Pneumonia in neonate

In 1990, a 30-year old primigravida patient consulted her GP at 26/40 with symptoms of a urinary tract infection (UTI). The GP took a history, examined her and sent a urine sample to the lab. He prescribed antibiotics on the basis of a presumptive diagnosis of UTI. The MC&S results returned four days later showing 90 white blood cells, but no growth. The patient was instructed to finish her course of antibiotics.

At 30 weeks gestation, the patient attended her local hospital with backache, tightening and a mucus show. She was examined by a midwife and discharged home after providing a urine sample. This sample showed mixed growth, indicating contamination. A copy of the urine sample result was sent to the practice and the GP arranged for a repeat sample to be taken. This was reported as normal.

The patient returned to hospital at 39/40 with a history suggestive of an amniotic fluid leak. This was investigated, discounted and the patient was discharged. She was admitted to hospital in spontaneous labour at term one week later. The baby was delivered by normal vaginal delivery and was in good condition at birth. But eight hours after delivery, the child developed respiratory difficulties and required resuscitation. 

The baby was diagnosed with Group B streptococcal pneumonia and suffered from disseminated intravascular coagulation, acute renal failure and pulmonary hypertension. He required ventilation for two weeks and was discharged home.

At age six, it was noted that the child had poor concentration and limited attention, thought to be part of a global learning disorder. The child had not walked until two years of age and had difficulty with motor skills.

Some eight years after the child's birth, the mother submitted a claim for compensation. The claimant's solicitors alleged that the GP did not adequately treat the mother's urinary tract infection and that the practice did not recognise that urinary tract infections during pregnancy, along with premature rupture of the membranes, are common indicators of Group B streptococcal infection. It was alleged that the child had developed brain damage as a result of the negligence.

The MDU investigated the claim and obtained a number of expert opinions. A GP expert advised that there was no evidence of a streptococcal urine infection in any of the specimens taken before or during this patient's pregnancy. He stated that there was no reason to believe that her GP mismanaged the patient during her pregnancy.

An expert microbiologist commented that there was no evidence to suggest that the mother was colonised with Group B streptococcus prior to the delivery of the baby or that it should have been actively sought. He also pointed out that there were no national guidelines for its eradication at that time and that there was no evidence of premature rupture of the membranes at 39/40.

An expert obstetrician agreed that there was a lack of evidence to demonstrate Group B streptococcal infection in the antenatal period. He also concurred that the advice for treating patients with IV antibiotics with this condition did not emerge until after this event.

On the basis of the expert evidence, the MDU submitted a letter of response to the claimant denying liability. Some months later, the claimant's solicitors advised that they were no longer instructed to pursue a claim.

Dr Sharmala Moodley
Deputy head of claims

This page was correct at publication on 04/12/2013. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.


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