Preventing cerebral palsy in premature babies: finding the best way to help maternity units improve their perinatal care

Premature birth is the main cause of brain injury and cerebral palsy in babies. Babies can be protected from brain injury by giving magnesium sulfate to mothers going into premature labour at less than 30 weeks gestation. It is a cheap and safe medicine that reduces the risk of cerebral palsy by around 30%. Until recently, it was not being consistently given in maternity units in the UK. This means many cases of brain injury in premature babies could have been avoided.

The AHSN Network’s national PReCePT (Prevention of cerebral palsy in pre-term labour) programme aimed to increase the use of magnesium sulfate to at least 85% of eligible mothers, using ‘Quality Improvement’ approaches. Quality Improvement (QI) is a systematic, formal approach to improving the performance of health services.

The PReCePT study was nested in the programme. The study was a randomised controlled trial in 40 maternity units across England. Randomised controlled trials are considered the ‘gold standard’ of research studies.

The PReCePT study was funded by the Health Foundation Scaling Up Improvement Programme and ran from December 2017 – November 2020. It was led by University Hospitals Bristol and Weston NHS Foundation Trust, in partnership with the National Institute for Health Applied Research Collaboration West (NIHR ARC West) and the West of England Academic Health Science Network (AHSN). The Chief Investigator is Professor Karen Luyt, a neonatologist at St Michael’s Hospital in Bristol.

Project aims

In the PReCePT study, we compared two different ways to help maternity units improve their use of magnesium sulfate, to see which was most effective and cost-effective.

What we did

The ‘control’ group were all taking part in the national PReCePT programme. This gave all maternity units in England clinical guidance, staff training, regional support from local Academic Health Science Networks (AHSNs), and funding for dedicated time of a ‘champion’ midwife at each unit.

The ‘enhanced support’ group were also taking part in the national programme, but received extra funding for staff time, and more personalised support from QI coaches.

We used data from the National Neonatal Research Database on mothers and babies, and we interviewed midwives and doctors working at maternity units to find out about their experiences.

What we found and what this means

Maternity units in both groups improved, with more mothers being given magnesium sulfate to protect their premature babies.

In the year before the study started, 68% of eligible mothers in the control group and 64% of mothers in the enhanced support group received magnesium sulfate. After the study, this had gone up to 84% and 85%. After adjusting for other factors, the two groups had improved by very similar amounts. The standard National PReCePT Programme (control group) supported by AHSNs was the most cost-effective way to improve use of magnesium sulfate.

However, staff in the enhanced support group tended to understand the issues better and had better teamwork. This may be important because a 2022 review of poor care in the worst-performing maternity units in England found that a lack of teamwork was a significant contributory factor.

What next?

We are now planning a study that will give a new and better measure of how well magnesium sulfate protects premature babies from cerebral palsy in the UK. It will find out how many cases of cerebral palsy have been avoided in England because of the PReCePT programme, and how much money has been saved by protecting these babies. And it will look at the overall trends in cerebral palsy in the UK, including how many children are affected and who is at higher risk.