A cascade of events that left a newborn baby with severe brain injuries was preventable by the administration of a medical product easily available to a paediatrician, the Port Elizabeth High Court heard on Tuesday.
The first 48 hours after the little girl was born on the morning of November 21 2008 were crucial and will form the basis of the R23m lawsuit against Netcare Greenacres Hospital and specialist paediatrician Dr Charmaine van Heerden, the lawyer representing the aggrieved parents of the child, now 10, said.
Chris Mouton SC, for the parents, told the court a reasonable paediatrician would have administered a surfactant timeously which, he claimed, added to the negligence for which the family is suing Van Heerden and the hospital.
A fluid secreted by the alveoli in the lungs is a surfactant and contributes to the elasticity of the lungs and air passages.
Prior to the case being heard, Mouton brought an application for the court to prohibit the identity of the girl and her parents being published.
Acting judge Nicholas Mullins granted the application, saying it would be in the best interests of the child.
According to Mouton, the parents have instituted the claim in respect of general damages, and past and future medical expenses, as well as for pain, suffering, disability, disfigurement and loss of amenities of life.
“[The parents] allege that both [Van Heerden and Greenacres Hospital] had a legal duty to provide care for [the child and her parents],” Mouton said.
The little girl born at 32 weeks was about eights weeks premature and, according to Mouton, was in a good condition but was shortly after birth diagnosed with hyaline membrane disease (HMD) by Van Heerden.
HMD, commonly known as respiratory distress syndrome, almost always occurs in premature babies when there is not enough surfactant produced but it is easily treated pre-birth or shortly thereafter.
“The primary focus [of this case] is the failure to administer surfactant timeously,” Mouton said.
Part of the claim is that Van Heerden allegedly did not order a further chest X-ray after diagnosing the baby with HMD or an arterial blood gas test in time to determine, among other things, the oxygen level in the child’s blood.
After diagnosing the baby with HMD, Van Heerden allegedly ordered that she be treated with a continuous positive airway pressure intervention, which Mouton claimed could be deadly for a baby.
“Evidence will be [presented that] a pneumothorax [or collapsed lung], which is air leaking from the lungs and collecting between the lung and chest wall, is the most common concern with a continuous positive airway pressure intervention.
“[Van Heerden and hospital staff] didn’t seem to consider a [collapsed lung] was developing.
“[They] failed to recognise that the infant showed all the relevant signs that a pneumothorax was developing.
“Had surfactant been administered we would not have been here today,” Mouton said.
Mouton said the main allegation that the child’s condition deteriorated after 4.30pm on November 21 2008 after Van Heerden had left the hospital with nonspecific instructions to nurses and the failure of hospital employees to perform an arterial blood gas test, showed causal negligence.
Neonatology head at Tygerberg Children’s Hospital, in Cape Town, Prof Johan Smith, said it was not clear in the documentation he had been given what type of continuous positive airway pressure intervention had been used on the baby but that between 7.10am and 2pm the pressure had been increased.“Progress showing the condition worsening [could be because] increased pressure can lower oxygen levels [in the blood].”Smith said that, according to the hospital records and nurses’ charts, there was an initial improvement in the baby’s condition but it was clear the baby was showing symptoms of respiratory distress syndrome.“The infant was in constant respiratory distress,” he said.Smith asked why Van Heerden had told staff in the neonatal ICU section at Greenacres Hospital to monitor the baby every six hours.“I do not agree with that. It is the ICU, they should monitor regularly, at least hourly,” Smith said.Barry Roux SC represents the hospital. Attorney Karen Lee acts for Van Heerden.