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

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.