Survey on use of antenatal magnesium sulphate for fetal neuroprotection prior to preterm birth in Australia and New Zealand – Ongoing barriers and enablers

Abstract

Background Clinical practice guidelines recommend the use of antenatal magnesium sulphate for fetal neuroprotection before preterm birth at <30 weeks’ gestation. Aims This survey assessed the use of antenatal magnesium sulphate for fetal neuroprotection to determine if use has changed since the previous survey in 2012, and to evaluate enablers and barriers to use. Materials and Methods A questionnaire was sent to clinical leaders at 29 hospitals with a neonatal intensive care unit in Australia and New Zealand asking at what gestational ages magnesium sulphate was given, if use was audited and any enablers and barriers to use. Results Responses were received for 24 (83%) hospitals. The use of magnesium sulphate for fetal neuroprotection was reported as 89% (IQR 80–90%), an increase from 80% (IQR 53–90%) from the earlier survey. The majority of health professionals were reported as using magnesium sulphate at <30 weeks’ gestation. The top enablers for use of magnesium sulphate were availability of pamphlets, posters, case record stickers and PowerPoint presentations. The main reasons as to why eligible women did not receive magnesium sulphate were imminent birth, the hospital being short staffed and the patient declined. The use of antenatal magnesium sulphate has been or is being audited in 11 (46%) of the hospitals. Conclusions Clinical leaders at institutions in Australia and New Zealand report that uptake in the use of magnesium sulphate for fetal neuroprotection has continued to increase since the earlier, bi‐national survey in 2012. Barriers to the use of magnesium sulphate identified have institutional and consumer implications.

Translating antenatal magnesium sulphate neuroprotection for infants born <28 weeks' gestation into practice: A geographical cohort study

“…Approximately 20 years after it was first suggested that magnesium sulphate might reduce cerebral palsy in children born preterm, and after more than 6000 fetuses were recruited into randomised controlled trials (RCTs), 6 antenatal magnesium sulphate for fetal neuroprotection was introduced in 2010 in Australia for women likely to deliver <30 weeks' gestational age 7 . Surveys subsequently reported that magnesium sulphate neuroprotection in high‐risk women had risen from 80% 8 in the early 2010s to 89% 9 in the late 2010s in Australia and New Zealand. Although surveys provide some insight, they do not measure precisely the translation of antenatal magnesium sulphate into clinical practice and its effects on rates of cerebral palsy in high‐risk infants, which need to be determined.…”

Antenatal magnesium sulphate for preventing cerebral palsy: An economic evaluation of the impact of a quality improvement program

“…For example, in a survey of perinatal clinicians throughout Australia and New Zealand in 2015, clinicians estimated that 89% of eligible mothers received magnesium sulphate. 18 Based on ANZNN data, the reality was closer to 60-70%. 6 Our study suggests that without Furthermore, our approach and model can be extrapolated to a larger data set such as the ANZNN.…”

eLearning significantly improves maternity professionals’ knowledge of the congenital cytomegalovirus prevention guidelines

“…These leaders could identify hospitalspecific enablers and barriers to implementation; location-specific solutions to these barriers; in-servicing solutions to support education for new staff; mechanisms to ensure educational materials are readily available, and could complete auditing of whether pregnant women are given CMV prevention advice to measure implementation progress. 26,31 New research is required to investigate whether these kinds of strategies would be useful for CMV prevention messaging, and whether they lead to a reduction in cCMV infection. This is the first CMV education course for midwives to be developed and evaluated in the Australian context.…”

“…A further limitation was that we did not explore what other strategies could support implementation of the CMV prevention guidelines beyond this education piece, for example engaging dedicated implementation leaders. These leaders could identify hospital‐specific enablers and barriers to implementation; location‐specific solutions to these barriers; in‐servicing solutions to support education for new staff; mechanisms to ensure educational materials are readily available, and could complete auditing of whether pregnant women are given CMV prevention advice to measure implementation progress 26,31 . New research is required to investigate whether these kinds of strategies would be useful for CMV prevention messaging, and whether they lead to a reduction in cCMV infection.…”