Case report: Jaundice and Kernicterus as result of negligent transfusion
T’s mother was blood group O rhesus negative. During the early course of the pregnancy with T a diagnosis of rhesus incompatibility was made. The rhesus incompatibility is potentially life threatening to the baby. It predisposes the baby to jaundice. T was born prematurely at 34 weeks. As a result of his prematurity and the rhesus incompatibility, he was a “sick” baby.
The bilirubin graphs available were 31 – 34 weeks’ gestation and 34 – 37 weeks’ gestation. T was 34 weeks’ gestation and, as such, either graph could have been used. As a matter of caution, many doctors would have used the 31-34 weeks’ gestation graph but T’s medical staff used the 34 – 37 weeks’ gestation graph to monitor T’s bilirubin levels. The “intervention” level for exchange transfusion on the 34 – 37 week graph for a “sick” baby was 270micromol/l.
As referred to above, the bilirubin graphs provide “intervention” lines for “well” (full term healthy babies) and “sick” babies. Again as referred to above, the “intervention” line for “sick” babies is lower than that for “well” babies.
Below is a table of T’s bilirubin levels over a period of 5 days.
It can be seen from the table that T’s bilirubin level was consistently above the “intervention” level of 270micromol/l. However, T did not receive the required treatment (a blood transfusion) until it was too late. T sadly went on to develop kernicterus and is profoundly brain damaged. He requires 24-hour care.
T’s mother instructed Solicitors to investigate the lack of treatment provided to T during the course of his first few days of life.
The Hospital denied responsibility for causing T’s brain damage and proceedings were issued in the High Court.
Whilst investigating T’s claim it became apparent that there was no standardised national approach in the UK to the management of jaundice in newborn babies.
Despite the long established use of bilirubin graphs for different gestation ages with different intervention levels for “sick” and “well” babies, there had been no consensus on Guidelines relating to the appropriate management, treatment and intervention.
Following the introduction of anti-D prophylaxis for mothers with the potential for rhesus disease and treatment options with phototherapy and exchange transfusion, kernicterus as a consequence of neonatal jaundice has become rare in the industrialised countries. But cases have still been occurring at the rate if between 6 and 12 a year. The incidence could become rarer still in the UK following the introduction of the NICE Guidelines on Neonatal Jaundice issued in 2010. T’s condition could have been wholly avoided had the medical staff followed the advice on the bilirubin graph as to when to perform an exchange blood transfusion.
T’s claim settled for £6 million.