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What are the signs that neonatal sepsis has been caused by negligence? 

Comment & OpinionWhat are the signs that neonatal sepsis has been caused by negligence? 
Article by Rachael Heyes, a specialist medical negligence solicitor at JMW Solicitors 

Sepsis is a life-threatening reaction to an infection, which can also lead to meningitis,  an infection in the membranes surrounding the brain and spinal cord. Sepsis in newborn babies is curable, but sadly there are cases where a failure to act on a baby’s clinical signs of infection and administer appropriate treatment results in severe injury or even fatal consequences for the child.

Given the potential for lifelong implications  from sepsis, there is guidance in place which clinicians must follow to ensure early and prompt treatment is provided, including screening for infection and commencing antibiotics. If this guidance isn’t followed and the symptoms of sepsis are missed, resulting in injury to the child, there can be a case for a clinical negligence claim.

What evidence needs to be assessed to demonstrate clinical negligence?

When considering whether clinical negligence played a role in a neonatal sepsis case, it is important to obtain a clear picture of the baby’s clinical condition following birth. This involves a detailed review of the medical records and an in-depth discussion with the baby’s parent/s about what they can remember. Parents are often best placed to provide details as to their baby’s condition and behaviour following birth. For example, they will often be able to comment on the baby’s responsiveness, lethargy, their breathing, ability to maintain their temperature, any changes to their colouring and any difficulties with feeding (either from mum or a bottle). This kind of analysis is an essential part of building the picture of the scenario that led to the sepsis going unnoticed.

It is also important to consider the baby’s gestation, as premature babies are at an increased risk of infection. Another factor is whether there was any meconium present (baby’s first poo), as this also increases their infection risk. A review of the records and speaking to the parent/s will indicate whether it should have been clear that a baby was showing clinical signs of infection following their birth.

If it can be shown that no action was taken either by the midwives or the treating doctors, despite clear evidence that the baby was at risk of infection, then this is an indicator that something has gone wrong, and that there was likely a failure to take appropriate action and administer timely treatment. If the baby has been harmed, then there would be cause to investigate further and find answers and potentially financial compensation for the family.

What are the common medical mistakes that lead to neonatal sepsis?

The most common medical mistakes leading to cases of neonatal sepsis relate to a failure to act on a baby’s clinical signs of infection. For example, behaviour changes, an inability to maintain their temperature and  poor appetite can all indicate sepsis. Failure to arrange for a review by a speciality or senior doctor could represent grounds for a negligence claim.

This is particularly important for babies who are premature. Midwives sometimes wrongly assume that the cause of their poor feeding and temperature issues relate to their prematurity and change in environment, meaning they fail to consider that the cause may be due to infection. However, the guidance is clear, and where a baby is demonstrating risk factors for infection, there should be a review by a doctor, leading to screening for infection and the prescription of antibiotics where necessary.

A lack of detailed record keeping is another common issue. This could include a failure to complete observation charts and sepsis charts, in addition to poor communication between the postnatal ward and the speciality doctors. This can result in a baby who is showing risk factors for infection not being escalated for senior review until their condition deteriorates, by which time it can be too late for successful treatment. Sadly, parental concerns are sometimes ignored in this process, in favour of a clinical bias that a baby appears to be well. This results in a failure to consider alternative causes for their condition, including infection.

From a legal perspective, it is key to gather as much evidence as possible to build a complete picture of the scenario. The clear guidance that the NHS has published has created far greater transparency when finding out whether there has been medical negligence. This means that parents of children that have had their condition missed by medical professionals are able to get the compensation they deserve, and the NHS is able to continue to improve the treatment process.

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