A BABY boy who died from an infection nine days after being born at a "seriously dysfunctional" maternity unit could have been saved if staff had acted earlier, a tribunal heard.

Midwives Lindsey Biggs and Holly Parkinson allegedly contributed to the death of Joshua Titcombe when they failed to notice he had a treatable infection at Furness General Hospital, in Barrow.

Joshua died from a lung haemorrhage nine days after being born at FGH, the Nursing and Midwifery Council heard. 

The midwives allegedly failed to act on advice given to them by a paediatrician to carry out three hourly observations and did not refer the situation when his temperature dropped. 

Observation charts for Joshua and his care plan were lost by the hospital, the hearing was told. 

Expert witness Caroline Duncan, who has 32 years' experience in nursing, said: "Earlier intervention would have given the baby a greater chance of survival.

"The failure to refer the situation to a paediatrician resulted in a significant loss of the baby’s chance of survival." 

The tribunal heard that many midwives working for the trust did not know low temperature could indicate infection. 

"But it is incorporated into a midwife’s training," said Ms Duncan. "I would expect a midwife to know the normal range (of temperatures) for a baby but even if she didn’t I would expect the referral to take place."

The hearing was told that it was normal for a newborn to feed eight to 12 times in the first 12 hours and Joshua had fed only three times. 

Joshua was born at 7.38am on October 27, 2008. 

Ms Parkinson had called a paediatrician when mother Hoa Titcombe and Joshua fell under her care at 9am on October 27 after concerns about Mrs Titcombe’s high temperature. 

The paediatrician told her to observe Joshua’s heart rate, respiratory rate and colour and tone every three hours. 

He was later placed in a warming cot due to a low temperature. 

Ms Biggs was on the night shift on October 27, the hearing was told. 

"At 2.30am Mrs Titcombe called for assistance as Joshua was breathing rapidly," said Amanda Hamilton, for the NMC. 

Ms Biggs said her observations were normal. The last recorded temperature for Joshua was 36.6 degrees at 11pm. 

This is at the lower end of the normal range, the hearing was told. 

By the next time Ms Biggs checked on Joshua at 6.50am, around four hours after her last observations, his temperature had dropped by 0.2 – 0.3 degrees, the tribunal heard.

There is no evidence of what Joshua’s temperature was at this time as the charts have been lost. 

Ms Biggs noted that the room was cold and put Joshua in a warming cot. She did not inform a paediatrician and said at the time she did not realise that a low temperature could mean an infection.

At 7.45am Mrs Titcombe called for help and Joshua was found collapsed. The emergency response team was called and found Joshua unresponsive with minimal respiratory function. He was moved to the intensive care ward and incubated. But Joshua had developed pneumococcal septicaemia and was moved to the Royal Victoria Hospital in Newcastle where he died on November 5, 2008.

"The omission to refer to a paediatrician took away the opportunity for the baby to be treated which resulted in a significant loss of chance of survival,’ said Ms Duncan. 

Both midwives face NMC charges in the wake of the damning Kirkup Report, which identified a series of failings at FGH's maternity unit. 

The inquiry said midwives were so cavalier they were nicknamed ‘The Musketeers’. 

Ms Biggs is charged with failing to ensure observations were carried out over three hours on October 27, not escalating Joshua’s low temperature and not keeping adequate records of care for Joshua or Mrs Titcombe. She denies all charges. 

Ms Parkinson is charged with not documenting a paediatrician’s advice that Joshua be checked every three hours, not escalating his low temperature and not keeping adequate record of the care given to Joshua. She admits to not documenting the three hourly observations but denies all other charges. The charges put to both midwives, who are present at the hearing, allegedly contributed to Joshua’s tragic death. The hearing continues.