PReCePT2: Reducing brain injury through improving uptake of magnesium sulphate in preterm deliveries

Premature birth is the leading cause of brain injury and cerebral palsy in babies. Evidence shows that you can protect babies from brain injury by giving women who are at risk of having a premature delivery magnesium sulphate. This protects babies’ brains and reduces the risk of cerebral palsy in a third of cases. But two thirds of premature babies in the UK do not receive this highly cost-effective treatment, which costs approximately £1 per dose.

To increase the uptake of the treatment, a quality improvement package, PReCePT1, has been successfully implemented in five maternity units in West England. The package was co-designed by clinical teams and mothers who had experienced premature deliveries. The proportion of women at these units receiving magnesium sulphate increased from 35% before the intervention to around 60% during and after the intervention. 

This Scaling Up Improvement project, PReCePT2, will scale this quality improvement package to another 10 maternity units across the UK. The project will use and evaluate the effectiveness of two different approaches to delivering the magnesium sulphate treatment: supported versus a self-engaged implementation.   

PReCePT2 is designed to increase awareness and knowledge about use of magnesium sulphate as a treatment during premature delivery. The project will provide practical tools and training to staff in acute clinical settings so they consider the treatment in women who are at risk of having a premature delivery.  

The project will involve clinical training at each site and quality improvement training at learning events. There will be visual data management and ‘nudges’ to remind staff and to encourage behaviour change. Engagement with patients and voluntary groups and use of social networks will all raise the profile of PReCePT2.

All women who are admitted to the participating maternity units with an imminent very premature delivery (less than 30 weeks gestational age) will benefit from this intervention, which if it were scaled up to a national level would mean around 11,000 infants per year benefiting. 

Funded by NHS England, PReCePT is also one of the seven local AHSN programmes to have been selected for adoption and spread across the national AHSN Network during 2018-2020. This work will be led by the West of England AHSN. 
 
This work will bring together the 15 AHSNs and the aligned drivers of the Maternal and Neonatal Health Safety Collaborative (MNHSC) and the national Patient Safety Collaboratives (PSCs) to support the aim of achieving 85% uptake of administration of magnesium sulphate to preterm babies in all maternity units in England, with a stretch target of 95% by 2020.

Find out more

• NIHR CLAHRC West: Magnesium sulphate as a neuroprotector in preterm birth and approaches to change in clinical practice
• West of England Academic Health Science Network video: Preventing cerebral palsy in preterm labour (PReCePT) 

Contact details

For further information about the project, please email Dr Karen Luyt, Consultant in Neonatal Medicines and Consultant Senior Lecturer in Neonatal Neuroscience, University Hospitals Bristol NHS Trust.