Every year around 4,000 women in the UK give birth very early because of complications with their pregnancy. Around one in ten babies of very low birth weight develop a form of cerebral palsy, which has a lifelong impact on children and families.
Magnesium sulphate (MgSO4) given during preterm labour protects the infant’s brain. This reduces the relative risk of cerebral palsy in very preterm infants by 30 per cent. A dose costs around £1.60 – the estimated lifetime societal savings per case of cerebral palsy avoided is around £1 million. (1)
In 2015, NICE (NG25) recommended giving MgSO4 during very preterm births as a core part of maternity care to help protect preterm babies from avoidable cerebral palsy. (2) However, University of Bristol research led by Professor Karen Luyt showed that the uptake in England was inconsistent, and lower than much of the developed world.
To increase uptake of MgSO4, an evidence-based QI programme PReCePT (Preventing cerebral palsy in preterm babies) was conceived alongside colleagues at St Michael’s maternity hospital in Bristol. In collaboration with and funded by Health Innovation West of England and NIHR Applied Research Collaboration (ARC) West, PReCePT was piloted in five NHS Trusts in the West of England. As well as designing, testing and embedding practice change, PreCePT incorporated the principles of coproduction and co-design, involving parents of preterm babies, obstetric, midwifery and neonatal clinical teams.
The pilot generated an example of regional best practice, which led to PReCePT becoming a national adoption and spread programme between 2018-2020. It was the first ever perinatal QI programme delivered at scale across the whole country.
By March 2020, all 152 maternity units in England had adopted PReCePT, significantly reducing variation in administration rates of MgSO4 and achieving the national target of 85% uptake (3). In 2023, an evaluation of the national programme, led by NIHR ARC West, found that PReCePT was both effective and cost-effective. (4)
PreCePT is one of seven interventions that form part of the Maternity and Neonatal Safety Improvement Programme’s preterm optimisation pathway. This is part of the wider National Patient Safety Improvement Programmes, which are a key part of the NHS Patient Safety Strategy to deliver safety and quality improvements across the NHS in England. The impact of these programmes helps meet the ambition of the NHS Patient Safety Strategy, to save an additional 1,000 lives and £100 million per year. (5)
References
(2) Overview | Preterm labour and birth | Guidance | NICE
(4) Preventing cerebral palsy in premature babies: the PReCePT programme – ARC West (nihr.ac.uk)