Recently, at the Safdarjung Hospital in Delhi, an infant born prematurely at 22 weeks was pronounced dead by qualified medical professionals.

Despite the medical superintendent of the hospital refuting any possibility of “medical negligence” – formal investigations have been commenced assessing why the infant was presumed to be dead.

Senior doctors were not informed

Several factors have contributed to this event, which transpired in the midst of several medical professionals. First and foremost, the official WHO guidelines delineate the parameters according to which an infant can be classified as not compatible with life.

These parameters include low birth weight (under 500 grammes) and premature delivery (around the range of 20 weeks of gestation). Both the parameters were satisfied in this case – as the infant was delivered before term, and was found to weigh only 460 grammes.

Further information corroborated why medical professionals harboured a suspicion that the child had passed away. Dr AK Rai, director of the Safdarjung Hospital in New Delhi stated that, “as the baby was not making any movement in his body and didn't cry during the time of delivery – the nurses attending the mother declared the baby dead without informing the senior doctors and wrapped him in a plastic sheet.”

It is important, in retrospect, to consider if things might have progressed differently if more senior physicians had been consulted or formal examinations had been conducted to assess whether the baby was alive (for instance, an examination of the infant’s heart rate and respiratory rate).

A professional also went on to state that such infants are observed for a minimum of one hour before a judgement can be made on their demise. Despite the baby not crying immediately after birth or there being no conspicuous respiration, other parameters of life could have been assessed before confirming the child as dead.

Impact on the family

Rohit Tandon, the 27-year old father of the aforementioned child, conveyed his emotions stating that he experienced “mixed reactions of shock, relief, joy and anger” upon finding his child alive.

He also said, “I shudder to think the consequences if I hadn't found the truth in time.” His concerns reflect the concern that most parents feel towards their children, and underscore the reason why additional caution should be exercised in communication of information to the parents.

Preparations for the child’s funeral were already underway when an opportune moment revealed that the child was indeed alive and moving.

Due to the time delay that had transpired between declaring the infant dead and discovering he was alive – the infant had become critically unwell and was reported to be “gasping” upon admission to hospital. If this delay had been avoided, more urgent action could have been initiated to ensure the health and safety of the child.

Involvement of hospital staff

Dr AK Rai, the medical superintendent of the hospital admitted that, “there has been a lapse on our part; as it appears that the staff on duty did not consult the doctor, and presumed the baby dead as it had no signs of life and weighed 460 grammes, which isn’t even viable as per standards.”

The attendants working at the maternity ward had simply wrapped the child in a plastic sheet and transferred it to the father. Despite the fact that foetuses of this birth weight are not adapted for survival, each case should be treated individually in order to confirm that there is definitely no chance of survival.

This case provides important learnings for all healthcare professionals. Not only is negligence not affordable in clinical practice – it also affects more lives than just the particular patient involved.

Efforts should be made to ensure communication between clinical staff is as efficient as possible and more senior staff should be consulted when there is any ambiguity regarding a clinical case. MIMS

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