A midwife who failed to give a routine Vitamin K dose to a newborn girl, who then had a brain bleed just days after birth, breached healthcare standards, the health and disability commissioner has found.
Commissioner Anthony Hill has referred the midwife to the Director of Proceedings, who will decide whether any further action should be taken. She has also been ordered to apologise in writing to the baby, "suitable for her to read when she is sufficiently mature to do so" and to her parents.
Hill said the midwife, whose name was not released, breached professional standards and the Code of Health and Disability Services Consumers' Rights.
Babies have low levels of the vitamin in their bodies, and need it to help clot blood and prevent serious bleeding. Without it, they are at risk of getting a rare bleeding disorder which can cause brain damage or death, according to kidshealth.
One injection of the vitamin given just after birth will protect the baby for many months. It is the lead maternity carer's responsibility to discuss Vitamin K with the parents.
The midwife's client, a 25-year-old nurse, went into labour with her first-born on a Thursday in late 2010.
She was told about Vitamin K in antenatal classes, and decided her baby would have the Vitamin K injection, instead of the oral form.
The midwife never talked with the woman before the birth about giving the baby Vitamin K, and when she talked to the father about it, he passed the decision on to his wife.
When the woman was in hospital with her baby, the midwife failed again to talk about the vitamin because she was "incredibly busy".
The woman was discharged on Saturday.
On Sunday, the midwife visited the family. When the mother asked the midwife about getting Vitamin K, the midwife said she would get it from the hospital.
That day, the baby became mildly jaundiced.
By Monday night, the baby was "a bit yellow", and not feeding.
The mother texted the midwife on Tuesday morning, when the baby was lethargic, not feeding, had "bright yellow jaundice", and had a 10 per cent weight loss since birth.
After a screening test, which the midwife took outside the recommended time period, the baby was admitted to hospital.
She had a brain haemorrhage, was anaemic and had high sodium levels, and was transferred to a paediatric intensive care unit.
She had surgery which temporarily removed a bone flap from the skull so blood on the surface of the brain could be removed.
The mother of the baby said she recovered very well and was thriving apart from a "lazy eye", because the bleed was close to her right optic nerve.
The midwife said she could not recall the details of a conversation with Mr and Mrs B about Vitamin K, although she is sure she would have discussed it. She said: "I remember just handing over the pamphlet and saying sort of, you know, to read the pamphlet as well."
Hill said the midwife's failure to give an assessment of the risks and benefits of Vitamin K was a breach of the code.
The midwife did not give a Guthrie (PKU) test until 5 days after the birth, when it should have done within 2 days. He said she did not respond to the baby's deterioration within an appropriate period after birth and did not ensure she received Vitamin K, which all together amounted to "a serious departure from expected standards".
- © Fairfax NZ News
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