Short Communication Implementation of a clinical practice guideline for antenatal magnesium sulphate for neuroprotection in Australia and New Zealand Emily BAIN, Tanya BUBNER, Pat ASHWOOD, Caroline A. CROWTHER and Philippa MIDDLETON, for The WISH Project Team Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, Robinson Institute, The University of Adelaide, Adelaide, South Australia, Australia Health professionals at 25 Australian and New Zealand tertiary maternity hospitals were surveyed about local implementation of a clinical practice guideline for antenatal magnesium sulphate for fetal neuroprotection. Seventy-six percent of respondents reported that their hospital is currently following a guideline; 36% confirmed that their hospital is auditing uptake. Estimates of uptake ranged from 53 to 90%. Ongoing education and support are needed to ensure that the guidelines are optimally implemented, and uptake and important health outcomes are monitored. Key words: antenatal care, clinical practice, guidelines, magnesium sulphate, preterm, survey. Introduction Babies born very preterm are at high risk of dying in their first weeks of life, and survivors are at risk of neurosensory disabilities, including cerebral palsy, blindness, deafness and cognitive dysfunction. 1,2 In Australia, over 600 children are diagnosed with cerebral palsy annually; approximately, 40% of cases are related to preterm birth. 3 In the 1990s, observational studies suggested an association between antenatal exposure to magnesium sulphate and reductions in intraventricular haemorrhage, cerebral palsy and neonatal mortality. 4,5 Four randomised controlled trials subsequently assessed the effects of antenatal magnesium sulphate for providing preterm fetal neuroprotection. Meta- analyses of these trials have shown a neuroprotective role for magnesium sulphate; in the 2009 Cochrane review, magnesium sulphate was associated with a 15% relative reduction in the risk of death or cerebral palsy (RR 0.85, 95% CI 0.74–0.98; four trials, 4446 infants) and a 29% reduction in the risk of cerebral palsy alone (RR 0.71, 95% CI 0.55–0.91; four trials, 4446 infants). 6 In 2010, the National Health and Medical Research Council (NHMRC) endorsed binational clinical practice guidelines for magnesium sulphate for women at risk of early preterm (<30 weeks gestation), imminent birth, for neuroprotection of the fetus. 7 However, it is recognised that implementation of the best available evidence is often challenging. 8 Based on knowledge of interventions likely to increase the uptake of evidence into practice, 9,10 the implementation project WISH (Working to Improve Survival and Health for babies born preterm) was designed, now funded by the Cerebral Palsy Alliance. 11 This project is ongoing, comprising a package of active implementation strategies to guide the introduction and local adaptation of guideline recommendations. ‘Guideline Action Packs’ containing the NHMRC-endorsed guidelines, 7 educational materials, health professional and consumer information were sent to Australian and New Zealand tertiary maternity hospitals in December 2011 and January 2012. The purpose of this survey was to assess current local implementation of a guideline for magnesium sulphate for fetal neuroprotection at all tertiary maternity hospitals across Australia and New Zealand and to assess early views of the Guideline Action Pack materials. Materials and Methods During March to June 2012, a web-based survey was conducted involving all tertiary maternity hospitals in Australia (N = 19) and New Zealand (N = 6). The invitation to participate was addressed to an identified clinical obstetric leader, who could nominate another health professional to complete the survey. Participation Correspondence: Miss Emily Bain, Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, Robinson Institute, The University of Adelaide, Level 1, Queen Victoria Building, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5006, Australia. Email: emily.bain@adelaide.edu.au Received 31 July 2012; accepted 8 September 2012. 86 © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Australian and New Zealand Journal of Obstetrics and Gynaecology 2013; 53: 86–89 DOI: 10.1111/ajo.12008 Te Australian and New Zealand Journal of Obstetrics and Gynaecology