National Program UK: Equal Access to Drug Preventing Cerebral Palsy in Premature Babies

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A national care program is levelling access to cerebral palsy prevention for preterm infants across England, reveals research led by the University of Bristol.

Bristol/UK – Researchers analyzed NHS England maternity and neonatal data from 2014 to 2024 to investigate whether sociodemographic differences existed in the use of antenatal magnesium sulphate. The treatment is recommended for women at risk of very preterm birth to help protect babies' developing brains and reduce the risk of cerebral palsy.

The study, published in BMJ Open Quality recently focused on mothers whose babies were born between 24 and 30 weeks' gestation and were admitted to NHS neonatal units.

The findings suggest that inequalities in access to the treatment have narrowed substantially following the introduction of the National Precept (Preventing Cerebral Palsy in Pre-Term Labor) Program (NPP), a nationwide quality improvement initiative launched in 2018 by the Health Innovation Network with funding from NHS England to increase the uptake of antenatal magnesium sulphate.

Before the program was implemented, mothers in the North of England were significantly less likely to receive magnesium sulphate, than mothers in the South. Women living in more deprived areas were also less likely to receive the treatment than those in more affluent areas.

However, after the rollout of the National Precept Program, the researchers found no evidence of ongoing regional or deprivation-related differences in treatment rates.

The study also found some evidence that white British mothers may have been slightly less likely to receive magnesium sulphate than mothers from other ethnic groups, although this difference was small and did not appear to change following implementation of the program. Maternal age showed little association with receiving the treatment.

Hannah Edwards, Senior Research Associate in Medical Statistics at the University of Bristol: “We know from recent inquiries that maternity care in the UK is not always fair, and some mums and babies seem to miss treatment they need and have worse outcomes. Our findings show progress in reducing inequalities in this aspect of maternity care.

“Since the rollout of the Precept program, the North-South divide in magnesium sulphate use has reduced, helping to ensure that mothers and babies across England can benefit from this important intervention, regardless of postcode."

Karen Luyt, Precept national clinical lead, Professor of Neonatal Medicine at the University of Bristol and Consultant Neonatologist at Bristol NHS Foundation Trust, added: “The success of Precept shows what can be achieved when evidence-based improvements are implemented consistently across the NHS. By reaching every maternity unit in England, the program has helped deliver better and more equitable care for women at risk of very preterm birth.

“We believe this approach could be applied to other challenges in maternity and baby care, helping to ensure that improvements benefit all families, regardless of where they live or their background."

The researchers conclude that previous sociodemographic inequalities in access to antenatal magnesium sulphate appear to have largely levelled-up across England. While the study cannot definitively establish cause and effect, the findings suggest that the universal implementation of the National Precept quality improvement program might have contributed to reducing these disparities.

By improving equitable access to evidence-based care, the program may be helping to ensure that more babies born very prematurely benefit from a treatment known to reduce the risk of cerebral palsy and other neurological complications.

The next steps for future research would be to understand why some groups of mums and babies seem to be disadvantaged in their overall care and outcomes.

This would help address the problem at the root cause. It is also important that other interventions to improve maternity and baby care also aim to reduce inequalities.

The research is part of a study organized and funded by the Health Innovation Network (formerly The AHSN Network), National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), and the Health Foundation.

Paper: ‘Antenatal magnesium sulphate for neuroprotection of preterm babies: data analysis of inequities in treatment in England 2014 to 2024’ by Hannah B Edwards, Lauren J Scott, Cheryl McQuire, Isobel L Ward, David Odd, Frank de Vocht, Karen Luyt in BMJ Open Quality.

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