Insight

When babies are born prematurely (before 37 weeks of pregnancy), survival rates are lower and there is a higher-chance of the baby having a long-term illness (1). ‘Optimisation and stabilisation of the preterm infant’ – making sure vital signs are stable and helping the infant to thrive –  aims to give babies who are born prematurely the best chance of survival and quality of life. It is one of two clinical workstreams within the Maternity & Neonatal Safety Improvement Programme (MatNeoSIP).

The primary aim of the MatNeoSIP is to reduce preterm births, stillbirths, neonatal deaths, brain injuries and unwarranted variation in maternity and neonatal care. The programme works with all maternity and neonatal providers in the East of England on a range of key improvement workstreams.

More than 53,000 babies are born prematurely each year in the UK and complications arising from premature birth are the leading cause of neonatal death (death in the first few weeks after birth) (1). The programme aims to contribute to the national ambition, set out in Safer Maternity Care action plan, to reduce the national rate of preterm births from 8% to 6% by 2030.

Intervention

The optimisation and stabilisation of the preterm infant workstream supports the adoption and spread of nine evidence-based interventions, outlined by the British Association of Perinatal Medicine, to improve health outcomes for mothers and preterm babies. These include but are not limited to:

• Ensure antenatal corticosteroids are offered to women in threatened preterm labour – to accelerate the lung development of the baby.
• Ensure magnesium sulphate is offered to women where preterm birth is imminent or planned – to protect the baby’s brain from injury and reduce the risk of cerebral palsy.
• Ensure optimal umbilical cord management by waiting 60 seconds before clamping the cord in preterm babies – to help prevent a sudden drop in the baby’s blood pressure.
• Ensure volume-targeted ventilation (VTV) is used in combination with synchronised ventilation as the primary mode of respiratory support, if invasive ventilation is required – provide breathing support for premature babies.

What Health Innovation East have been doing:

Health Innovation East’s East of England Patient Safety Collaborative (PSC) has been supporting maternity and neonatal improvement since 2018, with Tendai Nzirawa, maternity clinical improvement lead, leading the workstream since 2019.

The PSC supports the delivery of the ‘Regional Preterm Birth Forum’, bringing together local maternity and neonatal systems (LMNS’s). The forum facilitates collaboration and the sharing of best-practice, alongside promoting relevant research and data-sharing efforts.

At these forums, the PSC shares key data captured by trusts on Badgernet (an electronic maternity notes system) which is then analysed and presented in the MatNeo dashboard. Utilising measurement for improvement principles, clinical expertise and national intelligence, Tendai highlights specific interventions or trusts demonstrating significant progress, alongside interventions or trusts requiring targeted support. In doing this, Health Innovation East champions and enables best-practice to thrive, whilst simultaneously identifying and flagging to teams’ areas that – without immediate quality improvement (QI) – will be less likely to meet national ambitions and targets.

Our work involves engaging with local healthcare providers and supporting them to identify inefficiencies within their practice. By utilising Plan-Do-Study-Act (PDSA) cycles to test changes, we promote evidenced-based practices and support the spread, adoption and sustainability of successful interventions; notably, those where measurement for improvement data demonstrate a reduction in harm, and enhanced outcomes with regards to patient safety.

Impact

The National Patient Safety Improvement Programmes – maternity and neonatal – report that;

Between April 2020 and December 2024 in the East of England:

• Between 15 and 18 lives were saved due to women being given antenatal corticosteroids. This intervention helps to accelerate fetal lung maturity and reduces the risk of complications associated with premature birth.
• Between 42 and 61 babies born at less than 34 weeks survived due to optimal umbilical cord management. This intervention may have resulted in improved mean blood pressure and reduced the need for medication to alter the force of muscular contractions.
• 799 women giving birth before 30 weeks received magnesium sulphate. This may have prevented cerebral palsy in 21 babies. Supporting an increased quality of life and creating substantial societal cost-savings.
• Across all interventions within the pathway it is possible that between 120 and 164 lives were saved.

Between April 2020 and December 2024 the national optimisation pathway’s impact includes:

• 13,341 women giving birth at less than 30 weeks of gestation received magnesium sulphate within the 24 hours prior to birth – potentially 21 babies will not develop cerebral palsy, leading to societal cost-savings between £288million and £360 million.
• Across all interventions within the pathway it is possible that between 2,065 and 2,847 lives were saved.