Posted on June 12, 2023
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 Health Innovation South West and South West Neonatal Network.
Watch our introduction to PERIPrem animation.
The challenge
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
Our approach
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, we 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.
Watch our PERIPrem parent video.
Impacts to date
Over 2,299 premature babies have been cared for using the PERIPrem bundle (to August 2023).
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).
The National Neonatal Audit Programme’s (NNAP) 2022 report (published in November 2023) shows:
- The South West Neonatal Operational Delivery Network (ODN) has the lowest rates of severe preterm white matter brain injury or death
- The South West 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 is the only ODN in England demonstrating consistent improvement in this area during 2020-2022.
“The South West units have led the way in many of the NNAP quality metrics in 2022. We have for the last three years improved continuously with optimal place of birth for extremely preterm infants and if we can continue on this trajectory, we can enable still more babies to survive free from brain injury.
“The NCMD data return for 2021/2022 ranks the South West as the English region with the lowest neonatal mortality rate, which reflects the impact of our PERIPrem QI collaborative and the stellar efforts of every one of our 12 perinatal teams.”
Dr Karen Luyt, Professor of Neonatal Medicine at the University of Bristol and is PERIPrem’s Clinical Strategic Lead.
Perinatal team culture has also improved, with an enhanced common language and situational monitoring, according to an independent evaluation of PERIPrem conducted by Health Innovation South West in 2022. Staff are 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.
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 and PreCePT were highlighted as areas of good practice in November 2023 paper Quality and reporting of large-scale improvement programmes: a review of maternity initiatives in the English NHS, 2010–2023. Health Improvement Scotland referenced the PERIPrem evaluation in the in their patient safety perinatal change package launched in November 2023.
At the 2021 HSJ Patient Safety Awards, PERIPrem was highly commended as the Patient Safety Pilot of the Year. PERIPrem was also shortlisted for Provider Collaboration of the Year at the 2021 HSJ Awards.
There has been great interest in PERIPrem following the success of implementation across the South West region. PERIPrem Cymru launched in Wales early in 2023, and we have supported the adoption and spread of PERIPrem Cymru in Wales through sharing and adapting materials developed during the initial project. NHS Wales Executive have commissioned us to provide programme management and clinical leadership support during the initial set-up phases of PERIPrem Cymru.
