Reviewer's report 
 Antiviral Therapy In Neonatal Cholestatic Cytomegalovirus Hepatitis Title: 
 3  22 October 2006 Version: Date: 
 Gail Demmler Reviewer: 
Reviewer's report: 
General 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
Manuscripts has many limitations, but some potential for publicaiton after significant revisions. I have sent 
this review in on line once before in mid October. Was it not received????????????????????????????? I have many corrections to the manuscript and it is timie consuming to re enter them. 
Here are my suggestions: 
1. Statistical review is indicxated because the cells appear much too small for the statistics used and also 
the methods stated do not seem to be the correct name ("Fisher's Chi square??" 
2. The authors present a series of infants with hepatitis associated with laboratory evidence of active CMV 
infection, some of whom were treated and some of whom were observed. Specific comments include: 
a. Grammatical style and spelling issues to include 
1. it is not necessary to capitalize "hepatitis, cytomegalovirus, adenovirus, parvovirus, ganciclovir, etc. as it 
was done (page 2,3,4,5,8) 
2. Epstein-Barr virus is correct spelling, NOT "EBSTEIN-" as in manuscript (page 3 and page 8) 
3. the correct spelling fo ru>S. is "cidofovir" and not "sidofovir" as in manuscript (page 9) 
4. parenthesis is backward (page 3) 
5. term "antiviral serology" is not correct; better to state "serologic and virologic (page 2) 6. term "serologically improvement" is not acceptable; better to state "improvement serologically adn virologically" (page 2) 
7. spelling "alkaline" 
8. Better sentence "Approximately 40% of cholestatsis in infants is due to neonatal hepatitis ..." (page 2) 9. Methods - "Twelve infants diagnosed with neonatal CMV .." (page 2) 10. Conclusion- not accurate to state "perinatal infection has/is associated with CMV diseases " Better to 
make a clear distinction between congenital and perinatal and postnatal CMV infection as they are 
different.(page 2 and 3) 11. Not accurate to say "But there are some consequences about the pathology..." Better to say "Controversy exists about the pathogenesis..." (page 3). 
12. word "inconsiderable" is inaccurate better to say "of concern" (page 4) 
13. word use "control group: is not accurate; better to use "comparison group: as they were not really controls. (throughout manuscript/many pages) 14. spelling of word "intrauterine" not intrauterin (page 8) 
15. term "postnatal contamination" is not accurate; better to state "perinatal exposure to CMV infected 
cervicovaginal secretion and maternal breast milk " (*page 8) 16. "unlike" not accurate' "unlikley" is better term ; "presence" better than "existence".(page 8) 17. delete sentence on page9 that begins "Foscarnet and cidofovir..." and revise to say "Most common 
adverse effects of ganciclovir treatment include dose-dependent neutropenia and blood counts, inlduing 
ANC counts should be monitored closely during teatment" . Also, it is not really correct that ganciclovir is 
renal toxic; it is renal excreted. 
18. The conclusions should be revised considerably. 
Other comments: 
1.The design of the study is biased, since comparison group was self-selected and differed significantly by age (much older infants ) and severity of infection (less severe disease)that treatment group. This is a flaw. 
2. CMV DNA viral load is not a serologic test, it is a viral DNA test done on blood, sually whole blood. 
3. It is not clear wshther the infants were congneintal or perinatally infected or even post natally infected as 
infants. Was CMV testing done at birth or later?? Authors MUST iunclude this information. 
4. Why was 3 weeks chosen for duration of therapy and not longer or shorter? 
5. In the tables and manuscript, it is not necessary to report the nonsignificant P values, just state N.S. 
6. On page 6, it is stated "all babies", but it is not clear if this refers to both groups 1 and 2 or what ??? Please clarify. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Not suitable for publication unless extensively edited Quality of written English: 
 Yes Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests. 
Reviewer's report 
 Antiviral Therapy In Neonatal Cholestatic Cytomegalovirus Hepatitis Title: 
 3  22 October 2006 Version: Date: 
 Gail Demmler Reviewer: 
Reviewer's report: 
General 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
Manuscripts has many limitations, but some potential for publicaiton after significant revisions. I have sent 
this review in on line once before in mid October. Was it not received????????????????????????????? I have many corrections to the manuscript and it is timie consuming to re enter them. 
Here are my suggestions: 
1. Statistical review is indicxated because the cells appear much too small for the statistics used and also 
the methods stated do not seem to be the correct name ("Fisher's Chi square??" 
2. The authors present a series of infants with hepatitis associated with laboratory evidence of active CMV 
infection, some of whom were treated and some of whom were observed. Specific comments include: 
a. Grammatical style and spelling issues to include 
1. it is not necessary to capitalize "hepatitis, cytomegalovirus, adenovirus, parvovirus, ganciclovir, etc. as it 
was done (page 2,3,4,5,8) 
2. Epstein-Barr virus is correct spelling, NOT "EBSTEIN-" as in manuscript (page 3 and page 8) 
3. the correct spelling fo ru>S. is "cidofovir" and not "sidofovir" as in manuscript (page 9) 
4. parenthesis is backward (page 3) 
5. term "antiviral serology" is not correct; better to state "serologic and virologic (page 2) 6. term "serologically improvement" is not acceptable; better to state "improvement serologically adn virologically" (page 2) 
7. spelling "alkaline" 
8. Better sentence "Approximately 40% of cholestatsis in infants is due to neonatal hepatitis ..." (page 2) 9. Methods - "Twelve infants diagnosed with neonatal CMV .." (page 2) 10. Conclusion- not accurate to state "perinatal infection has/is associated with CMV diseases " Better to 
make a clear distinction between congenital and perinatal and postnatal CMV infection as they are 
different.(page 2 and 3) 11. Not accurate to say "But there are some consequences about the pathology..." Better to say "Controversy exists about the pathogenesis..." (page 3). 
12. word "inconsiderable" is inaccurate better to say "of concern" (page 4) 
13. word use "control group: is not accurate; better to use "comparison group: as they were not really controls. (throughout manuscript/many pages) 14. spelling of word "intrauterine" not intrauterin (page 8) 
15. term "postnatal contamination" is not accurate; better to state "perinatal exposure to CMV infected 
cervicovaginal secretion and maternal breast milk " (*page 8) 16. "unlike" not accurate' "unlikley" is better term ; "presence" better than "existence".(page 8) 17. delete sentence on page9 that begins "Foscarnet and cidofovir..." and revise to say "Most common 
adverse effects of ganciclovir treatment include dose-dependent neutropenia and blood counts, inlduing 
ANC counts should be monitored closely during teatment" . Also, it is not really correct that ganciclovir is 
renal toxic; it is renal excreted. 
18. The conclusions should be revised considerably. 
Other comments: 
1.The design of the study is biased, since comparison group was self-selected and differed significantly by age (much older infants ) and severity of infection (less severe disease)that treatment group. This is a flaw. 
2. CMV DNA viral load is not a serologic test, it is a viral DNA test done on blood, sually whole blood. 
3. It is not clear wshther the infants were congneintal or perinatally infected or even post natally infected as 
infants. Was CMV testing done at birth or later?? Authors MUST iunclude this information. 
4. Why was 3 weeks chosen for duration of therapy and not longer or shorter? 
5. In the tables and manuscript, it is not necessary to report the nonsignificant P values, just state N.S. 
6. On page 6, it is stated "all babies", but it is not clear if this refers to both groups 1 and 2 or what ??? Please clarify. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Not suitable for publication unless extensively edited Quality of written English: 
 Yes Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests. 
Please review this paper.
user
Reviewer's report 
 Antiviral Therapy In Neonatal Cholestatic Cytomegalovirus Hepatitis Title: 
 3  22 October 2006 Version: Date: 
 Gail Demmler Reviewer: 
Reviewer's report: 
General 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
Manuscripts has many limitations, but some potential for publicaiton after significant revisions. I have sent 
this review in on line once before in mid October. Was it not received????????????????????????????? I have many corrections to the manuscript and it is timie consuming to re enter them. 
Here are my suggestions: 
1. Statistical review is indicxated because the cells appear much too small for the statistics used and also 
the methods stated do not seem to be the correct name ("Fisher's Chi square??" 
2. The authors present a series of infants with hepatitis associated with laboratory evidence of active CMV 
infection, some of whom were treated and some of whom were observed. Specific comments include: 
a. Grammatical style and spelling issues to include 
1. it is not necessary to capitalize "hepatitis, cytomegalovirus, adenovirus, parvovirus, ganciclovir, etc. as it 
was done (page 2,3,4,5,8) 
2. Epstein-Barr virus is correct spelling, NOT "EBSTEIN-" as in manuscript (page 3 and page 8) 
3. the correct spelling fo ru>S. is "cidofovir" and not "sidofovir" as in manuscript (page 9) 
4. parenthesis is backward (page 3) 
5. term "antiviral serology" is not correct; better to state "serologic and virologic (page 2) 6. term "serologically improvement" is not acceptable; better to state "improvement serologically adn virologically" (page 2) 
7. spelling "alkaline" 
8. Better sentence "Approximately 40% of cholestatsis in infants is due to neonatal hepatitis ..." (page 2) 9. Methods - "Twelve infants diagnosed with neonatal CMV .." (page 2) 10. Conclusion- not accurate to state "perinatal infection has/is associated with CMV diseases " Better to 
make a clear distinction between congenital and perinatal and postnatal CMV infection as they are 
different.(page 2 and 3) 11. Not accurate to say "But there are some consequences about the pathology..." Better to say "Controversy exists about the pathogenesis..." (page 3). 
12. word "inconsiderable" is inaccurate better to say "of concern" (page 4) 
13. word use "control group: is not accurate; better to use "comparison group: as they were not really controls. (throughout manuscript/many pages) 14. spelling of word "intrauterine" not intrauterin (page 8) 
15. term "postnatal contamination" is not accurate; better to state "perinatal exposure to CMV infected 
cervicovaginal secretion and maternal breast milk " (*page 8) 16. "unlike" not accurate' "unlikley" is better term ; "presence" better than "existence".(page 8) 17. delete sentence on page9 that begins "Foscarnet and cidofovir..." and revise to say "Most common 
adverse effects of ganciclovir treatment include dose-dependent neutropenia and blood counts, inlduing 
ANC counts should be monitored closely during teatment" . Also, it is not really correct that ganciclovir is 
renal toxic; it is renal excreted. 
18. The conclusions should be revised considerably. 
Other comments: 
1.The design of the study is biased, since comparison group was self-selected and differed significantly by age (much older infants ) and severity of infection (less severe disease)that treatment group. This is a flaw. 
2. CMV DNA viral load is not a serologic test, it is a viral DNA test done on blood, sually whole blood. 
3. It is not clear wshther the infants were congneintal or perinatally infected or even post natally infected as 
infants. Was CMV testing done at birth or later?? Authors MUST iunclude this information. 
4. Why was 3 weeks chosen for duration of therapy and not longer or shorter? 
5. In the tables and manuscript, it is not necessary to report the nonsignificant P values, just state N.S. 
6. On page 6, it is stated "all babies", but it is not clear if this refers to both groups 1 and 2 or what ??? Please clarify. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Not suitable for publication unless extensively edited Quality of written English: 
 Yes Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests. 
assistant