National spread of South West perinatal project
Since the successful implementation and evaluation of PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth) in the South West, supported by Health Innovation South West, and Health Innovation West of England, the region continues to demonstrate a reduction in preterm mortality and brain injury. Throughout 2023-24, PERIPrem has been adopted into national perinatal pathways, recognised in several national reports, and other Health Innovation Networks are considering its adoption.
Preterm birth is the single biggest cause of infant mortality and newborn brain injury in England. Neonatal illness is the leading cause of life years burdened by disability globally, outranking ischaemic heart disease, stroke, diabetes and COPD. The NHS is aiming to reduce stillbirth, maternal and neonatal mortality, and serious brain injury in newborn infants by 50% by 2025.
PERIPrem is a unique care bundle of 11 evidence-based interventions that demonstrate a significant impact on brain injury and mortality rates amongst babies born earlier than 34 weeks.
The care bundle was implemented across 12 Trusts in the South West in 2020 in partnership with Health Innovation West of England and South West Neonatal Network, and now forms part of our Maternity & Neonatal Safety Improvement Programme.
Following its implementation, Health Innovation South West was commissioned to evaluate PERIPrem. Our independent, quantitative evaluation was published in the British Medical Journal Open Quality. It indicated 26% more mothers and babies born prematurely across the South West received the care interventions they were eligible for between July 2020 and June 2021, compared to before PERIPrem started.
In June 2023, publication of the third update to the NHS’s Saving Babies’ Lives Bundle, encourages providers of maternity and neonatal care to draw upon the learning of PERIPrem to aid the optimisation of perinatal care (element five).
Published in November 2023, the National Neonatal Audit Programme’s (NNAP) 2022 report shows that the South West Neonatal Operational Delivery Network (ODN) has the lowest rates of severe preterm white matter brain injury or death and is the top ODN for early breastmilk feeding and delayed cord clamping. Optimal place of birth is above average across the South West (80.4%) and the South West the only Neonatal ODN in England demonstrating consistent improvement in this area during 2020-2022.
- Over 1,500 premature babies have been cared for across 7 trusts in the South West using the PERIPrem bundle (to March 2024).
- The South West has demonstrated a reduction in preterm mortality and brain injury following implementation of PERIPrem (Luyt, 2024).
- Clinical Lead Sarah Bates submitted evidence to the House of Lords Preterm Birth Committee in Spring 2024.
- Resources have been adopted by the British Association of Perinatal Medicine (BAPM) in their perinatal optimisation pathway, Healthcare Improvement Scotland in their patient safety perinatal change package launched in November 2023, and PERIPrem Cymru launched in Wales early in 2023. After successful implementation and recognition in several national reports, other Health Innovation Networks are considering its adoption.
- In February 2024 PERIPrem featured here: Quality and reporting of large-scale improvement programmes: a review of maternity initiatives in the English NHS, 2010–2023 | BMJ Quality & Safety
The project has helped us integrate changes within the wider perinatal team and improve multi-disciplinary team working. Attending shared learning events, has contributed to local improvement opportunities. We have been able to embed many of PERIPrem practices including patient passports which has proved useful for our local women and families on their journey of premature birth. We continue to explore ways to improve the outcomes for our premature babies and their families and have recently managed to get agreement to have colostrum added to the drug chart for all of our babies born at less than 34 weeks. We are hoping this will mean that the majority of preterm infants born in North Devon will receive this vital intervention within the allotted time.
Janet Hutchins, Royal Devon University Hospitals (North), Neonatal Nurse and PERIPrem Lead
