Why is the NHS delaying use of magnesium sulphate for prevention of cerebral palsy in premature births?

21st January 2015 Clinical Negligence

Medical science is constantly evolving, refining practices and treatments so get the best outcomes for a huge range of problems. But are our hospitals keeping up? And if not, why not?

It's been several years since the Royal College of Obstetricians and Gynaecologists (RCOG) issued a Scientific Impact Paper on the use of the drug, magnesium sulphate, during preterm births to reduce the risk of baby developing cerebral palsy.

As a former midwife now working in JMW's specialist medical negligence team I know only too well that babies born very early are more susceptible to low oxygen levels and brain damage. This can lead to a range of life-long complications, such as cerebral palsy. However it is thought that magnesium sulphate given to women who are in premature labour helps to protect the brain cells from sustaining damage.

The RCOG looked at a large number of research studies which found that giving women in preterm labour a drip containing magnesium sulphate, their premature baby was less likely to suffer brain damage, including cerebral palsy. There have been similar reports from the colleges in America and Canada, as well as the World Health Organisation.

This sounds like a massive breakthrough and could save many babies from the lifelong complications of such disorders. Why then is this not being implemented widely across the UK? Some argue that they want more research, but with several well conducted studies proving benefit it is unlikely that further studies will be undertaken.

Magnesium sulphate is already widely used across the UK for treating women with the condition pre-eclampsia, so doctors really shouldn't be concerned with its use or safety for mum and baby. It is also a relatively inexpensive drug so any financial burden should not be a major concern, especially considering the long-term costs of supporting a child with cerebral palsy.

Some NHS hospitals have already updated their practice and have issued guidelines for women to be given this drug in premature labour, with some implementing their guideline back in 2011. Others, however, are still lagging behind, preventing women from having the opportunity to reduce their baby's risk of developing cerebral palsy. This delay by many hospitals and doctors is creating yet another NHS 'postcode lottery', when everyone deserves the same high standard of care, regardless of where they live in the UK.

This reluctance to change practice has many similarities to when research came out about giving women at risk of premature labour steroid injections to develop their baby's lungs. It took significant time for practice to catch up with the research, however this is now such common practice globally, it is hard to believe it took so long to catch on.

It is hoped that all hospitals understand the importance of keeping up to date with research and we don't have to wait too much longer before every hospital in the UK routinely offers this treatment to eligible women, hopefully saving many families from the potentially devastating effects of cerebral palsy.

 

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Eddie Jones is a Partner and Head of Department located in Manchesterin our Clinical Negligence department

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