcomes and risk differences with 95% CIs. Student's t-test and Mann-Whitney U test are mentioned for continuous variables. Exact p-values are reported (e.g., P=0.007, P=0.008). The sample size calculation and intention-to-treat approach are described. The CONSORT flowchart and Table 2 provide per-group n and event rates.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedADEQUATE

mathematical plausibilityN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 93% conf

Statistical tests are named, exact p-values and 95% CIs are reported, software is identified, and data presentation with per-group n and risk differences is adequate for a clinical trial.

Evidence

direct quote[Methods, 'Statistical analysis']

“Comparisons were performed using Student’s t test for parametric continuous variables, Mann-Whitney U test for non-parametric continuous variables, and χ 2 test for dichotomous variables, respectively.”

direct quote[Results, 'Primary outcome']

“risk difference −12.0 percentage points, 95% confidence interval −20.7 to −3.4; P=0.007”

direct quote[Methods, 'Statistical analysis']

“All statistical analyses were conducted in R software (version 4.4.2).”

PASSReviewer 2· 97% conf

Statistical methods are appropriate and well-reported, including named tests, exact p-values with confidence intervals, effect sizes, and software identification. Data presentation is adequate for a clinical trial. Mathematical plausibility checks are not applicable given the large-sample context.

Evidence

direct quote[Methods, 'Statistical analysis' subsection]

direct quote[Results, 'Primary outcome' subsection]

“risk difference −12.0 percentage points, 95% confidence interval −20.7 to −3.4; P=0.007”

direct quote[Table 2]

“27/170 (15.9) | 48/172 (27.9)”

PASSReviewer 3· 95% conf

Statistical methods are well-described: tests are named, exact p-values and CIs are reported, software is identified, and data presentation includes per-group n and defined error metrics.

Evidence

direct quote[Results, Primary outcome]

“risk difference −12.0 percentage points, 95% confidence interval −20.7 to −3.4; P=0.007”

direct quote[Methods, Statistical analysis]

“Comparisons were performed using Student’s t test for parametric continuous variables, Mann-Whitney U test for non-parametric continuous variables, and χ 2 test for dichotomous variables”

direct quote[Methods, Statistical analysis]

“All statistical analyses were conducted in R software (version 4.4.2).”

A data availability statement is present in the manuscript, stating that the code is in supplemental files and the data are openly available at a Mendeley Data repository with a DOI (10.17632/66gc4zb37c.1). This constitutes reported_and_adequate for all three applicable criteria: data_availability_statement, repository_deposit, and code_sharing. Accession numbers are not applicable as this is not sequencing data.

Sub-criteria

code sharingADEQUATE

accession numbersN/A

repository depositADEQUATE

data availability statementADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 96% conf

Data are deposited in a public repository with a DOI, and the code is available in supplemental files; a data availability statement is provided.

Evidence

direct quote[Data availability statement]

“The data underlying the findings in this paper are openly and publicly available and can be found at https://data.mendeley.com/datasets/66gc4zb37c/1 or Zhu, Xingwang (2025) “NHFOV as Primary Support in Very Preterm Infants With RDS,” Mendeley Data, V1, doi: 10.17632/66gc4zb37c.1”

direct quote[Data availability statement]

“The code used to analyse the data in the paper can be found in the supplemental files.”

WARNReviewer 2· 90% conf

The data availability statement is adequate, with data deposited in a public repository (Mendeley Data) with a DOI. However, the code is only available in supplemental files, not in a version-controlled public repository with a persistent identifier, which is inadequate.

Evidence

direct quote[Data availability statement section]

“The code used to analyse the data in the paper can be found in the supplemental files.”

PASSReviewer 3· 95% conf

Data and code availability are well-addressed: a data availability statement names a public repository with a DOI, access is stated as open, and code is shared in supplemental files.

Evidence

direct quote[Data availability statement]

“The code used to analyse the data in the paper can be found in the supplemental files.”

The trial is registered at ClinicalTrials.gov (NCT05141435). CONSORT guidelines are followed. All pre-specified primary and secondary outcomes are reported with results, including non-significant findings. A dedicated strengths and limitations section addresses sources of bias, generalizability, and other limitations. Conclusions appropriately state that NHFOV 'appeared superior' and note no significant differences in adverse events. Funding sources and a conflict of interest statement are provided.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 91% conf

The paper reports methods in sufficient detail for replication, is registered, cites CONSORT, discusses limitations, and conclusions are proportional; funding and competing interests are declared.

Evidence

direct quote[Abstract; Methods]

“Trial registration ClinicalTrials.gov NCT05141435”

direct quote[Methods, 'Study design']

“The trial was conducted in compliance with CONSORT (consolidated standards of reporting trials) guidelines.”

direct quote[Funding; Competing interests]

“The study was partially funded by National Key Research and Development Program of China (No 2022YFC2704803)”

PASSReviewer 2· 97% conf

The manuscript is transparent and complete, including trial registration, adherence to CONSORT, comprehensive outcome reporting, limitations discussion, proportional conclusions, and funding/COI disclosure.

Evidence

direct quote[Methods, 'Study design' subsection]

“The study was approved by the ethics committee of the Children's Hospital of Chongqing Medical University (No 2019.161) and was registered at ClinicalTrials.gov ( NCT05141435 ).”

direct quote[Discussion, 'Strengths and limitations' subsection]

“Nevertheless, several limitations should be acknowledged. Clinician masking was unfeasible owing to the inherently distinct interventions...”

direct quote[Funding and Competing interests sections]

“The study was partially funded by National Key Research and Development Program of China (No 2022YFC2704803)...”

PASSReviewer 3· 95% conf

The manuscript demonstrates high reporting transparency: trial registration, CONSORT adherence, limitations discussion, proportional conclusions, and funding/COI disclosure are all adequate.

Evidence

direct quote[Abstract, Methods]

“Trial registration ClinicalTrials.gov NCT05141435”

direct quote[Methods, Study design]

“The trial was conducted in compliance with CONSORT (consolidated standards of reporting trials) guidelines.”

direct quote[Discussion, Strengths and limitations]

“Nevertheless, several limitations should be acknowledged. Clinician masking was unfeasible owing to the inherently distinct interventions”

8 copyedit issues flagged: mostly typo, consistency, clarity.

Checked 37 references: 36 verified — 1 not checked.

Reproducibility

1 data/code link checked; 1 live.

Registered (1 ID: ClinicalTrials.gov). Reporting guideline cited: CONSORT.

Adcurare Rigor Action ItemsFinal pass before journal submission

The manuscript is ready after minor edits. The two warn-rated items (ethics framework statement, code repository) and the copyedit fixes (stray backtick, typo, Table 3 footnote mislabel) should be addressed before submission; none are likely to cause rejection if fixed.

1.
HIGHethics
Add an explicit statement that the trial was conducted in accordance with the Declaration of Helsinki and/or ICH-GCP guidelines in the Methods (Study design) section, alongside the existing CONSORT compliance statement.
Current regulatory compliance only references CONSORT (a reporting guideline), not an international ethical framework; this is required for ethical approvals adequacy.
2.
HIGHdata code
Upload the analysis code to a version-controlled public repository (e.g., GitHub, Zenodo, or OSF) with a persistent DOI and update the Data availability statement accordingly.
Code in supplemental files lacks version control and a permanent identifier, which is increasingly expected for full reproducibility.
3.
MEDIUMstatistics
Add a brief sentence in the Statistical analysis section describing whether test assumptions (normality, equal variance) were verified and, if so, the results (e.g., 'Normality was assessed using the Shapiro-Wilk test; non-parametric tests were used where assumptions were violated').
The absence of formal assumption verification was noted as a minor gap; making it explicit raises reporting quality.
4.
MEDIUMstatistics
Add a statement on how outliers in continuous outcomes were handled, or state that no data were excluded as outliers, in the Statistical analysis section.
Standard reporting practice for clinical trials to clarify a priori handling of extreme values.
5.
MEDIUMcopyedit
Remove the stray backtick after 'of' in the Abstract (Results): '27 of` 170' should read '27 of 170'.
Stray punctuation is a typographical error that will be noted by editors.
6.
MEDIUMcopyedit
Correct the typo in the Affiliations section: 'Technology & Resrach (A*STAR)' to 'Technology & Research (A*STAR)'.
Spelling error in author affiliations undermines manuscript polish.
7.
MEDIUMcopyedit
Revise the Table 3 footnote that states 'Risk difference reported as median (interquartile range)'; if a difference in medians is reported, rephrase to 'Difference in medians (interquartile range)' or clarify what is actually being presented.
Risk difference is a measure for proportions; mislabeling a median difference could confuse readers and editors.
8.
MEDIUMreporting
In the Discussion (Strengths and limitations), consider breaking the long sentence about surfactant redosing into two sentences for clarity.
Long sentences reduce readability; the copyedit flagged this as a clarity issue.
9.
LOWreporting
Report the number of infants screened per site to allow assessment of site-level variability in recruitment.
Highly recommended for multicentre trials, though not required; enhances transparency.
10.
LOWcopyedit
Standardise the spelling of 'mm Hg' throughout the manuscript (Methods and Table 1) to ensure consistent presentation.
Minor consistency issue flagged by the copyedit pass.
11.
LOWstatistics
Consider providing exact p-values (e.g., 0.22) rather than threshold statements for all secondary outcomes (already partially done in tables; verify consistency in text).
Exact p-values are already reported in tables; ensure the text also uses exact values where applicable.

Full text (50,834 chars)Analyzed: Jul 6, 2026

Read alongside