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Admission of liability for boy with brain injury from untreated neonatal hypoglycaemia
After a normal pregnancy but slow labour, the claimant was delivered, at term, by caesarean section owing to early decelerations on the fetal heart monitor. He was born in good condition. Blood tests confirmed he had not suffered from birth asphyxia. His birth weight was above the 2.5kg threshold for the hospital’s standard hypoglycaemia care protocol to be followed but on examination the paediatrician noted that he appeared small. He breast-fed on the morning of his birth and was given an extra blanket because the room was draughty. During the morning his temperature dropped to 36.4°C and he was noted to be jittery.
The hospital’s own guidelines specified that normal infant temperature was between 36.5°C and 37.5°C. Given the claimant’s low temperature, in addition to skin-to-skin contact, feeding and dressing him in several layers and using a heat pad, his blood sugar level should have been tested. If his temperature hadn’t improved an hour after taking steps to warm him up, advice should have been sought from the neonatal unit. Even if it had improved, the guidelines required his temperature to be monitored every four hours for the next 24 hours. Neither the claimant’s temperature, nor his blood sugar levels were taken and the neonatal team were not consulted.
The claimant’s jitteriness was a sign of hypoglycaemia which, coupled with the low temperature (which often accompanies neonatal hypoglycaemia) indicated that further action was needed to measure his blood sugar, seek medical advice and monitor his condition. None of these steps were taken by the hospital midwives. Throughout the following day, they failed to take the claimant’s temperature or test his blood sugar level. He was bathed, despite the hospital’s guidelines stating that bathing should be postponed if the baby is hypothermic.
By midnight the claimant’s mother was concerned that the baby was crying a lot and that his cry was louder and of higher pitch than normal. She called the midwife but was given an alternative explanation for the cry. She called for help again later, by which time, in addition to the crying, the baby was floppy. The midwife and nurse attended again and the midwife agreed that the baby was floppy, but they left without carrying out an examination. Soon afterwards the nurse returned and took the baby away to allow the mother to rest.
In the early hours of the next morning, the claimant was taken to the neonatal unit. He was examined and was found to be very floppy, with poor respiratory effort, dusky, jaundiced, cold and very lethargic. He was making abnormal jerking movements. He was moved to the resuscitaire, where his oxygen levels were found to be only 70% in air. He was given oxygen and his oxygen saturation levels improved to 95%. Blood tests revealed his blood sugar was very low. He was given a bolus dose of dextrose and saline and his blood sugar improved. He was started on a dextrose infusion. His temperature was also very low at 35.8°C and he was moved to an incubator. He remained on the neonatal unit until two weeks later, when he was discharged home and was able to demand feed.
An MRI brain scan revealed damage to the claimant’s brain consistent with neonatal hypoglycaemia.
Boyes Turner’s specialist brain injury solicitors investigated the claimant’s neonatal treatment in hospital and put the claim to the defendant NHS Trust. The defendant responded to the claim, admitting negligence by the midwife who failed to seek medical advice once the baby was noted to be floppy. If she had done so, they accept that the claimant’s hypoglycaemia would have been recognised and treated and his permanent brain damage would have been avoided.
We are now arranging for judgment on liability to be entered. An interim payment on account of damages will be obtained to meet the claimant’s immediate needs whilst we work with our experts to assess the full extent of his brain injury and the value of his claim.
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