Published: 29 March 2023
A low-cost treatment to prevent cerebral palsy
Every year, over 8,000 women in the UK go into labour less than 30 weeks into their pregnancy (preterm labour), which increases the risk of their babies being born with cerebral palsy. Evidence has shown that giving women a £1 injection of magnesium sulfate during preterm labour helps protect babies’ brains and reduces the risk of cerebral palsy by a third.
Since 2015, NICE guidelines have recommended that all women in preterm labour receive magnesium sulfate. However, uptake of this guidance had been slow, with only 64% of eligible women receiving it in England, Scotland and Wales during 2017. With this in mind, neonatologist Professor Karen Luyt and her team at University Hospitals Bristol and Weston (UHBW) NHS Foundation Trust developed the Prevention of Cerebral Palsy in PreTerm Labour (PReCePT) programme to raise awareness and increase the uptake of magnesium sulfate across England. Supported by the West of England Academic Health Science Network (AHSN), the team initially tested PReCePT in five maternity units in the West of England between 2013 and 2015, helping ensure women were given the choice of receiving magnesium sulfate.
Delivered as a quality improvement programme, their PReCePT toolkit provided training and encouraged teamwork between practitioners providing maternity care. Their approach proved successful, with 88% of eligible women receiving magnesium sulfate after the intervention compared with only 21% at the start. The pilot study was evaluated by NIHR Applied Research Collaboration (ARC) West.* Their evaluation’s results, published in BMJ Open Quality, supported NHS England’s decision to launch the PReCePT programme across all maternity units in England in 2018, with the aim of increasing the use of magnesium sulfate to at least 85% of eligible women by 2020.
Raising national awareness to improve care
Alongside PReCePT’s national rollout, the team carried out a second evaluation funded by the Health Foundation, which investigated the most effective way of increasing magnesium sulfate uptake within maternity units.
Led by UHBW NHS Foundation Trust, and in partnership with NIHR ARC West and West of England AHSN, this randomised controlled trial found that PReCePT alone improved magnesium sulfate uptake in all 40 units studied. Thirteen of these units received additional enhanced support but this didn’t further accelerate magnesium sulfate uptake, although it was associated with better perinatal teamwork.
In research published in the journal Archives of Disease in Childhood, NIHR ARC West’s evaluation estimated that PreCept increased uptake of magnesium sulfate by 6.3 percentage points across all maternity units in England. By mid-2020, 86% of eligible women in preterm labour received the treatment, meaning that between 100 and 200 cases of cerebral palsy were prevented each year.
As well as improving the quality of life for many children and families who could have been affected by cerebral palsy, the PReCePT initiative saved society around £3 million in the first year alone. These savings included lower healthcare costs as fewer babies developed cerebral palsy, as well as accounting for the cost of rolling out the programme.
NIHR ARC West’s Director and lead researcher of the evaluation, Professor John Macleod, said: “Our analysis has been able to demonstrate that the PReCePT programme is both effective and cost-effective. The programme has increased uptake of magnesium sulfate, which we know is a cost-effective medicine to prevent cerebral palsy, much more quickly than we could have otherwise expected.”
Professor Macleod continued: “We at NIHR ARC West are pleased to have played a part in helping get this cheap yet effective treatment to more babies.”
Elly Salisbury received magnesium sulfate as part of the PReCePT project when she went into preterm labour at 27 weeks in 2013. She now has a healthy 9-year-old son and works with the project as a public contributor.
"I am so glad that the PReCePT programme has been rolled out through the AHSNs nationally, and that the NIHR ARC West evaluation has found the programme to be so effective."
Elly Salisbury, mother of preterm baby
Creating long-term impact and wider benefits for NHS patients
The national uptake of magnesium sulfate is currently at 88.5%, despite the healthcare challenges of the pandemic, and every region in England has achieved and sustained their target uptake of 85%.
To confirm this, NIHR ARC West will be evaluating the longer-term impact of the national programme up to 2022, as well as comparing PReCePT with approaches used by Scotland and Wales to increase the use of magnesium sulfate.
"PReCePT demonstrates that investment in and targeted support of clinical teams to bring new treatments into routine use in hospitals, at national scale, can accelerate the use of new evidence-based treatments, enabling equitable health benefits to all babies and ultimately reductions in healthcare and societal costs."
Karen Luyt, Professor of Neonatal Medicine at University of Bristol and UHBW NHS Foundation Trust.
In a wider context, lessons learned from this research about delivering quality improvement among clinical staff can be used to accelerate national uptake of other therapies. To this end, NIHR ARC West are developing a toolkit to support the uptake of new NICE recommendations in other areas and improve wider healthcare for patients.
*The evaluation studies were supported by NIHR Applied Research Collaboration (ARC) West, which is one of 15 ARCs across England. ARCs bring together AHSNs, NHS providers, universities and other organisations to carry out health and care research and then help put those findings into practice to benefit the public.