Structured PREreview of Infectious disease outbreaks among hospitalised neonates in low- and middle-income countries: a systematic review

Does the introduction explain the objective of the research presented in the preprint?

Yes

The introduction clearly explains why neonatal outbreaks are an important public health concern in LMICs and identifies gaps in existing evidence. The authors clearly state their objectives to describe outbreak pathogens, antimicrobial resistance patterns, reported outbreak sources, and the use of WGS in outbreak investigations.

Are the methods well-suited for this research?

Somewhat appropriate

The systematic review design, PRISMA reporting, and registered protocol are well-suited for the study objectives. The use of meta-analysis and the STROBE-NI checklist also provides useful quantitative and reporting-quality assessments.

Are the conclusions supported by the data?

Somewhat supported

The data support the conclusion that drug-resistant Klebsiella is commonly reported in neonatal outbreaks and that WGS and outbreak source investigations remain limited in the included studies. However, the available literature may not represent all neonatal outbreaks in LMICs, especially those occurring in hospitals with limited laboratory or reporting capacity. The conclusions should therefore be interpreted within the context of published outbreak reports rather than all neonatal infections in LMICs.

Are the data presentations, including visualizations, well-suited to represent the data?

Somewhat appropriate and clear

The figures and tables are well-organized. Table 2 provides detailed antimicrobial resistance estimates across regions, while Figure 5 clearly illustrates reporting-quality gaps using the STROBE-NI checklist. However, some pooled AMR estimates have very wide confidence intervals.

How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research?

Somewhat clearly

The discussion has useful explanations of the major findings and their implications for neonatal infection prevention and surveillance. The authors also acknowledge several important limitations, including publication bias, incomplete laboratory data, and geographical underrepresentation. However, I think the discussion could provide more information about how differences in meta-analysis methods may influence the pooled resistance estimates.

Is the preprint likely to advance academic knowledge?

Somewhat likely

This preprint brings together clinical, microbiological, and molecular evidence on neonatal outbreaks in LMICs. It adds useful evident about antimicrobial resistance, reported outbreak sources, and the limited use of WGS.

Would it benefit from language editing?

No

This preprint is clear, and well-organized.

Would you recommend this preprint to others?

Yes, but it needs to be improved

I would recommend this preprint to researchers and healthcare professionals interested in neonatal infections, antimicrobial resistance, hospital epidemiology, and infection prevention. The review identifies important gaps in neonatal outbreak reporting and investigation. However, readers should interpret the pooled resistance estimates more clearly due to the limitations of the included studies.

Is it ready for attention from an editor, publisher or broader audience?

Yes, after minor changes

I think this preprint is worth editorial attention because it solves an important public health issue and provides a comprehensive synthesis of available evidence. Before publication, I would recommend more clarification of the meta-analysis methods, and sensitivity analyses for the pooled resistance estimates.

Competing interests

The author declares that they have no competing interests.

Use of Artificial Intelligence (AI)

The author declares that they did not use generative AI to come up with new ideas for their review.