Neonatal hypoglycaemia occurs when a newborn's blood sugar levels drop too low in the days after birth. (file image) Photo: 123RF
An Auckland primary maternity hospital and midwife's failures to properly care for an infant has left the baby with a neurological condition.
Health and Disability Commission (HDC) deputy commissioner Rose Wall said the baby was born healthy at Birthcare Auckland Limited in 2019, but his health declined in the 24 to 48 hours afterwards as he developed hypoglycaemia.
Neonatal hypoglycaemia occurs when a newborn's blood sugar levels drop too low in the days after birth, which can cause permanent brain damage and disability.
A delay in identifying the baby's condition resulted in him going into respiratory and cardiac arrest when he was being transferred to the neonatal intensive care unit, which required resuscitation.
The infant now has cerebral palsy with significant developmental delays, and the family faces ongoing uncertainty around the extent of harm and the impact it will have on his future development.
Wall said the infant's symptoms should have alerted the midwife to the seriousness of the situation and led her to investigate further, by way of a full assessment and then intervention.
The midwife failed to take appropriate action in recording vital signs or administering oxygen during the transfer, she said.
"The registered midwife did not follow the correct basic life support protocols required in an emergency situation such as this. The infant was in respiratory and cardiac arrest. Chest compressions should have been initiated promptly."
Wall said the Birthcare policy for treatment of neonatal hypoglycaemia was not consistently well understood by staff.
"While hypoglycaemia and its management are within a midwife's scope of practice, it is incumbent on providers, like Birthcare, to ensure its staff are aware of the particular requirements of its own policies to maintain a consistent standard of care."
Wall said there was a fundamental failure to deliver care and skill because no one at Birthcare administered the infant dextrose gel when he was hypoglycaemic.
She found Birthcare breached the Code of Health and Disability Services Consumers' Rights for their poor handling and management of the incident and the parents' subsequent complaint.
Wall also found Birthcare in breach for failing to communicate openly, honestly and effectively with the parents about the complaint.
The deputy commissioner made recommendations, including that Birthcare and the midwife provide written apologies to the infant and his parents for the deficiencies identified in the report.
She also wanted Birthcare to report to HDC with evidence of staff training in documentation of handover and escalation, emergency skills, and roles and responsibilities during ambulance transfers.
The case has also been referred to the director of proceedings to decide whether proceedings should be taken.