£3.1 million lump sum for brain injury suffered at birth

Boyes Turner obtained damages of £3.1 million lump sum, with annual periodical payments of £60,484 rising to £133,250 per annum, for a boy who suffered a brain injury from untreated hypoglycaemia in the first few days of his life. 

The claimant’s mother was admitted to hospital towards the end of her pregnancy with symptoms of pre-eclampsia. An ultrasound scan revealed the baby to have intra-uterine growth retardation (IUGR). The uterus was small for dates with almost no amniotic fluid but Doppler studies showed normal end diastolic flow, indicating that the baby hadn’t yet been damaged as a result of placental insufficiency.

Following artificial rupture of the membranes, the claimant was delivered by spontaneous vaginal delivery. Histology of the placenta confirmed signs of placental insufficiency but the claimant was born in good condition and did not require resuscitation. However, the claimant’s birth weight and head circumference were very low. He was on the 3rd centile and ‘small for dates’. The paediatrician who attended the delivery advised that the baby should be kept warm, fed early and that the paediatricians should be notified of any concerns.

The hospital’s own hypoglycaemia protocol identified ‘small for dates’ babies as being at increased risk of hypoglycaemia (low blood glucose), which it defined as below 2.6mmol/L. If a BM stix value was obtained between 2 and 2.6mmol/L, the protocol dictated that the test should be repeated before the next feed, with further pre-feed tests taken until the readings exceeded 2.6mmol/L for at least 2 consecutive readings.

The claimant’s IUGR at the end of the pregnancy had impaired his ability to store carbohydrates and fat to maintain his blood glucose in the neonatal period before an adequate intake of milk was achieved. He needed appropriate monitoring and help to prevent hypoglycaemia from developing.

On the postnatal ward, the nursing plan documented the need to prevent hypoglycaemia and hypothermia (low body temperature). The first BM stix reading, over 3 ½ hours after birth was 2.0mmol/L, indicating hypoglycaemia. The baby was breast feeding and his mother was advised to give him top ups of formula milk. The next BM stix reading, over 16 hours later, was 2.6mmol/L and wasn’t repeated, contrary to the protocol. No further BM stix tests were performed before the claimant was discharged from hospital on the second day of life, despite the mother expressing her concerns that the baby was lethargic, sleeping too much and not feeding well.

At home, the claimant slept excessively, wouldn’t feed and his lips turned blue. His mother wrapped him up, assuming that he was cold. When he began grunting, she telephoned the midwife and was told to bring him into hospital immediately. He stopped breathing on the journey, but re-started spontaneously and continued to grunt. In A&E his BM stix measurement was 1.7mmol/L. He was transferred to the neonatal unit where he was found to be profoundly hypoglycaemic (0.7mmol/L), pale, unresponsive and convulsing. He was given intravenous dextrose and anti-epileptic medication. His condition stabilised and within a week he was discharged home, feeding on demand.

As a result of the defendant hospital staff’s failure to monitor and adequately maintain the claimant’s blood glucose levels in the first few days of his life, he suffered brain damage from neonatal hypoglycaemia. He has epilepsy, intellectual impairment and developmental delay, behavioural problems and special educational needs, delayed speech and language skills, and delayed gross and fine motor co-ordination. He requires assistance with most aspects of daily living.

Boyes Turner’s specialist brain injury solicitors put the claimant’s case to the defendant NHS Trust, who denied liability, strongly defending the case – a position they maintained until just before trial when, no longer supported by their own experts, they finally admitted liability. Judgment was entered and the case adjourned to enable the claimant to undergo a behaviour management programme, expert assessment of his condition, and the purchase and adaptation of a suitable house so that he could have his specialist needs met yet remain at home with his family. Interim payments were obtained, totalling £1 million, to meet his urgent needs.

Boyes Turner helped his mother apply to the Court of Protection to be appointed as his deputy. A case manager was appointed to help manage his care and therapy regime and support his special educational needs at school. The case was relisted for trial to determine its value but settlement was achieved at a round table meeting with the defendant. The court approved the part lump sum, part periodical payment (PPO) order, which will ensure that both the claimant’s immediate capital needs and life-long care needs are met.