Summary
Preterm birth is the main cause of neonatal deaths and morbidity in the UK. While survival rates are improving, there is a growing population of children with neuro-disabilities due to premature birth.
PERIPrem is a unique care bundle of 11 evidence-based interventions designed to improve the outcomes for premature babies.
"
I truly believe that this package saved my boys’ lives, and without it I’m not quite sure where we’d be now. But because of PERIPrem I have two beautiful little boys who are just starting to smile, and that is down to PERIPrem.
"
Lauren, parent
What the project involved
The NHS Long Term Plan has committed to realising a 50% reduction in stillbirth, maternal and neonatal mortality, and serious brain injury by 2025, with an increased focus on preterm mortality.
The PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth) care bundle was co-created by clinicians, maternity and neonatal teams, and parents. It consists of 11 interventions proven to have an impact on brain injury and mortality rates amongst babies born before 34 weeks.
PERIPrem is a collaborative project led by the West of England and South West AHSNs in partnership with the South West Neonatal Network. Since April 2020, the AHSNs supported all 12 hospital trusts across the South West region to introduce the care bundle.
Quality improvement methodology was central to implementation, alongside coaching and forging new ways of working, enabling obstetrics, midwifery and neonatal clinicians to join forces to transform care.
Supporting units to focus on increasing use of interventions, the AHSNs provided backfill funding to every trust for two PERIPrem posts.
PERIPrem toolkits and clinical and parent passports were created to offer advice and reassurance to families.
The South West AHSN was commissioned to evaluate PERIPrem to understand the effectiveness of using QI methodology to support maternity and neonatal units in implementing the standardised bundle of care. The evaluation combined mixed methods data analysis, staff surveys on psychological safety and teamwork, qualitative interviews with maternity, neonatal and obstetric staff and QI coaches.
Over the evaluation period, 693 babies were born to 604 mothers.
Outcomes
The third update to the Saving Babies’ Lives Bundle, published in June 2023, encourages providers of maternity and neonatal care to draw upon the learning of PERIPrem to aid the optimisation of perinatal care (element five).
An independent evaluation by the South West AHSN and published in BMJ Open Quality, indicates the PERIPrem approach increased uptake of interventions in 12 NHS trusts across the South West. Research Square published the AHSNs qualitative evaluation on the barriers and enablers to the programme’s implementation.
By the end of the evaluation period, 26% more mothers and babies born prematurely in the South West received the care interventions they were eligible for.
During the 11-month implementation phase, there were significant improvements in use of several interventions including volume-guided ventilation, early breast milk, probiotics and prophylactic hydrocortisone, and a steady improvement in optimal place of birth for extremely preterm babies. By summer 2021, use of 10 out of 11 PERIPrem bundle interventions had increased.
Perinatal team culture also improved, with an enhanced common language and situational monitoring. Staff were empowered to increase their knowledge, skills and confidence in preterm birth and infant care, benefitting from strategic cues, protected time, and access to tailored resources and QI support.
Next steps
The evaluation indicates that PERIPrem is an ideal way for the NHS to achieve the improvement in preterm perinatal care it is aiming for.
The West of England and South West AHSNs are now sharing PERIPrem resources and learnings to support other AHSNs and NHS trusts as they consider implementing it in their regions.
