Eastern Cape High Court (Port Elizabeth) Acting Judge Nicholas Mullins heard that a cascade of events that left a new-born baby with severe brain injuries was preventable by the administration of a medical product easily available to a paediatrician, reports The Herald.
Chris Mouton SC, representing the parents of the child, now 10, said the first 48 hours after the girl was born in November 2008 were crucial and will form the basis of the R23m lawsuit against Netcare Greenacres Hospital and specialist paediatrician Dr Charmaine van Heerden, formerly of PE and now practising in Walvis Bay, Namibia.
According to the report, Mouton told the court a reasonable paediatrician would have administered a surfactant timeously which, he claimed, added to the negligence. A fluid secreted by the alveoli in the lungs is a surfactant and contributes to the elasticity of the lungs and air passages. The girl born at 32 weeks was about eight weeks premature and, according to Mouton, was in a good condition but was shortly after birth diagnosed with hyaline membrane disease (HMD) by van Heerden.
HMD almost always occurs in premature babies when there is not enough surfactant produced but it is easily treated pre-birth or shortly thereafter. ‘The primary focus (of this case) is the failure to administer surfactant timeously,’ Mouton said.
The report says part of the claim is that van Heerden allegedly did not order a further chest X-ray after diagnosing the baby with HMD or an arterial blood gas test in time to determine the oxygen level in the child’s blood. After diagnosing the baby with HMD, van Heerden allegedly ordered that she be treated with a continuous positive airway pressure intervention, which Mouton claimed could be deadly for a baby.
“Evidence will be (presented that) a pneumothorax (or collapsed lung), which is air leaking from the lungs and collecting between the lung and chest wall, is the most common concern with a continuous positive airway pressure intervention. “(Van Heerden and hospital staff) didn’t seem to consider a [collapsed lung] was developing. (They) failed to recognise that the infant showed all the relevant signs that a pneumothorax was developing. Had surfactant been administered we would not have been here today,” Mouton said.
Mouton said the main allegation that the child’s condition deteriorated after 4.30pm on 21 November 2008 after van Heerden had left the hospital with nonspecific instructions to nurses and the failure of hospital employees to perform an arterial blood gas test, showed causal negligence.
Neonatology head at Tygerberg Children’s Hospital, in Cape Town, Professor Johan Smith, said in the report it was not clear in the documentation he had been given what type of continuous positive airway pressure intervention had been used on the baby but that between 7.10am and 2pm the pressure had been increased.
“Progress showing the condition worsening (could be because) increased pressure can lower oxygen levels [in the blood].”
Smith said that, according to the hospital records and nurses’ charts, there was an initial improvement in the baby’s condition but it was clear the baby was showing symptoms of respiratory distress syndrome. “The infant was in constant respiratory distress,” he said.
The report says Smith asked why van Heerden had told staff in the neonatal ICU section at Greenacres Hospital to monitor the baby every six hours. “I do not agree with that. It is the ICU, they should monitor regularly, at least hourly,” Smith said.
Smith told the court it was his opinion that mismanagement of the baby’s treatment, including obscure ventilator settings and the delay in administering crucial medication by Van Heerden, led to the child suffering severe brain and lung injuries.
Smith said that had Van Heerden given the girl Surfactant prior to her collapsing at 3am on November 22 2008, her near-death injuries could have been avoided.
“I must emphasis the importance of Surfactant.
“[It] is widely available, especially in private practice.
“[Van Heerden] had nothing to lose by using the drug.
“[The baby] had a lot to lose by not receiving the proper treatment,” Smith said.
According to records before court, Van Heerden only administered the life-saving treatment after the child stopped breathing and had no blood pressure when she arrived at the hospital after being called by nursing staff.
Smith said he found it peculiar that Van Heerden had used unusual ventilator settings on the baby after she was resuscitated.
“[The ventilator] was blowing in more air rather than allowing the lungs time to release the air leading to ir trapping,” Smith said.
“There was too little time for the lungs to release air.”
Smith said there was extensive evidence that the role played by the Continued Positive Air Pressure (CPAP) and the resuscitation efforts had been contributing factors leading up to the child’s collapse, which could have been avoided if Surfactant was administered timeously.
The parents of the little girl, now 10, who are not being named as per a court order, are suing Van Heerden and Netcare Greenacres Hospital for R23m claiming negligence on behalf of both parties led to their daughter being severely disabled and brain-damaged.
Both Van Heerden, who now lives in Namibia, and Greenacres Hospital have denied negligence on their part.The Herald report (subscription needed)