Undiagnosed Pediatric Hydrocephalus Leads to Developmental Delay

Case Summary

This case involves a child who had a normal birth. The pregnancy was uncomplicated, and there were no noted hypoxic episodes or needle injuries during delivery.

In the first months of the patient’s life, a resident and an attending pediatrician saw the patient during well-child visits. Neither the resident nor the attending physician took head circumference measurements at any time.

Both the attending physician and the resident failed to properly screen the child. Easily identifiable symptoms went unrecognized. This resulted in a month-long delay in diagnosis. During this time, the child presented with obvious neurological symptoms, and treatment began.

As a result of the delay in diagnosis, the child experienced neurologic deterioration. The child received delayed neurosurgical intervention for the treatment of the condition. Years later, the patient continues to suffer from neurologic sequelae and is showing continued signs of developmental delay.

Case Theory

The case involves allegations that the attending pediatrician and resident pediatrician failed to perform standard diagnostic tests. Furthermore, the attending pediatrician and the resident allegedly failed to diagnose hydrocephalus in an infant. The failure to adhere to the medical standard of care during the outpatient pediatric well-visits, including head circumference measurements, resulted in a violation of the standard of care.

Hydrocephalus is a dangerous medical condition that can lead to brain injury, developmental delay, vision problems, and death. It affects 1 to 2 of 1,000 live births in the U.S. each year. The fluid that continues to build in the brain causes the head to swell and has definable symptoms including increased head circumference, a bulging fontanelle, downward deviation of the eyes, and prominent scalp veins. Most of these cases are diagnosed before birth, at the time of delivery, or in early childhood.

This child suffered a permanent brain injury because the hydrocephalus was allowed to progress without being properly diagnosed, delaying treatment.

Expert Witness Q&A

• What measures do pediatricians perform to screen for, diagnose, and treat hydrocephalus? Is it below the standard of care to not perform these tests?
• How important is the timeliness of intervention in hydrocephalus? What effect does a delay in treatment have in patients who develop hydrocephalus in the first months of life?
• How common is it to miss a diagnosis of hydrocephalus?
• What are the common ocular complications that are caused by a delay and diagnosis of hydrocephalus and would earlier treatment likely make a difference in the outcome of this case?
• Is damage caused by delay in diagnosis of hydrocephalus progressive or permanent?

Expert Witness Involvement

Pediatrics

A pediatric physician can speak to the common signs and symptoms of hydrocephalus in children. This expert can also testify to the testing measures used and how often an infant is screened for the condition. A pediatric physician can opine on the standard of care for identifying and diagnosing a possible case of hydrocephalus.

Pediatric Neurologist

A pediatric neurologist can speak to the brain development damage and future complications that a delay in diagnosis of hydrocephalus can cause.

Pediatric Ophthalmologist

Pediatric ophthalmologists are regularly consulted in children with hydrocephalus as the risk of developing several eye issues is high. Here, an expert can speak to the risks and symptoms the pediatrician should have looked for and missed.