Delivery of the National PReCePT (Prevention of Cerebral Palsy in the PreTerm Infant) Programme in the North East and North Cumbria (NENC) region

The aim of the PReCePT Programme was to increase the numbers of eligible women offered magnesium sulphate to prevent cerebral palsy in preterm babies to 85% nationally with minimal variation by March 2020. The stretch target was 95%. For North East and North Cumbria the baseline was 64% (based on 2017 figures).

Eligible women = women that delivered before 30 weeks gestation.

Magnesium sulphate is a cheap (approximately £1 per dose), easy to administer, and safe drug. It has a proven neuroprotective effect in preterm babies. To reach the 85% aim the challenges were to ensure 1) eligible women were offered the drug and 2) the data recording was correct.

Funding was provided by NHSE to support the delivery of this Programme across the region, and the AHSN NENC added a small amount of additional funding to this.

More information about the PReCePT Programme can be found on The AHSN Network website by clicking here.

Contact Details

Project Dates

Project Start 01/07/2018
Project End 31/03/2020



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Most midwives and probably junior doctors [in the hospital where I work] really weren’t aware of the benefits of magnesium sulphate prior to the PReCePT Programme… It’s such an easy win, it’s such a cheap drug to use.
Claire Cameron, Matron, Gateshead Health NHS FT
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  • For teams who receive only a small number of eligible mothers, meeting the national aim was challenging. For example, if within a year a Unit only had two eligible mothers, one of which was given magnesium sulphate and the other was not, this means that they would only reach 50%.
  • The aim did not take into account reasonable exceptions for not administering magnesium sulphate, such as the mother giving birth before arrival, arrival on the ward with imminent delivery, etc.
  • Even when magnesium sulphate was given this was not always recorded on, which is the data reporting system.
  • It was challenging making this programme a priority in a time of multiple competing maternity and neonatal initiatives, although this was achieved as all Trusts engaged in this work.

The purpose of the programme was to reduce the variation in the amount of woman receiving Magnesium sulphate and ensure that as many eligible women as possible received it.

  • Joint working with the AHSN, Maternity Northern England Clinical Network and Northern Neonatal Network.
  • Regional team appointed (PReCePT Regional Neonatal Lead, Quality Improvement Lead, Midwife).
  • Unit Midwife Lead, Unit Obstetric Lead, Neonatal Lead, and Executive Sponsor identified within each participating Trust.
  • Historic data analysis undertaken to ensure accuracy, and robust monthly data analysis process implemented.
  • PReCePT Support Event held where the Programme was launched, Trusts developed implementation plans, and QI methodology was taught.
  • Use and sharing of the excellent resources provided by the National Team.
  • Regular feedback and discussion (events, meetings plus Trust and regional calls) to support learning from sharing good practice and missed opportunities.
  • Developed PReCePT Regional Protocol and film clips which have been shared regionally and nationally.
  • All Trusts developed and implemented sustainability plans.
  • This work now forms part of the Maternity and Neonatal Safety Improvement Programme, and therefore continues even though the national programme has ended.


1467 members of staff identified to be trained have been trained. Training is now ‘business as usual’.


  • Data collection is now effectively collated and is accurate.
  • During the lifespan of the Programme, Trusts within the North East and North Cumbria region saw 301 eligible women. Of these, 249 were given magnesium sulphate for neuroprotection, demonstrating an average of 83%. Therefore, the national target of 85% was nearly met, but the region did fall short by 2%.
  • 52 eligible women did not receive the drug:
    • In 43 of these cases there were reasonable exceptions for non-administration (including, but not limited to, delivery before arrival at hospital, rapid deliveries where there is not time to administer the drug, and women who had class 1 emergencies where the first priority is to deliver the baby within 30 minutes of admission). Reasonable exceptions are not included in the reporting for the national target, but if they had been compliance would have been 97%.
    • There were nine cases where the potential to administer magnesium sulphate were missed (including, but not limited to, the drug not being offered, admission delivery times over 30 minutes, and delays to antenatal assessment).
  • One case of cerebral palsy is prevented for every 37 mothers who receive magnesium sulphate based on 95% confidence intervals 23, 102 (Crowther 2018). This means that since October 2018, the North East and North Cumbria region has potentially prevented 6.3 cases of cerebral palsy.
  • Based on a lifetime care cost of approximately £800,000, this equates to over £5.4 million saved.
  • As all appropriate staff have been trained staff feel more confident and competent in knowing when and how to administer magnesium sulphate. All Trusts also train new staff where necessary.
  • Leadership, management, data analysis and quality improvement training
  • Facilitation sharing learning and best practice
  • Communications (film clips, social media campaign, sharing national communications)
  • Some additional funding

This Programme was originally developed by the West of England AHSN in collaboration with University Hospitals Bristol NHS Foundation Trust.

Plans for the future:

  • The PReCePT Programme is now one of the Maternity and Neonatal Safety Improvement Programme’s system-level projects. As such, PReCePT will form part of the Safety Improvement Network events, held quarterly, where updates on compliance are given, with time incorporated for questions and discussion.
  • The AHSN and the Maternity and Neonatal Networks will continue to support the data analysis process for the foreseeable future.


  • No plans regionally as all eligible Trusts are already actively engaged.
  • As this is a national programme, spread and adoption is driven by the national team.

This link provides information relating to further information


PReCePT resources can be accessed here (but contact details need to be provided)


Film clips:

PReCePT Programme: Prevention of Cerebral Palsy in Preterm Labour

Administering Magnesium Sulphate

Side Effects of Magnesium Sulphate

Cost of Magnesium Sulphate

Magnesium sulphate as Protocol

The PReCePT Programme has been a really positive experience. It has built on the relationships we have developed through the Maternity and Neonatal Safety Collaborative Programme… The relationships that have been created through this Programme I think will extend into other areas of maternity and neonatal care.
Karen Hooper, Regional PReCePT Midwife, AHSN NENC