Newborn Brain Injury Due To Delayed Delivery And Improper Intubation
Lawsuit Against Fairview Northland Medical Center
On November 8, 2022, WVFK&N attorneys Keith Forman and Myles Poster filed a medical malpractice claim on behalf of a newborn who suffered an avoidable brain injury.
The complaint alleges that on August 10, 2021, the baby’s mother presented to Minnesota Health Fairview Northland Medical Center at approximately 12:55 a.m. with reported complaints of bleeding and difficulty urinating with burning sensation. She was at 28 weeks’ gestation and had been receiving routine prenatal care at Minnesota Health Fairview Clinic Princeton. According to her prenatal records, the pregnancy was “high-risk” secondary to a past medical history of cesarean delivery, molar pregnancy, obesity, and other conditions. She was also reported to be fully compliant with her prenatal care as of August 2021. After her arrival electronic fetal heart rate monitoring was connected. This monitoring revealed moderate variability, accelerations, and no decelerations consistent with a healthy and well-oxygenated fetus. Uterine contractions were also noted to be absent during this initial hospital admission. Urinalysis cultures revealed evidence of Escherichia coli (“E-coli”) for which Amoxicillin was ordered. At the time of the initial discharge around 2:00 a.m., a nurse noted that the fetal heart rate baseline was within normal limits with moderate variability and no contractions. Approximately two hours after being initially discharged, the mother re-presented to Minnesota Health Fairview Northland Medical Center around 4:05 a.m. A nurse reported complaints of nausea, tingling in the mouth and lips, feeling hot and sweaty, and chest pressure and tightness. Upon presentation to the unit, the patient’s face was pale, she was vomiting, shaking, and the skin on her arms, belly, and legs was red. There was also difficulty finding the fetal heart rate. After connecting electronic fetal heart rate monitoring, the nurse noted a bradycardic fetal heart rate with moderate variability, audible decelerations, and no accelerations reflecting a material change in fetal heart rate status compared to the initial discharge just two hours earlier. The nurse also reported that uterine contractions were occurring every 2 minutes – an additional clinical change in maternal status. The nurse documented the mother as being a “patient with possible drug reaction, now with contractions and fetal decels.” According to the nurse’s note, the “MD Update” recommendation was to “[c]ontinue to monitor.” Despite continued abnormalities in the fetal heart rate, according to the nurse’s note the plan of care called for an additional hour of monitoring before reassessment. At 7:19 a.m., the nurse called the doctor “about nearly absent variability” at which time he was “asked to assess [the] patient.” In response, the doctor noted that he was working to contact a maternal-fetal medicine specialist for a consultation and would call back to the unit. However, the doctor did not present to the mother’s bedside until around 9:10 a.m. – nearly two hours later. At 8:22 a.m., the doctor called the unit at which time an order was placed for a STAT biophysical profile (hereinafter “BPP”). From approximately 8:25 a.m. until 9:25 a.m. a BPP was performed with a listed indication history of “non-reassuring fetal heart rate.” The results of this BPP were reported as a 2 out of 8 and the interpreting radiologist noted the “patient’s clinician was aware of the exam results following completion of the exam.” At 9:45 a.m., a sinusoidal fetal heart rate tracing was noted at which time an emergency cesarean section was ordered by the doctor. The baby was delivered at 10:25 a.m. on August 10, 2021, via emergency cesarean delivery. At the time of birth, the baby weighed 1,091 grams (2 lbs., 6.5 oz.) and had “spontaneous crying and respirations.” Her initial Apgar score was reported as 1 at one minute. Initial cord blood gases were collected secondary to concern for placental abruption and were returned showing a pH of 7.49 and base excess of -3.0, thereby ruling out evidence of metabolic acidosis and perinatal asphyxia. Following attempted intubation, however, at 10:32 a.m., the baby’s pulse oximetry was markedly low (50%) before continuing to decrease to 45% a minute later. At 10:34 a.m., the baby’s pulse oximetry was reported as 75% and repeat measurements at 10:39 a.m. and 10:43 a.m. showed a continued decrease in oxygen saturation of 35% and 43%, respectively. This value further decreased at 10:47 a.m. Compared to initial umbilical cord gases, repeat blood gases from around 10:40 a.m. showed evidence of metabolic acidosis with a pH of 7.06 and base excess of -10.3. According to the University of Minnesota’s NICU transport note, the neonatal team arrived at approximately 25 minutes of life. At the time of the transport team’s arrival, the baby was noted to be pale, limp, and intubated receiving PPV and undergoing active CPR. She also remained bradycardic with an oxygen saturation of 27%. Following their arrival, the NICU transport team reported breath sounds but no color change in the carbon dioxide detector at which time an “x-ray was at bedside and obtained quickly noting esophageal intubation.” At this time, the ETT was pulled and bag/mask PPV was initiated with a “good response” by the baby with a rising heart rate and improvement in oxygen saturation to “>90% in 100% FiO2.” Based on the observed esophageal intubation, the baby was re-intubated on the first attempt by the transport team. Successful intubation was subsequently confirmed by good “CO2 color change and T2-3 on CXR.” Immediately thereafter, the baby’s color, heart rate, and oxygen saturations stabilized. After being stabilized, the baby was transported to the NICU at University of Minnesota Masonic Children’s Hospital. The baby was diagnosed with hypoxic-ischemic encephalopathy and exhibited seizure activity. A brain MRI performed on October 4, 2021 was reported as showing the “sequela of [a] prior diffuse anoxic brain injury involving the basal ganglia and thalami to the greatest degree.” Today, the baby continues to suffer from the neurological sequela of her hypoxic-ischemic brain injury including, among other things, spastic quadriplegic cerebral palsy, and global developmental delay.
The lawsuit alleges that the injuries were a result of the negligence of Fairview Northland Medical Center and its employees in failing to timely respond to concerning clinical signs and failing to timely deliver the baby and failing to timely and properly intubate the baby.
The action is pending in the District Court for Hennepin County, Minnesota.