Dear editor,
Prematurity is defined by the World Health Organization as when a baby is born before 37 weeks. A subclassification can also be made, such as extremely premature when the birth occurs before 28 weeks of gestation, very premature when the birth occurs between 28 and 32 weeks of gestation and moderate to late premature when it occurs between 32 and 37 weeks of gestation.¹ Preterm birth is one of the main causes of neonatal morbidity and mortality, and can lead to short- and long-term complications, such as intellectual and growth problems and the early onset of chronic diseases, which is uncommon in babies born at term. The risks brought about by prematurity are inversely proportional to the gestational age at which the birth occurred, making newborns considered extremely immature the most susceptible to problems related to the condition.²
A detailed analysis of the publication "Training in infant care and auriculotherapy techniques for mothers of premature newborns: a double-blind clinical trial"³ reveals that important information about the results was not presented and that it deserves to be clarified for its usefulness as scientific evidence and in clinical practice.
In the Table below, we present the data from Table 3 of the study by Ghasempour et al.³ with additional information on the clinical effect measure (Cohen's d) for the significant outcomes.⁴ First, it is noted that the training group produced a clinical effect classified as large (d=0.99), while the auriculotherapy group had a medium effect (d=0.78) in reducing anxiety. Despite the relevant clinical effects, the training group performed better in this outcome. Similarly, in the stress outcome, the clinical effect is very similar, both being of large magnitude (d≥0.80) (Table 1).
As for the depression outcome, a large and medium clinical effect was observed for the training and auriculotherapy groups, respectively, in reducing depressive symptoms. However, the control group showed worsening of depressive symptoms considered to be of almost medium effect, which highlights the importance of psychological support to avoid this outcome. This information was not presented in the results; they only showed the statistical difference without its real semantics (Table 1).
For the coping response outcome, it was observed that both the control, auriculotherapy and training groups had relevant clinical effects (d≥0.50). However, the training group showed a very large clinical effect for coping responses (d≥1.20), more than twice the effect of the auriculotherapy group. In addition, it is possible to highlight that the natural history of the event itself produces strong improvements in coping responses (control: d=0.50). This same pattern is observed for the problem-oriented outcome (Table 1).
This new information on clinical effect and direction of effect is useful in assessing the practical applicability of interventions, since statistical differences alone are not sufficient to use research findings. Therefore, the training group has been shown to be more efficient in improving symptoms of anxiety, depression, coping response and problem-oriented response than auriculotherapy. Furthermore, the absence of intervention worsens depressive symptoms and, on the contrary, helps in coping response and problem-oriented response.

References
1. World Health Organization (WHO). Preterm birth [Internet]. Geneva: WHO; 2023. [access in 2024 Nov 7]. Available from: https://www.who.int/news-room/fact-sheets/detail/preterm-birth
2. Ohuma EO, Moller AB, Bradley E, Chakwera S, Hussain-Alkhateeb L, Lewin A, et al. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet. 2023 Oct 7; 402 (10409): 1261-71.
3. Ghasempour Z, Abolhassani M, Gholami A, Karimi F, Dokhaei M, Rabiee N. Training in child care and carrying out auriculotherapy techniques for mothers of premature newborns: double-blind clinical trial. Rev Bras Saúde Mater Infant. 2024; 24: e20220391.
4. Kallogjeri D, Piccirillo JF. A Simple Guide to Effect Size Measures. JAMA Otolaryngol Head Neck Surg. 2023 May; 149 (5): 447-51.

Author's contribution: All the authors participated in the drafting of the letter to the editor and approved the final version. The authors declare no conflict of interest.

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Received on December 17, 2024
Final version presented on December 18, 2024
Approved on December 18, 2024

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Associated Editor:Alex Sandro Souza