Failure to Detect Irregular Cord Blood Gasses Causes Lifelong Neurological Damage

This child neurology case involves the failure of physicians to detect irregular cord blood gasses in a neonatal patient. The arterial cord blood values were indicative of severe fetal acidemia but there was no intervention attempted by the neonatal hospital staff. The case also involves a delayed diagnosis of the infant’s neurological deficits. The parents made regular complaints to the pediatricians concerning the patient’s gait and his overall body posture. The patient finally underwent an MRI after the parents consulted another pediatrician for an independent evaluation. The MRI revealed neurological injury consistent with an in utero hypoxic event.

Question(s) For Expert Witness

1. Should the in utero hypoxic event have been noticed sooner?

Expert Witness Response E-000764

This is a very interesting case with a diagnosis that was clearly delayed. By doing so, a window of opportunity for therapeutic interventions (whole body cooling, physical and occupational therapy, etc) was likely missed, impacting the long term use of his right arm/hand, gait, or other areas of the child's development. A base deficit of >16mEq/L is biochemical evidence of birth asphyxia, thereby warranting further diagnostic tests in the neonatal period, especially if there are other concerning factors (an acute perinatal event, low apgar scores, respiratory distress, any slightly abnormal neuro exam, etc.). Additional tests might include arterial blood gas, lactate, LFTs, electrolytes, cranial ultrasound, brain MRI. Certainly, when problems in his motor development became apparent (arm use/positioning, abnormal gait, etc) an MRI and/or a thorough evaluation by a pediatric neurologist, developmental pediatrician, or NICU follow-up specialist should have been done.