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

BMC Pregnancy and Childbirth

Sarah McIntyre²  Jonathan Morris¹  Vicki Flenady³  Tanya Bubner⁵  Pat Ashwood⁵  Emily Bain⁵  Philippa F Middleton⁵  Caroline A Crowther⁴ 

[1] Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, Australia;Cerebral Palsy Institute, The University of Notre Dame Australia, Sydney, Australia;Centre for Translating Research into Practice, Mater Medical Research Institute, Brisbane, Australia;Liggins Institute, The University of Auckland, Auckland, New Zealand;Australian Research Centre for Health of Women and Babies, Robinson Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia

关键词: Preterm birth;    Cerebral palsy;    Neuroprotection;    Magnesium sulphate;    Implementation;    Evidence-based practice;   

Others  :  1131881
DOI  :  10.1186/1471-2393-13-239

 received in 2013-11-22, accepted in 2013-12-13,  发布年份 2013

【 摘 要 】

Background

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. 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/Design

The 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).

Discussion

The 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.

【 授权许可】

   
2013 Crowther et al.; licensee BioMed Central Ltd.

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