Working to improve survival and health for babies born very preterm: the WISH project protocol

Wish Project Team ,Caroline A Crowther,Vicki Flenady,Pat Ashwood,Emily Bain,Jonathan Morris,Sarah Mcintyre,Tanya Bubner,Philippa F Middleton

doi:10.1186/1471-2393-13-239

Abstract

BackgroundBabies born very preterm (before 30 weeks gestation) are at high risk of dying in their first weeks of life, and those who survive are at risk of developing cerebral palsy in childhood. Recent high-quality evidence has shown that giving women magnesium sulphate immediately prior to very early birth can significantly increase the chances of their babies surviving free of cerebral palsy. In 2010 Australian and New Zealand clinical practice guidelines recommended this therapy. The WISH (Working to Improve Survival and Health for babies born very preterm) Project aims to bi-nationally improve and monitor the use of this therapy to reduce the risk of very preterm babies dying or having cerebral palsy.Methods/DesignThe WISH Project is a prospective cohort study. The 25 Australian and New Zealand tertiary level maternity hospitals will be provided with a package of active implementation strategies to guide the introduction and local adaptation of guideline recommendations. Surveys will be conducted at individual hospitals to evaluate outcomes related to local implementation progress and the use and value of the WISH implementation strategies. For the hospitals participating in the ‘WISH audit of uptake and health outcomes data collection’, the primary health outcomes (assessed through case note review, and 24 month corrected age questionnaires) will be: the proportion of eligible women receiving antenatal magnesium sulphate; and rates of death prior to primary hospital discharge and cerebral palsy at two years corrected age in infants born to eligible mothers. For hospitals wishing to assess factors influencing translation locally, barriers and facilitators will be measured through interviews with health care professionals, to further guide implementation strategies. Study outcomes for the early phase of the project (Year 1) will be compared with the later intervention phase (Years 2 and 3).DiscussionThe WISH Project will offer insight into the effectiveness of a multifaceted implementation strategy to improve the uptake of a novel neuroprotective therapy in obstetric clinical practice. The successful implementation of antenatal magnesium sulphate for fetal neuroprotection in Australia and New Zealand could lead to over 90 fewer very preterm babies dying or suffering the long-term consequences of cerebral palsy each year.

Highlights

Babies born very preterm are at high risk of dying in their first weeks of life, and those who survive are at risk of developing cerebral palsy in childhood
Over 600 children in Australia and over 150 in New Zealand are diagnosed with cerebral palsy each year [4]; with approximately 40% of all cases being related to preterm birth [5]
The updated Cochrane review ‘Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus’ [9], including five randomised controlled trials, showed for the first time that magnesium sulphate given to women prior to preterm birth can reduce the risk of death or cerebral palsy, and of cerebral palsy alone

Summary

Introduction

Babies born very preterm (before 30 weeks gestation) are at high risk of dying in their first weeks of life, and those who survive are at risk of developing cerebral palsy in childhood. Recent high-quality evidence has shown that giving women magnesium sulphate immediately prior to very early birth can significantly increase the chances of their babies surviving free of cerebral palsy. Preterm birth and cerebral palsy: the burden of disease Babies born very early are at high risk of dying in their first few weeks of life, or if they survive, they may have damage to their developing brain, manifesting as cerebral palsy, blindness, deafness or cognitive dysfunction [1,2,3]. The Cochrane review showed that 63 women need to be treated with antenatal magnesium sulphate for neuroprotection for one baby to avoid cerebral palsy. This was a very important finding, as few interventions to date have been found to prevent the devastating and lifelong consequences of cerebral palsy

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