A Toronto Mother was induced at 37 weeks’ gestation and gave birth to a healthy baby after a normal labour and delivery. The only cause for concern was that the baby was Small for Gestational Age (SGA). Even though the neonatal intensive care unit (NICU) and the hospital had a policy categorizing SGA infants as high-risk and requiring them to be assessed by the NICU, the protocol was not activated by the defendant nurses.
After the baby’s temperature dipped slightly several hours after birth, she was wrapped in a blanket and towel to warm up. Her blood pressure was 117 beats per minute, but her temperature continuously fluctuated from 36.8 degrees to 37.5 and then decreased to 36.5 degrees. Despite her heart rate being normal, no other vital signs or other assessments were done. The hospital’s policies stated that if an infant’s temperature is more than 36 degrees, it is to be checked every 30 minutes until it is less than 36.6 degrees for two consecutive readings. Despite this, and another policy which dictated that an infant’s temperature should be stabilized within 4 hours, the baby’s temperature was not checked again for over 5 hours.
Symptoms of bacterial infection are usually subtle in a newborn infant, and even minimal deviations from normal behaviour should be regarded as possible indications of invasive infection. Since an elevated temperature without an accompanying infection in full-term infants is uncommon, the hospital’s septic work-up includes temperature instability as a cause for concern.
The doctor finally came to assess baby and Mom. Although the doctor pointed out that the baby had developed red spots on her chest and that she was feeding poorly, she was discharged anyway. There was no indication that the doctor knew of the baby’s problematic history, or that he took her vital signs. A discharge was even more inappropriate in the circumstances, since the nurse had noted cyanosis around the mouth, slight jaundice, decreased movement and increased sleep. These were all signs of sepsis that were not acted upon.
The baby was re-admitted to the NICU three hours after being discharged. Within 6 hours of her arrival at the NICU, a blood culture tested positive for group B streptococcus. Shortly afterwards, the baby developed seizures and septic shock. A neurological examination showed decreased muscle tone.
The baby became extremely ill, requiring intubation, blood and platelet treatments and ventilation. She had severe hypotension which required treatment with several medications. The sepsis and presumed meningitis, together with poor cerebral perfusion, reduced the flow of blood to her brain. She had encephalopathy which resulted in brain injury. She has cerebral palsy, significant developmental delay and a seizure disorder.
Sommers Roth & Elmaleh Professional Corporation has over 40 years of experience in medical malpractice litigation in the Greater Toronto Area (GTA), Ontario, and across Canada.
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