Abstract
Background:
Since 2015, the National Institute for Health and Care Excellence (NICE) guidelines have recommended antenatal magnesium sulfate (MgSO4) for mothers in preterm labour (<30 weeks’ gestation) to reduce the risk of cerebral palsy in the preterm baby. However, implementation of this guideline in clinical practice was slow, and MgSO4 use varied between maternity units. In 2018, the PReCePT programme, an evidence-based Quality Improvement intervention to improve use of MgSO4, was rolled-out across England. Earlier evaluation found this programme to be effective and cost-effective over the first 12 months. We extended the original evaluation to determine the programme’s longer-term impact over four years, its impact in later preterm births, impact of the COVID-19 pandemic, and to compare MgSO4 use in England (where PReCePT was implemented), to Scotland and Wales (where it was not).
Methods:
Quasi-experimental longitudinal study using data from the National Neonatal Research Database on babies born <30 weeks’ gestation and admitted to an NHS neonatal unit. Primary outcome was the percentage of eligible mothers receiving MgSO4, aggregated to the national level. Impact of PReCePT on MgSO4 use was estimated using multivariable linear regression. The net monetary benefit (NMB) of the programme was estimated.
Results:
MgSO4 administration rose from 65.8% in 2017 to 85.5% in 2022 in England. PReCePT was associated with 5.8 percentage points improvement in uptake (95%CI 2.69 to 8.86, p<0.001). Improvement was greater when including older preterm births (<34 weeks’ gestation, 8.67 percentage points, 95%CI 6.38 to 10.96, p<0.001). Most gains occurred in the first two years following implementation. PReCePT had a NMB of £597,000 with 89% probability of being cost-effective. Following implementation, English uptake appeared to accelerate compared to Scotland and Wales. There was some decline in use coinciding with the onset of the pandemic.
Conclusions:
The PReCePT Quality Improvement programme cost-effectively improved use of antenatal MgSO4, with anticipated benefits to the babies who have been protected from cerebral palsy.
Since 2015, the National Institute for Health and Care Excellence (NICE) guidelines have recommended antenatal magnesium sulfate (MgSO4) for mothers in preterm labour (<30 weeks’ gestation) to reduce the risk of cerebral palsy in the preterm baby. However, implementation of this guideline in clinical practice was slow, and MgSO4 use varied between maternity units. In 2018, the PReCePT programme, an evidence-based Quality Improvement intervention to improve use of MgSO4, was rolled-out across England. Earlier evaluation found this programme to be effective and cost-effective over the first 12 months. We extended the original evaluation to determine the programme’s longer-term impact over four years, its impact in later preterm births, impact of the COVID-19 pandemic, and to compare MgSO4 use in England (where PReCePT was implemented), to Scotland and Wales (where it was not).
Methods:
Quasi-experimental longitudinal study using data from the National Neonatal Research Database on babies born <30 weeks’ gestation and admitted to an NHS neonatal unit. Primary outcome was the percentage of eligible mothers receiving MgSO4, aggregated to the national level. Impact of PReCePT on MgSO4 use was estimated using multivariable linear regression. The net monetary benefit (NMB) of the programme was estimated.
Results:
MgSO4 administration rose from 65.8% in 2017 to 85.5% in 2022 in England. PReCePT was associated with 5.8 percentage points improvement in uptake (95%CI 2.69 to 8.86, p<0.001). Improvement was greater when including older preterm births (<34 weeks’ gestation, 8.67 percentage points, 95%CI 6.38 to 10.96, p<0.001). Most gains occurred in the first two years following implementation. PReCePT had a NMB of £597,000 with 89% probability of being cost-effective. Following implementation, English uptake appeared to accelerate compared to Scotland and Wales. There was some decline in use coinciding with the onset of the pandemic.
Conclusions:
The PReCePT Quality Improvement programme cost-effectively improved use of antenatal MgSO4, with anticipated benefits to the babies who have been protected from cerebral palsy.
| Original language | English |
|---|---|
| Article number | e017763 |
| Number of pages | 11 |
| Journal | BMJ Quality and Safety |
| Early online date | 27 Apr 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 27 Apr 2025 |
Bibliographical note
Publisher Copyright:© Author(s) (or their employer(s)) 2025.
Research Groups and Themes
- NIHR ARC West
- HEHP@Bristol