Posted on August 12, 2022
Launched in April 2020, PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth) is a unique perinatal care bundle that aims to improve the outcomes for premature babies across the West and South West regions.
PERIPrem reflects the NHS Long Term Plan ambition to reduce stillbirths, maternal and neonatal mortality and serious brain injury by 50% by 2025, with an increased focus on pre-term mortality.
The bundle, which now forms part of our Maternity and Neonatal Safety Improvement Programme, consists of 11 interventions that demonstrate a significant impact on brain injury and mortality rates amongst babies born earlier than 34 weeks.
“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 (17-week-old) beautiful little boys who are just starting to smile, and that is down to PERIPrem.”
Lauren, PERIPrem parent.
PERIPrem was developed as a model in the West of England with the project working collaboratively with South West Academic Health Science Network and South West Neonatal Network.
Preterm birth is the main cause of neonatal mortality and morbidity in the UK, survival rates are improving in preterm babies; but rates of severe disability have not followed the same trajectory and there is a growing population of children with neuro-disabilities due to prematurity.
The NHS Long Term Plan (2019) has committed to realising a 50% reduction in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025, with an increased focus on pre-term mortality. PERIPrem directly contributes to this ambition, as well as those of the national NHS Maternity and Neonatal Safety Improvement Programme.
“Perinatal services across the South West have worked with great passion to implement the PERIPRrem Project in order to support improved outcomes and experiences for infants and families who journey through neonatal services. We are so proud to be part of a team of such dedicated, caring professionals.”
Mary Leighton, Network Manager, South West Neonatal Network
The PERIPrem bundle was co-created by clinicians, maternity and neonatal teams and parents. The interventions range from ensuring that mums give birth in the right place, to offering mothers magnesium sulphate, which has been shown to reduce the risk of the baby developing cerebral palsy later in life, and optimal cord clamping.
Quality Improvement (QI) methodology was at the heart of implementation alongside coaching and forging new ways of working, where clinicians from obstetrics, midwifery and neonatal, join together to drive forward and revolutionise care for pre term babies.
To enable units to focus on increasing rates of PERIPrem interventions the AHSNs provided funding to each trust to backfill two PERIPrem Leads, one neonatal nurse and one midwifery lead. In addition, units were encouraged to identify PERIPrem Champions to act as advocates for selected bundle interventions, with a focus on obstetrician and neonatologists.
The PERIPrem Steering Group developed a toolkit of resources and materials for each element of the bundle. Units were encouraged to use and adapt these to meet their needs. PERIPrem clinical and parent passports were also created to offer advice and reassurance to families and many resources were made available in multiple languages. The PERIPrem team also ran virtual share and learn sessions and sent weekly newsletters to distribute resources, connect disparate teams kept apart by the COVID pandemic and celebrate success.
Impacts to date
Over 1700 premature babies have been cared for using the PERIPrem bundle (to December 2022).
The National Neonatal Audit Programme’s (NNAP) 2021 report (published in November 2022) shows units across the South West achieved, on average, the:
- highest rate of delayed cord clamping (by over 25%);
- highest rates of parental presence at one or more consultant rounds (for admissions lasting more than 24 hours);
- second highest rates of maternal early breast milk;
- second lowest rates of severe grade Intraventricular Haemorrhage or death;
- second lowest rates of necrotising enterocolitis alongside
- third lowest rates of mortality to discharge for babies born at less than 28 weeks in England.
In September 2022 PERIPrem was awarded best regional/national project at that year’s BAPM Gopi Menon Awards.
In August 2022, an independent 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. Explore a summary graphic of the PERIPrem evaluation.
Official PERIPrem resources have received Neonatal Nurses Association (NNA) endorsement.
In April 2022, PERIPrem featured as a case study in the latest NHS GIRFT Neonatology report with teams also being encouraged to access our resources (see pages 10 and 66). PERIPrem case studies were also published by NHS Confederation (April 2022) and the National Child Mortality Database thematic report (pages 21-22 – August 2022).
PERIPrem was highly commended in the Patient Safety Pilot of the Year category at the 2021 HSJ Patient Safety Awards and a finalist in the Provider Collaboration of the Year 2021 HSJ Awards.