Introducing a bundle of care to improve outcomes for premature babies

Innovation Status


Innovation type

Complex intervention

Solution theme


Preterm birth is the main cause of neonatal deaths and morbidity in the UK. While survival rates are improving, there is a growing population of children with neuro-disabilities due to premature birth.

PERIPrem is a unique care bundle of 11 evidence-based interventions designed to improve the outcomes for premature babies.



“I truly believe that this package saved my boys’ lives, and without it I’m not quite sure where we’d be now. But because of PERIPrem I have two beautiful little boys who are just starting to smile, and that is down to PERIPrem.” Lauren, parent
What the project involved

The PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth) care bundle was co-created by clinicians, maternity and neonatal teams, and parents. It consists of 11 interventions proven to have an impact on brain injury and mortality rates amongst babies born before 34 weeks.

These interventions include ensuring mums give birth in the right place, offering mothers magnesium sulphate to reduce risk of babies developing cerebral palsy, and optimal cord clamping.

The model was developed by the West of England AHSN, working with South West AHSN and South West Neonatal Network. Since April 2020, the AHSNs supported all 12 hospital trusts across the South West region to introduce PERIPrem.

Quality improvement methodology was central to implementation, alongside coaching and forging new ways of working, enabling obstetrics, midwifery and neonatal clinicians to join forces to transform care.

Supporting units to focus on increasing use of interventions, the AHSNs provided backfill funding to every trust for two PERIPrem posts: a neonatal nurse and a midwifery lead. Units were also encouraged to identify PERIPrem champions to act as advocates for selected interventions.

The PERIPrem Steering Group developed a toolkit of resources for each bundle element. Units could adapt these to meet their needs. PERIPrem clinical and parent passports were created to offer advice and reassurance to families and many resources were available in multiple community languages. The PERIPrem team ran regular share and learn webinars and sent weekly newsletters to distribute resources, connect disparate teams kept apart during COVID, and celebrate success.


An independent evaluation by the South West AHSN and published in BMJ Open Quality, indicates the PERIPrem approach increased uptake of interventions in 12 NHS trusts across the South West.

By the end of the evaluation period, 26% more mothers and babies born prematurely in the South West received the care interventions they were eligible for.

During the 11-month implementation phase, there were significant improvements in use of several interventions including volume-guided ventilation, early breast milk, probiotics and prophylactic hydrocortisone, and a steady improvement in optimal place of birth for extremely preterm babies. By summer 2021, use of 10 out of 11 PERIPrem bundle interventions had increased.

Perinatal team culture also improved, with an enhanced common language and situational monitoring. Staff were empowered to increase their knowledge, skills and confidence in preterm birth and infant care, benefitting from strategic cues, protected time, and access to tailored resources and QI support.

Next steps

The West of England and South West AHSNs are now sharing PERIPrem resources and learnings to support other AHSNs and NHS trusts across the UK as they consider implementing and adapting the care bundle in their regions.

Interested to find out more?

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