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Administration of Vitamin K to newborn baby (11HDC00957)

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(11HDC00957, 10 June 2013)

Midwife ~ Vitamin K ~ Jaundice ~ Guthrie test ~ Screening ~ Care planning ~ Documentation ~ Rights 4(1), 4(2), 6(1)(b)

A 25-year-old woman complained about the care provided by her midwife during her first pregnancy. On a Thursday in late 2010, the woman had a rapid delivery, following which she required the manual removal of a retained placenta and suturing of tears under anaesthetic. The midwife had not discussed the administration of Vitamin K with the woman during the antenatal period, and she asked the father whether he agreed to the baby being given Vitamin K. The father was unsure and asked to defer the decision until his wife returned. The midwife did not discuss the administration of Vitamin K again while the woman and her baby were in hospital.

The woman was discharged on Saturday. The midwife visited the family at home on Sunday. At that visit, the woman asked about the Vitamin K and the midwife said she would get it from the hospital. On Sunday, the baby became mildly jaundiced.

The midwife visited the family at home again on Monday. The woman asked again about the Vitamin K, and the midwife said she would pick it up and bring it the next day. By Monday, the baby was "a bit yellow", and by that night/the following morning she was not feeding at all.  

When the midwife visited on Tuesday, the baby was lethargic, not feeding, had "bright yellow jaundice", and had had a 10% weight loss since birth. The midwife called the public hospital and performed a Guthrie test (a screening test to detect a number of conditions, recommended to be carried out within 48 hours of feeding or as soon as possible after this). The baby was admitted to the public hospital with neonatal jaundice, anaemia and high sodium levels. It was found that she had suffered a large right cerebral haemorrhage and she was transferred to a paediatric intensive care unit. The baby required an urgent craniotomy and evacuation of a subdural haematoma.

It was held that the midwife's care planning and documentation were not in accordance with professional standards and, accordingly, she breached Right 4(2). Her lack of discussion with the parents about Vitamin K administration during the antenatal period was a failure to provide an explanation of the options available including an assessment of the risks, side effects, and benefits of each option. Accordingly, she breached Right 6(1)(b).

The failures to perform a Guthrie test within an appropriate period after birth, to respond to the baby's deterioration appropriately, and to ensure that the baby received Vitamin K were together a serious departure from expected standards. The midwife failed to provide services with reasonable care and skill and, accordingly, breached Right 4(1).

The midwife was referred to the Director of Proceedings for the purpose of deciding whether any proceedings should be taken.

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