Legal Briefs

Abstract

A 2,320-g 33–2/7-weeks' gestation male infant was delivered to a 30-year-old woman whose pregnancy was complicated by 4 days of premature prolonged rupture of membranes (PPROM). The mother was afebrile, and she received antenatal steroids and amoxicillin. When labor began, a repeat cesarean section was performed. Resuscitation consisted of blow-by oxygen. The Apgar scores were 8 and 8 at 1 and 5 minutes, respectively. The infant was asymptomatic, was not started on antibiotics, and received intravenous fluids via the peripheral route. A complete blood count (CBC) yielded unremarkable results. Blood cultures were drawn. On postnatal day 2, small feedings were begun. On day 3, results of a CBC and C-reactive protein (CRP) measurement were unremarkable. The pathology report available on day 2 showed chorioamnionitis with green discoloration of the membranes and nonspecific villitis. The blood culture drawn on the day of birth was negative on day 3. The infant continued to be asymptomatic until postnatal day 5, when he had a residual of 6 mL from a 17-mL feeding. Five hours later, he experienced an apneic episode. Shortly thereafter, he began having tachycardia, worsening apneic episodes, and elevated temperatures (37.8°C) despite a serial reduction in the ambient temperatures. The physician was not notified of any of the findings until many hours later, when the apneic episodes worsened. The plaintiff's experts were critical of the nurses for not notifying the physician of the gastric residual, the tachycardia, the elevated temperatures, and the apneic episodes. The nurses said in their depositions that they did not need to call the physician; they were entitled to make judgments about notifying a physician. The treating neonatologists agreed with the nurses. They further claimed that the apnea was probably due to reflux or apnea of prematurity (AOP) and that a residual of that magnitude was not …