Issue 8 – June 2019

Corticosteroids and magnesium sulfate delivered to a mother who is at risk of preterm delivery improve a newborn’s short- and long-term outcomes. Magnesium sulfate reduces the relative risk of cerebral palsy in very preterm infants by 30%¹, while steroids promote lung maturity and circulatory stability². The American College of Obstetricians and Gynecologists recommends that women who are at risk of delivery between 24 weeks 0 days and 33 weeks 6 days gestation receive both interventions³.

This analysis included 242,850 infants born 22 to 29 completed weeks’ gestational age. From 2012 to 2017, exposure to antenatal steroids increased from 80% to 84% while exposure to magnesium sulfate increased from 46% to 63%.

In West-England we co-designed, with parents, obstetric, midwifery and neonatal clinical teams, a quality improvement initiative called PReCePT (Prevention of Cerebral Palsy in Preterm Labour), which was implemented in five maternity units starting in 2015. The uptake of magnesium sulfate increased from 21% to 88% within six months, with sustained effect three years later⁴. The PReCePT results influenced the United Kingdom national preterm labor guideline, which recommends intrapartum magnesium sulfate in preterm labor below 30 weeks gestation⁵. Magnesium sulfate for neuroprotection was recently adopted into national health policy by inclusion in the National Health Service Long Term Plan⁶.

PReCePT is now being scaled up as a national program to all 152 maternity units in England⁵, using a regional academic health service network (AHSN) implementation model⁷. The aim is to achieve at least 85% uptake in eligible mothers, to match the uptake of antenatal steroids, and eliminate variability between regions. The first wave of AHSNs is already reporting uptakes of magnesium sulfate exceeding 80% of births <30 weeks gestation. Parent advisers on the PReCePT program have strongly advised that magnesium sulfate be offered to all eligible mothers to help improve the life chances of preterm babies^8,9.

Vermont Oxford Network members, with their long legacy of quality improvement initiatives, are in a strong position to adopt similar perinatal quality improvement interventions that encourage and enable maternity and neonatal teams to collaborate to achieve better neurological outcomes in preterm infants.

1. Doyle LW, Crowther CA, Middleton P, Marret S, Rouse D. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev. 2009(1):CD004661.
2. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006(3):CD004454.
3. Committee Opinion No. 455: Magnesium sulfate before anticipated preterm birth for neuroprotection. Obstet Gynecol. 2010;115(3):669-671.
4. Burhouse A, Lea C, Ray S, et al. Preventing cerebral palsy in preterm labour: a multiorganisational quality improvement approach to the adoption and spread of magnesium sulphate for neuroprotection. BMJ Open Qual. 2017;6(2):e000189.
5. National Institute of Health and Care Excellence. Preterm labour and birth (NG25). 2015.
6. National Health Service. https://www.longtermplan.nhs.uk/online-version/chapter-3-further-progress-on-care-quality-and-outcomes/a-strong-start-in-life-for-children-and-young-people/maternity-and-neonatal-services/
7. The AHSN Network. https://www.ahsnnetwork.com/about-academic-health-science-networks/national-programmes-priorities/precept/
8. PReCePT: A mum’s perspective. https://vimeo.com/301193950
9. PReCePT – using Magnesium Sulphate in Preterm labour https://www.youtube.com/watch?v=PMEjXrBGXpA

This report is made possible by Vermont Oxford Network members who voluntarily contribute data in a global effort to improve the care of high-risk newborns. VON members can view center-specific data by logging on to Nightingale and benchmark against this NICU by the Numbers report.

Editor: Erika Edwards, PhD, MPH

Analyst: Lucy Greenberg, MS

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