Obstetrician Expert Witness Discusses Respiratory Problems in Infant

This case involves a two-day-old male who developed neonatal respiratory distress syndrome shortly after birth. The boy was born prematurely at thirty-two weeks gestation. The mother was concerned about the early delivery but her physician reassured her that the baby was in good health. Shortly after delivery, the child showed signs of breathing difficulties evidenced by tachypnea, tachycardia, chest wall retractions, grunting, and nasal flaring. An x-ray was taken which showed a uniform infiltrate with a ground-glass appearance. The child was diagnosed with neonatal respiratory distress syndrome secondary to poor lung development as a consequence of prematurity. During the pregnancy, a lecithin-to-sphingomyelin ratio (LS ratio) was never ordered. The child now required continuous positive airway pressure (CPAP) and intravenous fluids. Even after these therapies were initiated, the child still showed signs of breathing difficulties. This required the placement of an endotracheal tube to assist with respirations. An artificial surfactant was also administered to the child and a one-month hospitalization was warranted. Upon discharge, the mother was told that the child developed bronchopulmonary dysplasia as a consequence of his condition. The finding was supported by inflammation and scarring of the child’s lungs. During the following months, the child’s pediatrician expressed concern that the child did not properly develop. Normal pulmonary functioning in the child was also never fully restored.

Question(s) For Expert Witness

1. Did this obstetrician practice the standard of care when managing the health of a premature child, and what should have been done to facilitate proper development of this child?

Expert Witness Response

The obstetrician, in this case, did not properly protect the premature child from developing neonatal respiratory distress syndrome. If a child is being delivered prematurely, a lecithin-to-sphingomyelin ratio (LS ratio) should have been ordered to investigate lung maturity. Premature children commonly do not have fully developed lungs due to a surfactant deficiency. Surfactant helps with lung development and prevents airway collapse. If an LS ratio of less than 2.0 was found, the mother should have been given glucocorticoids to facilitate the production of surfactant in the child. These measures were not taken in this case. Additionally, the mother was falsely reassured about the condition of her child. Due to the fact that these measures were not taken by the obstetrician, the child suffered permanent lung damage and delays in development. This child will require future follow-up with a pulmonologist to ensure that he will not develop future complications.