MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP)—implementation of a national guideline in Canada
Abstract Background Evidence supports magnesium sulphate (MgSO4) for women at risk of imminent birth at < 32–34 weeks to reduce the likelihood of cerebral palsy in the child. MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP) was a multifaceted knowledge translation (...
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| Format: | Article |
| Language: | English |
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BMC
2018-01-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13012-017-0702-9 |
| _version_ | 1817999915265032192 |
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| author | Dane A. De Silva Anne R. Synnes Peter von Dadelszen Tang Lee Jeffrey N. Bone MAG-CP, CPN and CNN collaborative groups Laura A. Magee |
| author_facet | Dane A. De Silva Anne R. Synnes Peter von Dadelszen Tang Lee Jeffrey N. Bone MAG-CP, CPN and CNN collaborative groups Laura A. Magee |
| author_sort | Dane A. De Silva |
| collection | DOAJ |
| description | Abstract Background Evidence supports magnesium sulphate (MgSO4) for women at risk of imminent birth at < 32–34 weeks to reduce the likelihood of cerebral palsy in the child. MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP) was a multifaceted knowledge translation (KT) strategy for this practice. Methods The KT strategy included national clinical practice guidelines, a national online e-learning module and, at MAG-CP sites, educational rounds, focus group discussions and surveys of barriers and facilitators. Participating sites contributed data on pregnancies with threatened very preterm birth. In an interrupted time-series study design, MgSO4 use for fetal neuroprotection (NP) was tracked prior to (Aug 2005–May 2011) and during (Jun 2011–Sept 2015) the KT intervention. Effectiveness of the strategy was measured by optimal MgSO4 use (i.e. administration when and only when indicated) over time, evaluated by a segmented generalised estimating equations logistic regression (p < 0.05 significant). Secondary outcomes included maternal effects and, using the Canadian Neonatal Network (CNN) database, national trends in MgSO4 use for fetal NP and associated neonatal resuscitation. With an anticipated recruitment of 3752 mothers over 4 years at Canadian Perinatal Network sites, we anticipated > 95% power to detect an increase in optimal MgSO4 use for fetal NP from < 5 to 80% (2-sided, alpha 0.05) and at least 80% power to detect any increases observed in maternal side effects from RCTs. Results Seven thousand eight hundred eighty-eight women with imminent preterm birth were eligible for MgSO4 for fetal NP: 4745 pre-KT (18 centres) and 3143 during KT (11 centres). The KT intervention was associated with an 84% increase in the odds of optimal use (OR 1.00 to 1.84, p < 0.001), a reduction in the odds of underuse (OR 1.00 to 0.47, p < 0.001) and an increase in suboptimal use (too early or at ≥ 32 weeks; OR 1.18 to 2.18, p < 0.001) of MgSO4 for fetal NP. Maternal hypotension was uncommon (7/1512, 0.5%). Nationally, intensive neonatal resuscitation decreased (p = 0.024) despite rising MgSO4 use for fetal NP (p < 0.001). Conclusion Multifaceted KT was associated with significant increases in use of MgSO4 for fetal NP, with neither important maternal nor neonatal risks. |
| first_indexed | 2024-04-14T03:15:33Z |
| format | Article |
| id | doaj.art-1d8236797aff4c48ac0b302348535309 |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-04-14T03:15:33Z |
| publishDate | 2018-01-01 |
| publisher | BMC |
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| series | Implementation Science |
| spelling | doaj.art-1d8236797aff4c48ac0b3023485353092022-12-22T02:15:29ZengBMCImplementation Science1748-59082018-01-0113111610.1186/s13012-017-0702-9MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP)—implementation of a national guideline in CanadaDane A. De Silva0Anne R. Synnes1Peter von Dadelszen2Tang Lee3Jeffrey N. Bone4MAG-CP, CPN and CNN collaborative groupsLaura A. Magee5Department of Obstetrics and Gynaecology, University of British ColumbiaBC Children’s Hospital Research Institute, University of British ColumbiaDepartment of Women and Children’s Health, St Thomas’ HospitalDepartment of Obstetrics and Gynaecology, University of British ColumbiaDepartment of Obstetrics and Gynaecology, University of British ColumbiaDepartment of Women and Children’s Health, St Thomas’ HospitalAbstract Background Evidence supports magnesium sulphate (MgSO4) for women at risk of imminent birth at < 32–34 weeks to reduce the likelihood of cerebral palsy in the child. MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP) was a multifaceted knowledge translation (KT) strategy for this practice. Methods The KT strategy included national clinical practice guidelines, a national online e-learning module and, at MAG-CP sites, educational rounds, focus group discussions and surveys of barriers and facilitators. Participating sites contributed data on pregnancies with threatened very preterm birth. In an interrupted time-series study design, MgSO4 use for fetal neuroprotection (NP) was tracked prior to (Aug 2005–May 2011) and during (Jun 2011–Sept 2015) the KT intervention. Effectiveness of the strategy was measured by optimal MgSO4 use (i.e. administration when and only when indicated) over time, evaluated by a segmented generalised estimating equations logistic regression (p < 0.05 significant). Secondary outcomes included maternal effects and, using the Canadian Neonatal Network (CNN) database, national trends in MgSO4 use for fetal NP and associated neonatal resuscitation. With an anticipated recruitment of 3752 mothers over 4 years at Canadian Perinatal Network sites, we anticipated > 95% power to detect an increase in optimal MgSO4 use for fetal NP from < 5 to 80% (2-sided, alpha 0.05) and at least 80% power to detect any increases observed in maternal side effects from RCTs. Results Seven thousand eight hundred eighty-eight women with imminent preterm birth were eligible for MgSO4 for fetal NP: 4745 pre-KT (18 centres) and 3143 during KT (11 centres). The KT intervention was associated with an 84% increase in the odds of optimal use (OR 1.00 to 1.84, p < 0.001), a reduction in the odds of underuse (OR 1.00 to 0.47, p < 0.001) and an increase in suboptimal use (too early or at ≥ 32 weeks; OR 1.18 to 2.18, p < 0.001) of MgSO4 for fetal NP. Maternal hypotension was uncommon (7/1512, 0.5%). Nationally, intensive neonatal resuscitation decreased (p = 0.024) despite rising MgSO4 use for fetal NP (p < 0.001). Conclusion Multifaceted KT was associated with significant increases in use of MgSO4 for fetal NP, with neither important maternal nor neonatal risks.http://link.springer.com/article/10.1186/s13012-017-0702-9Preterm birthFetal neuroprotectionMagnesium sulphateCerebral palsyKnowledge translationImplementation |
| spellingShingle | Dane A. De Silva Anne R. Synnes Peter von Dadelszen Tang Lee Jeffrey N. Bone MAG-CP, CPN and CNN collaborative groups Laura A. Magee MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP)—implementation of a national guideline in Canada Implementation Science Preterm birth Fetal neuroprotection Magnesium sulphate Cerebral palsy Knowledge translation Implementation |
| title | MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP)—implementation of a national guideline in Canada |
| title_full | MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP)—implementation of a national guideline in Canada |
| title_fullStr | MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP)—implementation of a national guideline in Canada |
| title_full_unstemmed | MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP)—implementation of a national guideline in Canada |
| title_short | MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP)—implementation of a national guideline in Canada |
| title_sort | magnesium sulphate for fetal neuroprotection to prevent cerebral palsy mag cp implementation of a national guideline in canada |
| topic | Preterm birth Fetal neuroprotection Magnesium sulphate Cerebral palsy Knowledge translation Implementation |
| url | http://link.springer.com/article/10.1186/s13012-017-0702-9 |
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