Inexpensive drug, pioneered at University Hospitals Bristol and Weston, can prevent cerebral palsy in premature babies

Giving women at risk of premature birth a simple magnesium sulphate infusion (or ‘drip’) can prevent their babies from developing cerebral palsy, a recent review has confirmed.

St Michael’s Hospital, part of University Hospitals Bristol and Weston NHS Foundation Trust, was one of the early adopters of the drug, following the first Cochrane review in 2009 through an innovative implementation programme called called PReCePT (prevention of cerebral palsy in pre-term labour).

Offered to mothers going into labour before 30 weeks of gestation, and some women between 30 and 33 weeks depending on clinical factors, the magnesium sulphate infusion is a potentially life-altering treatment for pre-term babies, preventing cerebral palsy by 30%.

PReCePT has since been rolled out to all NHS Trusts in England and between 2018 and 2023, magnesium sulphate was given to 14,270 eligible women across the country, resulting in an estimated 385 fewer cases of cerebral palsy.

There are now recommendations, following a more recent Cochrane Review, (an organization which gathers and reviews evidence from around the world to make better healthcare decisions) that this intervention should be offered more widely and equitably.

Karen Luyt, the University Hospitals Bristol and Weston NHS Foundation Trust consultant who introduced the treatment to St Michael’s Hospital, and a Professor of Neonatal Medicine at the University of Bristol said: “When the Cochrane meta-analysis was published in 2009, I realised that magnesium sulphate, given to mothers in preterm labour, was a potential game changer.

“Our goal was to give every eligible mother in preterm labour in England the choice to receive Magnesium Sulphate and for every preterm baby the chance to develop to their full potential.

“The PReCePT collaboration managed to close the evidence-to-practice gap in England, achieve health equity for babies living in the most socio-economically deprived regions and build the evidence base for successful future implementation of perinatal interventions.”

Supported by Health Innovation West of England and co-designed by parents and maternity ward staff, the programme provides practical tools and training to ensure eligible mothers are offered magnesium sulphate.

One of the first women to receive magnesium sulphate through the programme was Elly Salisbury. She was offered the drug when pregnant with her son Cormac, who is now a healthy 11-year old boy.

“It fills me with pride and joy that all mothers in my situation across England are offered magnesium sulphate thanks to the PReCePT programme,” says Elly. “Behind every infusion of magnesium sulphate is a little boy or girl, just like Cormac, and a family just like ours. Every family deserves the chance to be given this drug, wherever they are in the world. I hope that health systems around the world take inspiration from PReCePT’s success to make this a reality.”[HD4] 

The widespread use of this life-changing treatment was made possible by the original Cochrane review led by Professors Lex Doyle and Caroline Crowther.

However, despite clear evidence that magnesium sulphate is both cost-effective and life-changing, not all mothers are receiving it.

Dr Emily Shepherd of the South Australian Health and Medical Research Institute, lead author of the updated Cochrane review said: “The trials combined in our review are all from high-income countries, where hospitals are comparatively well set-up to administer magnesium sulphate infusions and fulfil maternal and fetal monitoring requirements.

"In low resource settings, this may not always be possible. It would be helpful for future studies to establish the minimum effective dose, and alternative or simpler regimens, particularly intramuscular administration, to aid widespread implementation including across low and middle-income countries.

"We are currently undertaking a new research project to explore some of these questions based on existing data, which we hope will help to standardize international recommendations and aid translation. Our hope is that women whose children will likely not benefit are not exposed unnecessarily, and that all women whose children are likely to benefit are offered treatment across the globe.”