The birth injury attorneys at ABC Law Centers. obtained $5 million (total annuity payout: $15.7 million) for a little boy who has cystic periventricular leukomalacia (PVL) and cerebral palsy. The boy, who was born prematurely, was injured when the NICU team failed to properly monitor and manage his health during the neonatal period. When nurses made notes in the baby’s chart that were indicators of brain and lung problems, the entire medical team failed to act on these signs. By the time the baby crashed, multiple body systems weren’t functioning properly, which caused serious medical problems, including extremely acidic blood (acidosis).
Even though the boy was premature, he was not given the care that premature babies in the NICU typically receive. A physician only saw the newborn once a day, during rounds. Otherwise, his care was handled entirely by nurses who failed to notify physicians of significant changes in the baby’s condition, failed to give medications that were ordered, and gave medications that were never ordered.
Witness credibility and timing of lab tests are important issues in medical malpractice cases. The blood gas results at the heart of this case were listed in the records with different times. Reiter & Walsh, P.C. attorneys deposed the nurse who drew the blood, as well as the director of the lab that analyzed the blood. The attorneys ultimately determined that the nurse had lied about when the blood gas was drawn.
Steps That Would Have Prevented Respiratory Arrest, Periventricular Leukomalacia (PVL), Brain Damage and Cerebral Palsy
Babies are primarily admitted to the NICU when they are at risk for certain medical conditions and must be closely monitored. In this case, the boy was not properly monitored in the NICU. Shortly before he crashed, there were numerous documentations in the chart that his condition was deteriorating. However, the physician was not notified of these changes, nor did the medical team take any action to try and determine the reasons for the changes so that medical interventions could be performed. For example, the day before the little boy crashed, he had multiple periods in which he would stop breathing, which is known as apnea. During these apneic periods, the oxygen level in his blood would drop very low and his heart rate would slow down. The little boy’s temperature was unstable, his color was gray, his breathing was often shallow with sharp increases in his breathing rate, and he had poor muscle tone. These are all signs of neurological problems and brain injury that require urgent attention from the medical team. Furthermore, most of these signs are an indication of impending respiratory failure and respiratory arrest. When these signs began to occur, a blood gas should have been drawn so the team could assess the baby’s breathing and pH (oxygenation, ventilation and certain important metabolic factors). While the blood gas was being ordered and drawn, preparations should have been made to give the little boy a breathing tube (intubation) for assistance from a breathing machine (ventilator). Of course, if a baby shows persistent signs of impending respiratory failure, the medical team should not wait for blood gas results in order to intubate.
These critical signs were occurring on March 15 and into the 16th, and the baby crashed and went into respiratory arrest in the early morning hours of the 16th. At 2:45 a.m., the baby was intubated. A blood gas drawn shortly before the intubation showed severe acidosis that had been ongoing. The NICU physician assigned to the baby boy testified that the infant likely had acidic blood for over 2 hours. Acidosis can cause brain damage in multiple ways (decreased blood flow to the brain, decreased oxygen in the blood, etc.).
As soon as the little boy began to show signs of neurological problems and impending respiratory failure, he should have been examined and assessed for intubation and other forms of medical support. His breathing and neurological problems were noted almost a full day before he crashed. A blood gas sample drawn at this time likely would have shown that he was in respiratory/ventilatory failure, or that failure was impending. Had the physician intubated the baby at the appropriate time, the prolonged acidosis would have been avoided and the infant would not have gone into respiratory arrest. Furthermore, intubation would have prevented the baby from having the apneic events on the 15th and 16th that caused him to have low oxygen in his blood and low heart rates. Apnea and associated problems can also cause periventricular leukomalacia (PVL), brain damage and cerebral palsy.