This case involves a 26 y/o female who presented to Defendant Hospital at 39 weeks gestation with report of being kicked in the abdomen/abdominal trauma and subsequent decreased fetal movement. A NST was performed and was read as non-reactive. Mom was admitted for induction. A Kleihauer Betke test was ordered for concerns of maternal-fetal transfusion and was resulted during labor (4:26am on May 23, 2020). Baby was born via vaginal delivery at 1:04am on May 24, 2020. We request review by a neonatologist to assess causation of injury and management of post-birth/neonatal care. Please note that due to the expert rules/laws in Michigan, the doctor reviewing these materials must be a board certified Neonatologist, devoting more than ½ of his/her professional time to the practice of Neonatology. The baby was enrolled in therapeutic hypothermia and was diagnosed with HIE, neonatal seizures, and anemia from feto-maternal transfusion. See attached neonatal record excerpts.
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Do you believe there might have been medical error?
Etiology of neonatal encephalopathy was abdominal trauma 2 days prior to arrival to hospital. It is possible after full review of maternal records and FHR strips if there was a delay in delivery as fetal anemia shows a characteristic fetal heart rate pattern.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Not sure of timing of neonatal blood transfusion and if a partial exchange was the source of treatment for severe anemia. It appears that seizures and altered tone occurred early in life and that the brain injury proceeded time of delivery
What makes you a good expert for this case?
Expert in neonatal encephalopathy 40 years of experience as an academic clinical teacher
How often do you encounter cases similar to this one in your practice?
Infrequently. 10-20 cases over 40 years
Do you believe there might have been medical error?
Infant presented with respiratory depression and signs of encephalopathy. The baby had profound anemia with metabolic acidosis. Because of the progound anemia there is low oxygen content available for delivery to the brain and other organs. The Kleihauer-Betke test was positive. Therapeutic hypothermia was begun for presumed HIE with apparent seizure activity. Given the report of prenatal assault on the mother, sonography of the infant's organs and pathology of the placenta and umbilical cord would be important. The infant appears to have been managed appropriately, with the limited information provided for review.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
One question is whether there would be an I dication for earlier delivery given mother's report that infant wasn't moving. An OB expert is needed to answer that question.
What makes you a good expert for this case?
I am a board-certified neonatologist with over 38 years of clinical experience. I directed two Level 3 NICUs and have provided direct medical care for infants with encephalopathy, seizures, and .anemia
How often do you encounter cases similar to this one in your practice?
We cared for 4-6 infants each year with HIE receiving therapeutic hypothermia. I have cared for a handful of infants presenting with profound anemia.
Do you believe there might have been medical error?
The main issue in this case is whether the baby was delivered promptly after the mother came in with a complaint of being kicked in the abdomen and she felt decreased movements of the fetus. This is a very high risk situation and the status of the fetus should have been determined right away and baby delivered by immediate C-section if there was any evidence of severe fetal distress. I did not see any records of fetal heart tracings after mom was admitted. What did they show? Induction of labor is a slow means of delivering a fetus in distress. Did the fetal heart tracings justify taking this slow route? Postnatal management seems reasonable on the whole. Baby was immediately resuscitated and ventilated. Whole body cooling was though I would like the exact time line. Only issue I see right away is that the baby was not given an anticonvulsant right away. An asphyxiated baby is at high risk for seizures and this should have been started immediately.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
If delivery of the fetus was delayed.
What makes you a good expert for this case?
I have over 40 years of experience as a neonatologist and have served on many such cases as an expert. The lawyers who have used me as an expert have all been very satisfied with my expertise. Please refer to my cv.
How often do you encounter cases similar to this one in your practice?
I am at a tertiary center with mainly in-born babies so such problems occur infrequently however we do referrals from outside about 5-10 times a year
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