Research highlights

• Significant reduction in risk of Cerebral Palsy in preterm births.
• More equitable implementation of key drug across regions and demographic groups.
• Major influence on healthcare guidelines and NHS strategy.

Advances in neonatal medicine have led to progressively better survival rates for preterm infants. However, until recently, less improvement had been made in preventing brain damage or severe disability during premature birth. Preterm delivery is the leading cause of Cerebral Palsy, for example, which has a lifelong impact on children and families. Every year in the UK around 500 preterm babies develop the condition. 

A programme run out of the University of Bristol has now helped to make significant advances in reducing the risk of neurological damage. The Preventing Cerebral Palsy in Pre-Term birth (PReCePT) programme has successfully reduced cases of Cerebral Palsy by driving the national uptake of magnesium sulphate (MgSO4) for women in England during preterm labour.

PreCEpt, an evidence-based quality improvement programme, has also removed inequalities in health provision and informed national strategies for maternity and neonatal services.

Early research builds case 

The PreCEpt programme is led by Professor Karen Luyt, whose previous research had revealed that current evidence-based clinical interventions with proven benefits for neonatal neuroprotection were underused.

In particular, Professor Luyt showed that uptake of MgSO4, a drug that reduces the risk of Cerebral Palsy by at least 30% when given to women in preterm labour, was highly inconsistent across maternity units, regions and demographics across the UK. In 2014, only one in three babies delivered before 30 weeks’ of pregnancy had the benefit of MgSO4.   

Building on this knowledge, Professor Luyt conceived and developed the PReCePT programme in collaboration with the St Michael’s Perinatal Unit in Bristol. Working with several other partners*, Professor Luyt also played a key role in starting a pilot in five NHS Trusts in the West of England to generate an example of local best practice.

The pilot used the Institute of Healthcare Improvement model to design, test and embed practice change. The pilot was also built on the principles of co-design and involved parents of preterm babies, as well as obstetric, midwifery and neonatal clinical teams.  

Benefit for patients 

The evaluation of the pilot study showed a positive impact on knowledge and practice across the five maternity units. This success subsequently led to a national scale-up of PReCePT that aimed to achieve at least 85% MgSO4 uptake in eligible mothers and eliminate variability between regions.

Across the 156 maternity units in England, the average uptake of MgSO4 as of 31 December 2020 was 88%, with 7,644 mothers and 9,555 preterm babies benefitting during the two-year programme.

Variability between the 14 English regions has also closed impressively; from 37-79% uptake in 2016 to 81-97% in 2020. By maintaining 85% uptake, the annual year-on-year impact will be over 3,000 preterm babies receiving neuroprotection.  

Preterm birth is associated with socio-economic disadvantage and disproportionately affects mothers of BAME heritage. The four English regions with the highest levels of socio-economic deprivation, according to the Marmot Review (2019), were all well below the average national MgSO4 uptake levels in 2016 and 2017.

By 2020, after full implementation of PReCePT, each of these poorest regions were all within 1-2% of the national average of 85%.

The implementation gap between the most and the least deprived regions has effectively closed. Consequently, every preterm baby now has equitable access to MgSO4 neuroprotection to improve their life chances.  

Informing NHS policy and guidance 

Professor Luyt’s early research findings also influenced the original 2015 NICE Preterm labour guideline (NG25), which recommended use of MgSO4 during birth in preterm labour below 30 weeks’ gestation.

Following engagement in the consultation process by Professor Luyt, the 2019 update to the NICE guideline also includes a new recommendation on the use of intravenous MgSO4 for neuroprotection of the baby for women in the 23rd week of pregnancy.  

The NHS Long Term Plan (2019) sets a target to  ‘accelerate action to achieve 50% reductions in stillbirths, maternal mortality, neonatal mortality and serious brain injury by 2025’. Part of this strategy is built around encouraging the NHS towards the ‘clinically appropriate use of magnesium sulphate’ and universal adoption of the PReCePT programme.  

*  The partners that helped establish and fund the pilot were the West of England Academic Health Science Network (WEAHSN) and the NIHR Collaboration for Leadership in Allied Health Research and Care West (CLAHRC West), now NIHR ARC West