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Monday, 24 November 2014

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Doc disputes claim Dalton baby could have lived

A DOCTOR has disputed whether actions taken to help an ill baby could have saved her life, had they been carried out earlier.

An inquest into the death of Amelia Jade Bower yesterday (18) heard a report carried out after she died said she would probably have survived if she had been ventilated and moved from Furness General to a specialist hospital immediately after her birth.

Instead, Amelia, born to 21-year-old parents Kelly Hine and Carl Bower at 12.15am on April 3 last year, was not put onto ventilation until around nine hours later, and transfer arrangements did not begin until around 8am. Amelia died at FGH that evening.

During the second day of the inquest, Doctor Saeed Ghanim, the consultant paediatrician who dealt with Amelia, was questioned over the timings.

During Dr Ghanim’s three hours of evidence, Amelia’s family’s barrister, Mr Jason Wells, read an extract from a report commissioned by the University Hospitals of Morecambe Bay NHS Foundation Trust, which runs FGH.

The report criticised the management of Amelia’s case.

In the report, the doctor who wrote it said: “I would have to conclude that establishing Amelia on ventilation support soon after the birth, and arranging immediate transfer would have, on the balance of probabilities, allowed Amelia to survive.”

But Dr Ghanim disagreed.

He said: “The author does not know that when I left, Amelia was stable. He (the author) based his judgment on incomplete information.”

Amelia died of meconium aspiration, which happens when a baby breathes meconium – its early feces – into the lungs.

Meconium is sometimes passed by babies still inside the uterus, usually when under stress because their oxygen or blood supply is decreasing, as Amelia’s was, because the cord was wrapped around her ankle.

Yesterday, FGH Special Care Baby Unit (SCBU) neonatal nurse, Lynda Fisher, said she mentioned to doctors, shortly after Amelia was born, that she should be transferred to a specialist baby unit at another hospital.

This opinion was echoed by Laura Leigh, the other SCBU nurse who looked after Amelia during the early hours of that morning.

In evidence, both said they automatically expected Amelia to be transferred because she needed to be given a higher level of oxygen.

This opinion had also been shared by Doctor Sarrah El-Munshid, the registrar who treated Amelia from immediately after her birth, and who gave evidence on Tuesday(17/4).

Having been called in urgently by Dr El-Munshid in the minutes following Amelia’s birth, Dr Ghanim said, it was decided Amelia would stay at FGH because she was irritated following her stressful birth, and moving her would cause discomfort.

The doctor thought it was better to keep an eye on her and see how she progressed, he said.

The inquest heard arrangements did not begin to be made to transfer Amelia to a specialised baby unit until around 7.45am, when the Cot Bureau, which regularly calls hospitals to check whether baby transfers are needed, phoned FGH SCBU for a routine check.

During the inquest, Dr Ghanim was also repeatedly asked to explain why ventilation was not done sooner.

Intubation, which allows a baby to be ventilated, was not carried out until after Dr Ghanim was called back to FGH later that morning.

He had gone home at around 2.40am, he said, because Amelia appeared to be stable.

He established a plan with Dr El-Munshid for Amelia to be monitored, and a review to be carried out if her condition did not approve.

But the inquest heard Amelia’s condition began to deteriorate at 5am.

Her oxygen levels were decreasing and she was needing to be given more and more.

Attempts were made to put her on CPAP, a type of ventilation therapy, but she did not tolerate it.

It was now around 6am and Mrs Fisher alerted Dr El-Munshid, who said she would make an urgent call to Dr Ghanim while starting to carry out X-rays and other tests.

Dr Ghanim told the inquest he returned knowing he would intubate Amelia so she could be ventilated.

Asked by Mr Wells why it took so long between Amelia’s condition changing at 5am and her being ventilated around 9am, Dr Ghanim said he did not know why he was not contacted in the two hours between 5am and 7am.

He said he arrived at around 7.30am, but this would be within 15 minutes of being called.

Amelia was given morphine at 8.08am to prepare for intubation, and it took three attempts to get a tube into her.

The inquest also heard yesterday how a team from the Royal Preston Hospital arrived to see to Amelia at 10.05am.

Giving evidence yesterday, advanced neonatal nurse practioner, Andrew Gibson, who led that team, described their efforts to prepare Amelia to leave FGH for Preston.

However, her continued deterioration throughout the day meant they were never able to move her.

The inquest is expected to conclude today.

 

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