Legal Briefs: Was This Case of Necrotizing Enterocolitis Preventable?

Abstract

A 28 1/7 week gestational age male infant with a birthweight of 1,280 g was born to a 23-year- old gravida 3, para 0-0-2-0 woman. The pregnancy was uneventful until the night before delivery when she developed preterm labor. She received 1 dose of betamethasone 8 hours before delivery. She also received 3 doses of penicillin for unknown group B Streptococcus status. Artificial rupture of membranes occurred a few hours before birth and the amniotic fluid was clear. The birth was via normal spontaneous vaginal delivery. The placenta appeared grossly normal, but subsequent pathologic examination showed mild chorioamnionitis. The infant’s Apgar scores were 8 at 1 minute and 9 at 5 minutes of age. The infant was clinically stable and treated with continuous positive airway pressure. The infant had a normal complete blood cell (CBC) count and was started on antibiotics because of preterm labor. The infant also received intravenous fluids at 80 mL/kg per day. On day 1, caffeine was initiated and phototherapy was started because the infant’s bilirubin was 8.1 mg/dL (138.5 μmol/L). At that time, the infant’s weight was down 11% from birthweight. On day 2, a percutaneous intravenous central catheter (PICC) was placed. On day 3, the infant’s weight loss was down 13% from birthweight and his sodium was 151 mEq/L (151 mmol/L) with a blood urea nitrogen of 30 mg/dL (10.7 mmol/L). The infant was started on trophic breast milk feedings of 1.5 mL every 3 hours. With the intravenous fluids being infused at 122 mL/kg per day, the total volume of fluids was 154 mL/kg per day. The infant did not receive probiotics. As the feedings increased, the volume infused diminished. The plaintiff neonatologist thought that the infant should have had his hydration status better managed to prevent dehydration and that it was inappropriate …