Legal Briefs

Abstract

A 2,222-g 34-weeks' gestation male twin was delivered in the winter to a mother whose pregnancy was unremarkable except for diamniotic, dichorionic twins. This twin was delivered via normal spontaneous vaginal delivery. Apgar scores were 8 at 1 and 5 minutes. Both twins were admitted to the newborn intensive care unit because of their gestational age. The male twin exhibited tachypnea at birth and received a 7-day course of antibiotics. Findings on chest radiography were consistent with transient tachypnea, and a blood culture was negative after 1 week. Other than mild apnea of prematurity and a slightly elevated serum bilirubin concentration, his course was unremarkable. The mother missed several days of visitation near the time of discharge because she had an upper respiratory tract infection. The infant was discharged 16 days after birth at 36–1/7 weeks' gestation. He had three siblings at home: his twin sister, who was discharged close to the time he went home; a 3-year-old brother who had an upper respiratory tract infection; and a 7-year-old healthy sister. After being home for 6 days, when he was 22 days old (37 weeks' gestation), his mother called the pediatrician because the infant had developed nasal congestion, refused to nurse, and seemed excessively sleepy. The pediatrician reassured the mother over the telephone. A few hours later, she brought the infant to the hospital because he had vomited three times and she had ongoing concerns about his poor feeding and excessive sleepiness. On physical examination, the infant's respiratory rate was 40 breaths/min, temperature was 37.4°C, heart rate was 140 beats/min, and oxygen saturation was 97% in room air. The emergency department (ED) physician noted clear breath sounds, unlabored breathing, and moist mucous membranes. The ED nurse noted and documented a congested cough for the infant, and the heart rate was …