Legal Briefs: Devastating Outcome Following PDA Ligation and Inadequate Anesthesia

Abstract

A 32-weeks’-gestation male infant was born to a 38-year-old G3P1Ab1 woman whose pregnancy was complicated by severe pregnancy-induced hypertension. A week before delivery, the biophysical profile (BPP) was 10/10. The mother noticed decreased fetal movement, a repeat BPP evaluation was performed, and it was 4/10. Because of this reduction in BPP, the obstetrician decided to perform an emergent cesarean delivery. One dose of antenatal steroids was given before a vigorous 1,600-g infant was delivered. Cord gases were unremarkable. Apgar Scores were 6 and 9 at 1 and 5 minutes, respectively. The baby was intubated at 5 minutes because of respiratory difficulty. He was given one dose of surfactant replacement therapy. The initial mean blood pressure (BP) was 36 mm Hg. Ampicillin and cefotaxime were started. His complete blood count showed a white blood cell count (WBC) of 5.5 × 103/uL with a normal differential, a hematocrit of 39.5% (0.39) for which he was transfused packed red blood cells, and a platelet count of 114 × 103 u/L. The nucleated red blood cell count was 363 per 100 WBC. The neonatologist retained by the defense pointed out that this elevated nucleated red blood cell count suggested brain damage in utero. The plaintiff neonatologist disagreed and said it suggested stress, not damage. The following day, day 1, the baby remained intubated on a low ventilator setting. His creatinine was 1.4 mg/dL. The neonatologist retained by the defense pointed out that this high creatinine at birth suggested brain damage in utero. The neonatologist retained by the plaintiff said it was not possible to determine if it was from the baby or the mother because her creatinine level was not evaluated, but an elevated creatinine does not necessarily imply brain damage in utero, even if it were from the baby. He had …