Neonatology Expert Witness Opines on Sepsis Developing After NEC

This case involves a forty-seven-year-old mother at thirty-one weeks gestation who delivered via cesarean section. The mother had a past medical history of chronic hypertension and diabetes mellitus. The patient experienced some painless vaginal bleeding the day of delivery, and she was later diagnosed with placenta previa. The previa spanned the majority of the internal Os, and therefore, the decision of an emergent cesarean section was made. Surfactant administration was carried out and empiric therapy for sepsis was begun.

A week later, the infant developed bradycardia and feeding difficulties. The following day, the patient developed hematemesis and the physical exam showed a firm distended abdomen. The resident physician ordered an abdominal x-ray, which showed necrotizing enterocolitis (NEC) with perforation. A repeat abdominal x-ray was ordered the following morning by the attending physician and was found to be consistent with the original showing NEC with pneumatosis. Pediatric surgery was then consulted and the patient was sent to the OR. The patient subsequently developed periventricular leukomalacia (PVL) and later died due to complications of sepsis.