Jaundiced newborn dies after slip-ups
AN INFANT BORN AT 36 WEEKS and the baby’s 20-year-old mother were discharged from the hospital fewer than 48 hours after delivery, with an appointment with a visiting nurse for the following day and a pediatrician 3 days later. Hospital medical records reported infrequent breast feeding, significant decrease in weight, and a bruise on the back of the infant’s head.
The visiting nurse who examined the baby noted moderate facial jaundice, mild jaundice in the groin, and slight jaundice in the sclera of the eyes, as well as the bruise on the back of the head. The nurse didn’t notify the pediatrician of the jaundice. The mother said that when she voiced concern about the jaundice, the nurse told her to feed the infant more often and expose her to sunlight.
The day after the nurse’s visit, the parents noticed that the baby was more jaundiced and had started to arch her back, grunt, and whine. The mother called the pediatrician’s office that day and reported the symptoms; the nurse told her that the pediatrician felt that he didn’t need to see the baby before her appointment the following day. As the symptoms worsened, the mother called the pediatrician’s office 3 more times before 6 PM, speaking with 2 nurses, neither of whom took a medical history.
The mother called again after the office had closed. A nurse arranged for the infant to be seen at the hospital, where the baby was admitted with a critically low temperature, decreased muscle tone, arching of the back, and an elevated bilirubin level of 35.4 mg/dL. Despite phototherapy and intubation, the infant’s condition deteriorated, and she was airlifted to another medical facility for more advanced care. The baby was given cardiopulmonary resuscitation on arrival, but died 4 hours later of acute bilirubin encephalopathy.
PLAINTIFF’S CLAIM In light of her symptoms, the baby shouldn’t have been discharged from the hospital. The visiting nurse should have reported the baby’s symptoms to the pediatrician or recommended that the parents take the baby to the doctor right away. The nurses in the pediatrician’s office were negligent in not taking a full medical history. The pediatrician should have seen the baby immediately. He failed to recognize the symptoms of possible hyperbilirubinemia, a medical emergency.
DOCTOR’S DEFENSE No information about the doctor’s or nurses’ defense is available.
VERDICT $460,000 Massachusetts settlement.
COMMENT This case illustrates, once again, the importance of care coordination and sharing information on a timely basis.