We liked both the quantification of the improvements seen in neurocognitive behavior and the context that is provided by an expert not associated with the study. Clear emphasis put on the fact that it’s a very small study and needs confirmation.
Although the preterm birth rate in the United States has fallen in the past several years, it still hovers in the 12% range. Premature birth is associated with a host of short term and long term problems for the child so therapies designed to reduce both are welcomed. The use of drugs to stimulate blood production, obviating the need for transfusions highlighted in this story is a step toward a better understanding of how best to treat this vulnerable population.
The costs of care for premature infants is very high (estimated to be $50,000 in a 2007 study) in comparison to children born at term. Both drugs used in the study are expensive as well, adding to the cost of care. We appreciate that there are likely economic and clinical tradeoffs that extend to later life in these children (at least based on the study results) but some estimate of treatment costs could easily have been included in the story.
We liked the way in which the tidy results were provided. We are told of the absolute scoring differences between the groups.
“They scored about 12 points higher on average on IQ tests than the untreated kids but about 10 points lower than the normal-weight group. On tests measuring memory and impulsive behavior, the treated kids fared as well as those born at normal weight.”
And then provided with some very some helpful context. “Here’s how those differences would show up in a preschool setting: The untreated group would be the kids who struggle a little in class, while the those who got the medicines would do OK but not as well as those born at a normal weight, said Dr. Michael Schreiber, a prematurity expert at the University of Chicago’s Comer Children’s Hospital.”
Even if a study is silent on potential harms, the terrific added value of reporting a story for the public is that journalists can ask questions a study does not, and provide additional context. In this case, it would have strengthened the piece if one of the experts quoted had been asked to address potential harms even in a general way.
The story does not provide sufficient information about the study, its design and potential shortcomings. The study design was a double blind placebo controlled trial that originally enrolled 102 preterm infants with all three groups receiving additional treatments including blood transfusions and iron supplementation. An interim report provided information on 80 subjects and this report is on 53 children. Based on the story the reader may get the impression that there were no subjects lost to follow up. We think this is always an important issue for journalists covering studies to include.
There is no evidence of disease mongering.
In addition to the enthusiastic comments of the senior author and Dr. Juul (who is conducting an ongoing trial) we are provided with quote from an unaffiliated expert in the field who provided a great comment on what the neuro-cognitive test results could mean in the life of the child.
Beyond a brief mention of blood transfusions, the story does not provide information on what is currently done clinically to help premature infants. As noted, the subjects in the study all received additional standard treatments which are presumably provided as routine care. Some discussion of comparisons would have been helpful.
The story does provide information on the availability of both drugs and there widespread use in cancer treatments. In that context, we were pleased to see the comments by Dr. Schreiber who “…said larger studies including more diverse patient populations are needed to determine if the drugs can help a broader range of preemies,” according to the story.
The use of erythropoetin in premature infants has been the subject of a number of studies primarily looking at the need for blood transfusion. A 2010 published report in a larger sample followed for 10-13 years reported similar findings. Admittedly, the study was an observational study and not randomized. Technically then this is a first of its kind study.
The story does not rely on a news release.