Implementation of national guidelines on antenatal magnesium sulfate for neonatal neuroprotection: extended evaluation of the effectiveness and cost-effectiveness of the National PReCePT Programme in England

Edwards, Hannah B., Sillero-Rejon, Carlos, McLeod, Hugh, Hill, Elizabeth M., Opmeer, Brent C., Peters, Colin, Odd, David ORCID: https://orcid.org/0000-0002-6416-4966, de Vocht, Frank and Luyt, Karen 2025. Implementation of national guidelines on antenatal magnesium sulfate for neonatal neuroprotection: extended evaluation of the effectiveness and cost-effectiveness of the National PReCePT Programme in England. BMJ Quality & Safety 10.1136/bmjqs-2024-017763

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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 (CP) in the preterm baby. However, the implementation of this guideline in clinical practice was slow, and MgSO4 use varied between maternity units. In 2018, the PRrevention of Cerebral palsy in PreTerm labour (PReCePT) programme, an evidence-based quality improvement (QI) 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 4 years, its impact in later preterm births, the 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 a National Health Service 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 a 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 2 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 with Scotland and Wales. There was some decline in use coinciding with the onset of the pandemic. Conclusions The PReCePT QI programme cost-effectively improved use of antenatal MgSO4, with anticipated benefits to the babies who have been protected from CP.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Medicine
Publisher:	BMJ Publishing Group
ISSN:	2044-5415
Date of First Compliant Deposit:	16 September 2025
Date of Acceptance:	28 March 2025
Last Modified:	16 Sep 2025 14:30
URI:	https://orca.cardiff.ac.uk/id/eprint/181130

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