Evaluation finds PReCePT programme effective in helping prevent cerebral palsy in premature babies
A new evaluation of a national programme to prevent cerebral palsy in premature babies, which the South West Academic Health Science Network (South West AHSN) delivered, has found the innovative initiative to be both effective and cost-effective.
Preventing Cerebral palsy in PreTerm labour, or PReCePT, is an evidence-based project designed to reduce the risk of cerebral palsy in babies by giving magnesium sulphate to mothers in preterm labour.
Premature birth is the main cause of brain injury and cerebral palsy in babies. Evidence shows that babies can be protected from brain injury by giving magnesium sulphate to women who are at risk of premature birth, reducing the risk of cerebral palsy by a third. However, in 2017 only 64% of eligible women were being given magnesium sulphate in England, Scotland and Wales.
PReCePT was developed to increase awareness in maternity practitioners and thereby improve administration of magnesium sulphate.
Originally developed by the West of England Academic Health Science Network in collaboration with University Hospitals Bristol NHS Foundation Trust, the programme was chosen by NHS England for adoption and spread across England during 2018-20 via the national AHSN Network. Here in the South West, the South West AHSN supported the implementation of PReCePT in maternity units in seven NHS Trusts across our region.
The evaluation of the national programme, led by National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), looked at data from the UK National Neonatal Research Database for the year before and year after PReCePT was implemented in maternity units in England.
While use of magnesium sulphate had been increasing before, the study showed that PReCePT was able to accelerate uptake. It increased by 6.3 percentage points on average across all maternity units in England during the first year, over and above the increase that would be expected over time as the practice spread organically. After also adjusting for variations in when maternity units started the programme, the increase in use of magnesium sulphate was 9.5 percentage points. By May 2020, on average 86.4% of eligible mothers were receiving magnesium sulphate.
The researchers also estimated that the programme’s first year could be associated with a lifetime saving to society of £3 million. This accounts for the costs of the programme, administering the treatment and of cerebral palsy to society over a lifetime, and the associated health gains of avoiding cases. This is across all the extra babies the programme helped get access to the treatment during the first year. The findings are published in the Archives of Disease in Childhood.
John Macleod, NIHR ARC West Director, Professor in Clinical Epidemiology and Primary Care at the University of Bristol and principal investigator of the evaluation, said:
“Our in-depth analysis has been able to demonstrate that the PReCePT programme is both effective and cost-effective. The programme has increased uptake of magnesium sulphate, which we know is a cost-effective medicine to prevent cerebral palsy, much more quickly than we could have otherwise expected. We are pleased to have played a part in helping get this cheap yet effective treatment to more babies.”
Watch our video telling the story of premature baby Violet and the midwives who worked to deliver PReCePT at Royal Cornwall Hospital.
While the PReCePT programme is complete, the innovation continues to practiced by maternity and neonatal staff in the South West. The success of PReCePT led to the development of PERIPrem, an innovative bundle of 11 perinatal interventions, including magnesium sulphate, to reduce brain injury and mortality in babies born before 34 weeks’ gestation. The latest data collected from maternity units in the seven NHS Trusts across the South West (October and November 2022) show rates of magnesium sulphate administration have been sustained and continue to improve, with 13 out of 14 eligible mothers receiving the element (93%).