Partners: Hillingdon Hospitals NHS Foundation Trust, NHS England’s Maternity and Neonatal Safety Improvement Programme (MatNeoSIP)
Alignment with three shifts: Sickness to prevention
Premature babies face significant challenges, such as respiratory difficulties, infections, brain injury, and feeding issues. And, sadly, not all preterm babies receive the same level of care – mothers and babies often move between multiple teams (midwifery, obstetrics, neonatology), with poor communication sometimes leading to delays or missed steps.
Hillingdon Hospital NHS Foundation Trust has undertaken a sustained journey to enhance the perinatal care pathway for preterm babies, starting in 2020. The centrepiece of this innovation is the BestPrem Bundle, designed for infants born under 34 weeks’ gestation. This bundle brings together nine evidence-based interventions, including:
• Delayed (optimal) cord clamping
• Maintaining normothermia (normal body temperature) immediately after birth
• Early initiation of maternal breast milk within six hours
ICHP’s implementation support has included joining the Preterm Optimisation Team’s monthly meetings (becoming part of the multi-organisation, multi-disciplinary team), offering process mapping, data and QI support, and sharing insights and best practice from other Trust teams regionally and nationally.
NNAP Improvements from Q2 2022/23 baseline data to Q2 2025/26 indicate:
- Optimal cord management: The proportion of babies born <34 weeks having had their cord clamped at/after 1 minute increased from 56% to 78.7%, above the national standard of 75%. Most of the babies that did not receive delayed cord clamping were babies where there was abruption and monochorionic twins.
- Normothermia: Proportion of babies born <34 weeks and admitted within 12 hours of birth with a first temperature between 36.5 C and 37.5 C, increased from 68.1% to 83.3%.
- Breastmilk feeding at 24 hours: The number of preterm babies receiving breastmilk in their first 24 hours increased from 50% to 85.2%.
- Breastmilk at discharge: Infant feeding of breast milk at Day 14 and at discharge increased from 65.8% to 81.1%.
- Full optimisation of care : Babies receiving all the above and the additional components in the Optimisation Care Bundle (including Antenatal Steroids, Antenatal Magnesium Sulphate, Intrapartum Antibiotics, Optimising place of birth, Caffeine, non-invasive ventilation and early surfactant and colostrum and maternal milk feeding) increased from 7.7% to 37.7%.
Staff knowledge and confidence has also significantly increased through simulation and video-based training.
In 2025/26 we’re focused on scaling this innovation across NWL via:
- Monthly audits and stakeholder meetings to maintain progress
- Knowledge-sharing events
- Continued engagement with rotational staff and improvement of workforce planning
- Greater integration with digital maternity care pathway
- Monthly Best-Prem meeting with wider-multidisciplinary team (deep dive into 2 sections as a minimum)
- Quarterly Best-Prem study day
- Monthly teaching with neonatal nursing team
- Attendance and presentation at regional and national forums
