Perinatal Excellence to Reduce Injury in Premature birth Cymru: Reducing Variation in Evidence-Based Perinatal Optimisation in Wales for 'Pob Babi Bob Tro'

Swansea Bay University Health Board

Introduction:

PERIPrem Cymru (Perinatal Excellence to Reduce Injury in Premature Birth Cymru) aims to reduce unwarranted variation in evidence-based perinatal care across Wales. This national improvement programme supports the delivery of a 10-element bundle of life and brain-saving interventions for babies born before 34 weeks gestation, aiming to improve survival and reduce preterm brain injury.

Methods:

Following concerning baseline data in 2022 – including low compliance (5%) with the full bundle and wide variation in care – the programme was launched in March 2023. Drawing on the successful model from Southwest England, the team adapted and standardised the bundle for Wales. Key components included a national leadership team, shared goals, live data dashboards, QI support, parent co-production, and cross-centre collaboration. Implementation was driven by local teams supported through coaching, shared learning events, and regular data reviews.

Outcomes:

Since launch, over 1,200 babies have benefitted. Bundle compliance rose from 5% to 13%, and the optimisation score reached the 70% target. Eight of ten interventions improved, with statistically significant gains for maternal breast milk and probiotics. National preterm mortality fell from 7.8% to 6.6%. Parental feedback highlighted improved communication, consistency of care, and empowerment through tools like the PERIPrem passport.

Learnings:

The initiative demonstrated the power of data visibility, national collaboration, and involving parent voices. Challenges included variation in steroid timing and correct place of birth, which require broader system changes. Strengthening QI capacity across teams remains a priority.

What Next?

A roadmap of 73 recommendations has been developed to embed PERIPrem Cymru into routine practice. Priorities include formal evaluation, organisational accountability, and improving longer-term outcomes for preterm children. The success of PERIPrem Cymru offers a blueprint for scaling national QI initiatives in other areas of NHS Wales.