Legal Briefs

Abstract

A 1,255-g 28–5/7 weeks' gestation female infant was delivered to a 40-year-old woman whose pregnancy was marked by placenta previa and bleeding. After a course of antenatal steroids, a cesarean section was performed. Apgar scores were 5 at 1 minute and 7 at 5 minutes. The infant was bruised on the right side of the body and briefly needed positive-pressure ventilation via mask because of a heart rate of 70 beats/min at birth. The admitting vital signs were: temperature of 35.5°C, heart rate of 183 beats/min, respiratory rate of 52 breaths/min, and blood pressure of 63/53 mm Hg, with a mean of 58 mm Hg. At 30 minutes after birth, the infant was endotracheally intubated and given surfactant and intravenous lines were placed. At 45 minutes after birth, a venous blood gas showed: pH of 7.13, Pco2 of 59 mm Hg, Po2 of 63 mm Hg, and base deficit of −9 mEq/L on 35% Fio2 and ventilator settings of peak inspiratory pressure of 17 H2O, peak expiratory pressure of 5 H2O with a rate of 35, and mean airway pressure of 7 cm H2O. Chest radiograph obtained 1 hour after birth appeared clear. The complete blood count was unremarkable. The hematocrit was 49% (0.49). At 5 hours after birth, dopamine 5 μg/kg per minute was started because the blood pressure was drifting downward to a nadir of 36/19 mm Hg, with a mean of 25 mm Hg. An order was written to maintain the mean blood pressure at 32 mm Hg or greater and to obtain cardiac echocardiography the next or following day. The admitting neonatologist, who stayed overnight at the hospital, was notified multiple times. He provided small amounts of sodium bicarbonate twice during the first 16 …