Medical Negligence

 

What is a neonatal brain injury and how do I claim?

What is a neonatal brain injury?

Neonatal literally means newborn. In medical terms, the neonatal period relates to the first few weeks of life. A neonate is a newborn baby. Neonatal care is the specialist care of babies – often born prematurely, unwell or who are small for their gestational age – within the first weeks of life. Neonatal care usually takes place in a neonatal unit (NNU) or special care baby unit (SCBU) or a neonatal intensive care unit (NICU), depending on the level of monitoring and treatment and breathing support that is needed.

Can I get Legal Aid for a neonatal brain injury medical negligence claim?

Legal Aid is available for birth injury and neonatal claims resulting in neurological injury where the injury was caused during the mother’s pregnancy, the baby’s birth or the first eight weeks of the baby’s life. Where our specialist brain injury lawyers believe the severely injured child has a viable claim and they are eligible for Legal Aid, Boyes Turner make a Legal Aid application on the child’s behalf.

Does my newborn baby’s admission to NICU, NNU or SCBU mean that they have a claim for negligence?

There are many reasons why a newborn baby might be admitted to a neonatal unit. Some of the more common reasons include:

  • They need help with breathing and maintaining their oxygen levels by ventilation or continuous positive airway pressure (CPAP)
  • They are at risk of hypoglycaemia and need close monitoring and help with feeding to maintain their blood sugar and nutrition
  • Their heart rate needs monitoring
  • They are at risk of kernicterus and need phototherapy for jaundice
  • They are recovering from or are receiving treatment for an infection
  • They are recovering from surgery or other treatment
  • They need therapeutic cooling after suffering HIE (hypoxic ischaemic encephalopathy - brain damage from lack of oxygen)

Premature babies (born before 37 weeks of pregnancy) or those with very low birth weights often need neonatal care as they need more support and are at greater risk of complications.

In full term babies (born after 37 weeks) who have been admitted to a neonatal unit, most admissions relate to problems with respiration, hypoglycaemia (low blood sugar), jaundice or asphyxia. NHS Improvement has identified poor treatment associated with these conditions as potential causes of greatest harm which, where causing serious neurological injury, can give rise to a claim.

In a patient safety alert in 2017, NHS Improvement said: “It is a priority for the NHS to reduce avoidable harm that can lead to full-term babies (babies born after 37 weeks of pregnancy) being admitted to neonatal units. The number of unexpected admissions to neonatal units is seen as a proxy indicator that preventable harm may have been caused at some point along the maternity or neonatal pathway.”

Perinatal asphyxia or HIE, respiratory problems from meconium aspiration during birth, kernicterus from untreated jaundice, delayed treatment of infection and neurological injury from untreated hypoglycaemia are the most common neonatal brain damage claims that we see at Boyes Turner. Our clients come to us at many stages of their child’s development - shortly after birth, in early childhood or in teenage years - depending on when the damage becomes evident. Negligent medical treatment of the newborn child can cause severe disability which lasts far beyond the baby’s first few weeks.

Neonatal brain injury can present with a wide range of features. Once the damage is done, the injured areas of the brain cannot recover and as the baby grows and develops, the full extent of the problems caused by the neonatal injury are gradually revealed. These impairments can range from near normal development to a diagnosis of cerebral palsy and can present as:

  • delayed development
  • missed early years milestones
  • behavioural problems
  • difficulties with feeding or speech
  • impaired fine motor control
  • damage to the senses
  • spasticity
  • athetosis
  • severe cognitive damage. 

If you are caring for a child who has suffered a brain injury from negligent care at birth or in the first few weeks of life, contact us 0118 952 7219 or email mednegclaims@boyesturner.com.

Neonatal hypoglycaemia is a cause of brain damage - how do I know if my child has a claim?

What is neonatal hypoglycaemia?

Neonatal hypoglycaemia is a common metabolic condition in newborn babies which, if left untreated, can cause long-term brain damage and disability. Hypoglycaemia means low blood glucose or sugar. It becomes dangerous when the newborn’s blood sugar drops below safe levels, such as before the baby has established a regular feeding pattern enabling it to keep its blood glucose up in the first few days of life. 

What are the risk factors for neonatal hypoglycaemia?

Until adequate feeding is established all newborn babies are at some risk of hypoglycaemia, which is why it is part of the post-natal midwives’ job to ensure that the baby is receiving enough milk. The baby’s blood sugar is measured by a heel-prick blood test and is carried out routinely in some hospitals but should always be carried out for babies who are known to be at risk.

Those at increased risk include:

  • Newborn babies with birthweights below 2.5kg - the standard threshold level below which the baby’s blood glucose must be monitored
  • Babies with diabetic mothers
  • Babies who are small for dates with intra-uterine growth retardation (IUGR)

Regardless of birthweight or their mother’s state of health, any baby who is not feeding properly could be at risk, for example by:

  • Not waking up for feeds
  • Not sucking properly
  • Demanding feeding very frequently because they are not getting enough food at each feed

Is neonatal hypoglycaemia a medical emergency?

If acted upon quickly, neonatal low blood sugar can be corrected quickly by feeding, either by breastfeeding if that provides enough milk, by expressed breastmilk or formula milk or, if necessary, intravenously by a glucose drip.

In a review of medical negligence claims relating to neonatal hypoglycaemia, NHSLA (the NHS Litigation Authority, now known as NHS Resolution, which represents the NHS in legal claims) found that abnormal feeding behaviour was very closely associated with the condition, both as a cause and as a potential consequence of hypoglycaemia. Maternal concerns about abnormal feeding behaviour were often ignored by health professionals, missing a vital opportunity to take action to prevent hypoglycaemia before permanent damage was done to the infant’s brain.

If neonatal hypoglycaemia is severe or is left untreated, the baby’s condition will deteriorate, demonstrating other signs of illness. Neonatal hypoglycaemia with abnormal clinical signs must be regarded as a medical emergency requiring immediate action to avoid permanent brain damage and severe neurodevelopmental disability. Abnormal signs which are commonly seen with hypoglycaemia include:

  • Hypothermia (low body temperature)
  • Floppiness
  • Fitting or jitteriness
  • Infection
  • Respiratory (breathing) difficulties

Hypoglycaemia can also occur alongside and in combination with other serious conditions.

My baby has brain damage from hypoglycaemia – do I have a claim?

In its review of 25 neonatal hypoglycaemia claims which succeeded against the NHS over a ten year period at a total cost of over £162 million, NHSLA identified the most common errors in clinical care as:

  • Delays in obtaining blood glucose test results
  • Delays in taking action on a low blood glucose result
  • Delays in referring babies to the paediatrician once concerns have been identified
  • Delays in admitting babies who have been diagnosed with clinically significant hypoglycaemia to the neonatal unit (NNU)
  • Delayed administration of intravenous glucose on the NNU
  • Insufficient glucose being administered to correct the hypoglycaemia
  • Delayed attendance by the paediatrician when called by the midwife to review
  • Failing to advise the mother properly when the baby is discharged home.

Unlike asphyxial (oxygen deprivation) causes of perinatal brain injury, neurodevelopmental disability from neonatal hypoglycaemia might not be obvious to the parents in the immediate aftermath of the traumatic birth or the infant’s early childhood. Neurodevelopmental disability from avoidable neonatal hypoglycaemia might be disregarded or downplayed until the child grows and the impact of their injury later becomes evident when they struggle to cope at school.

In its review, NHSLA said it was likely that whilst the cases they knew about were those where the parents had identified potential deficits in care, it is likely that others who were harmed have not been notified to NHSLA via the litigation process.

Boyes Turner’s specialist brain injury solicitors are experienced in obtaining compensation for children and teenagers with neurodevelopmental injury from avoidable neonatal hypoglycaemia. We work with experts to ensure that, where liability for the injury is established, the extent of the injury and the impact on the individual’s mobility, cognition, education, work and independence is properly assessed to ensure that our clients are properly compensated. In addition, our special educational needs (SEN) team can help families with children affected by neonatal brain injury secure the educational support that they need for their child within the school that is right for them.

If you are caring for a child who has suffered neurodevelopmental disability from negligent medical care, contact us on 0118 952 7219 or email mednegclaims@boyesturner.com.

Brain Injury from Meningitis - sensory after effects

As Meningitis Now’s #MayMayhem dedicated fund raising month here at Boyes Turner comes to an end and we finish off the abundance of cakes and sweet treats on sale, and the sound of party poppers slowly fades from the kitchen, it’s worth mentioning that meningitis survivors often experience sensory impairments from the damage that has been done to their brain by this virulent disease.

What sensory damage could my child suffer after brain injury from meningitis?

Meningitis Now provides helpful information for parents about how meningitis-related brain injury might affect their child:

  • Hearing loss

The most common sensory after-effect of meningitis is loss of hearing caused by damage to the inner ear. In fact, 8% of all meningitis sufferers experience some permanent loss of hearing (sensori-neural hearing loss). Children should be offered a hearing test within four weeks of recovery from bacterial meningitis or meningococcal septicaemia as early management is essential to reduce the impact on the child’s language development.

Damage to the inner ear can also cause tinnitus and problems with balance and coordination. 10% of survivors of childhood meningitis will have ongoing difficulties with balance. Balance difficulties can occur even when the child’s hearing has not been affected. This might cause problems with delayed sitting or walking in early childhood, riding a bicycle, balancing in the dark or on uneven surfaces, or in situations such as running around a busy playground. The sufferer may have dizziness, unsteadiness or vertigo.

  • Visual problems

Following brain injury both vision and the ability to understand what is seen (visual perception) can be impaired. Visual fields (the extent of what is seen without moving the eyes or head), visual acuity (seeing at different distances) and visual perception can all be affected, as can the ability to track and  change focus, coordinate information from both eyes, or fix on a series of stationary objects quickly – an essential skill for reading. The child might experience double vision.

The child might not be aware of the extent of their visual problems or might try to ignore them, so it is important that parents report any concerns about their child’s vision following meningitis or brain injury to their doctor and ask for a specialist referral.

  • Taste, smell and touch

After damage to the brain, children may experience problems with taste and smell affecting their eating habits and exposing them to increased safety risks. They may lose the ability to identify objects by touch. Altered responses to temperature or pain exposes the child to additional risks of harm.

Where a client has sensory after-effects from meningitis-related brain injury caused by negligence, Boyes Turner’s brain injury and SEN specialists work with a range of experts, including audiologists, ophthalmologists, neurologists, physiotherapists, occupational therapists and psychologists to assess the child’s disability, facilitate rehabilitation and ensure that the child receives proper treatment, support and compensation for their injury.

If you or someone you care for are disabled as a result of negligent medical treatment for meningitis please contact our specialist team on 0118 952 7219 or email mednegclaims@boyesturner.com.

Julie Marsh, Believe & Achieve mentor for Meningitis Now

Julie Marsh, a senior associate - solicitor within Boyes Turner’s medical negligence team, is delighted to have been accepted to offer mentoring to young people through leading meningitis charity, Meningitis Now’s Believe & Achieve programme.  

What is the Believe and Achieve programme?

Believe and Achieve is a new venture which will enable the charity to offer personalised, age-specific and accessible support to 14 to 25-year-olds affected by meningitis. The programme is designed to be flexible so that the charity can respond to varying levels of need for support, depending on the young person’s individual experience following meningitis, their current difficulties, their strengths and their goals for what they want to develop or achieve.

Help and support is now on hand from free activities, events and workshops to support young meningitis survivors in their education, work and other areas of life. Believe & Achieve also offers signposting and referrals to other organisations, such as the National Citizenship Service, Young Carers and the Child Brain Injury Trust.

How can I get one to one help from Meningitis Now’s Believe & Achieve programme?

  • What is counselling and how can it help?

Meningitis Now can now offer counselling to help young meningitis survivors cope with their feelings and worries by talking through their experiences in private with a non-judgemental, professional, fully checked counsellor. Counselling can help the young person come to terms with what they have been through and help develop new ways to cope with situations. Believe & Achieve’s free 50 minute counselling sessions take place somewhere that’s local, friendly and private, once a week for about six weeks. Counsellors can be male or female, as preferred.

  • What is coaching and how can it help?

One to one coaching is available for those who want focussed help with a specific goal, such as getting a job or overcoming fears about public speaking in preparation for making a presentation at school. The fully trained coach can help with setting goals and planning how to achieve them, developing skills and improving performance and effectiveness. Where coaching is needed, Believe & Achieve offers coaching once a week for a six-week period, either face to face, by phone or by email.

  • What is mentoring and how can it help?

Through Believe & Achieve young people affected by meningitis can also benefit from six weeks of personal mentoring in three one-to-one sessions with a mentor. A mentor uses their own experience, wisdom and resources to support, advise and motivate others to succeed in achieving their own goals.

  • How do I get help if I think I have a claim?

At Boyes Turner our brain injury lawyers are skilled in securing compensation for clients who have been disabled or have suffered long-term injury as a result of delayed diagnosis and treatment of meningitis.

Where liability is established, we secure interim payments to help provide care, therapies, special educational support, specialist equipment, such as prostheses and vehicles, and adapted accommodation. We recognise the importance of getting rehabilitation underway and restoring mobility and independence as soon as liability is admitted, so that our clients don’t have to put their lives on hold until the claim is finally settled.

Our solicitors understand the devastating impact of meningitis on the sufferer’s physical, emotional and psychological wellbeing. We also understand that the suffering caused by this disease extends far beyond those whose circumstances give rise to a claim. We are delighted that Julie is able to offer young people affected by meningitis the benefit of her knowledge, experience and caring support, by providing mentoring through Meningitis Now’s Believe & Achieve programme.

If you or someone you care for are disabled as a result of negligent medical treatment for meningitis please contact our specialist team on 0118 952 7219 or email mednegclaims@boyesturner.com.

Brain injury from meningitis - understanding its effects on speech, language and communication

#MayMayhem continues at Boyes Turner in aid of Meningitis Now’s fundraising campaign to help reduce the risk and alleviate the suffering caused by meningitis.

When meningitis strikes, its consequences can be deadly unless swift action is taken to admit the sufferer to hospital for urgent intravenous antibiotics. Meningitis and its associated condition of septicaemia can kill and cause permanent disability. Prompt treatment saves lives and reduces the risk of long-term damage, but survivors of serious infection from the illness may suffer continuing disability from the injury to their brain.  

How does brain injury from meningitis affect speech, language and communication?

Speech, language and communication problems are common after a brain injury and vary depending on the affected area and severity of the damage to the brain. The skills needed to speak, interpret and use language and understand the more subtle, social cues and conversational ‘rules’ relating to communication continue to develop as the child grows older. The full effects of an acquired brain injury (ABI) on the child’s speech, language and communication may, therefore, take time to become apparent.

Hidden difficulties

After ABI some children will retain the ability to speak at their pre-injury level, particularly if the brain is still able to control the muscles which physically control the formation of speech. Whilst their speech might appear normal, they may encounter a variety of hidden difficulties which hinder their ability to communicate. These problems can come from damage to areas of the brain which directly control understanding and use of speech and language but can also be affected by memory, attention and concentration deficits and fatigue which often follow ABI. Reading and writing can be affected by post ABI coordination and visual problems affecting the ability to hold or control a pen. The child may have no insight into their problems and feel frustrated and isolated as they struggle to communicate, to keep up at school and to interact with their friends.

Specific problems in speech, language and communication

Meningitis Now’s helpful factsheets explain some of the ways in which a child’s ability to communicate might be impaired by brain injury after meningitis.

Aphasia affects the production and understanding of speech, and the ability to read and write. Receptive aphasia is an impairment of the understanding of language. Expressive aphasia is an impairment of the use of language.

Children with receptive aphasia might demonstrate the following without realising what they are doing:

  • Being able to speak fluently but using words in the wrong order
  • Having varying levels of skill in different areas of language
  • Needing to use non-verbal skills to communicate, such as pictures or gestures
  • Using incorrect or made-up words, which makes their speech hard for others to understand
  • Struggling to recognise written letters or words or to understand simple sentences – affecting reading

Children with expressive aphasia might:

  • Have limited fluency of speech and vocabulary and speak in short, simple sentences
  • Be able to understand language but not be able to use it
  • Struggle to name people and objects and be unable to use cues to help
  • Struggle to write certain letters, or put letters in the wrong order in words

Dysarthria is where the physical ability to speak is impaired when the area of the brain which controls the muscles used for speech is damaged. Dysarthria can cause varying levels of impairment from slurring to complete loss of speech.

Dyspraxia is difficulty with planned and coordinated movements which might prevent the child from being able to say what they are thinking.  

More complex ‘executive function’ impairments can hinder problem solving or understanding the nuances of language (such as jokes). The child might need more time to process information, affecting their ability to learn and keep up at school.

Following ABI they might struggle with social interaction and friendships owing to difficulties understanding the unspoken ‘rules’ of social communication, such as taking turns to speak, using appropriate language and understanding body language or facial expressions.

At Boyes Turner we understand the importance of assessing and understanding the full extent of each individual client’s injuries and needs. Only by doing so can we ensure that their compensation meets their lifelong needs, whether for care, special educational support, assistive technology, therapies, adapted accommodation, specialist equipment or prostheses.

Where our clients have suffered an acquired brain injury following negligent delays in diagnosis and treatment of meningitis, other errors in medical care or as a result of an accident caused by another’s fault, Boyes Turner’s brain injury lawyers work with experts in a range of disciplines, including speech and language therapy, assistive technology, educational psychology, neuropsychology, physiotherapy and occupational therapy to understand and assess the value of the claim. Where liability is established, or the Rehabilitation Code can be invoked depending on the cause of the injury, we obtain interim payments to provide early rehabilitation and meet the family’s immediate needs without having to wait for final settlement of the claim.

If you are caring for someone who has suffered a brain injury then please contact our specialist solicitors on 0118 952 7219 or email mednegcaims@boyesturner.com

Meningitis and brain injury - what can you expect?

Boyes Turner are supporting Meningitis Now’s #MayMayhem campaign in which the focus is on putting the fun into workplace fundraising to support the charity’s important work. 

Message behind the #maymayhem

Meanwhile, the message behind the mayhem is that meningitis kills. It also maims, leaving its survivors permanently disabled by limb loss and damage to the brain.

Whilst many of the physical effects of an acquired brain injury give rise to obvious disability, other consequences of the damage to the child’s developing brain can be more subtle, appearing and changing over time, making them harder to understand.

Emotional and behavioural after-effects of brain injury are often misinterpreted, particularly in a growing child or teenager. It is important for the child’s parents, wider family and school to recognise that the child may not be able to control or understand their own emotions and challenging behaviour, and to seek appropriate specialist help to support the child.

What emotional and behavioural changes can I expect following my child’s meningitis brain injury?

Meningitis Now lists some of the common difficulties that children may experience after a brain injury:

  • Tiredness leads to frustration and irritability when the child finds it difficult to return quickly to former activities or struggles to cope at school.
  • Mood swings, such as crying or laughing more quickly, temper tantrums, bedwetting and nightmares are common in the recovery period. Tiredness only makes them worse.
  • Anxiety, depression and loss of confidence come from realising that the illness has changed their life, worry about becoming ill again and coping with the long-term effects of their injury.
  • Apathy, lethargy, despondency and poor motivation can be misinterpreted as laziness, whereas they can arise from damage to the areas of the brain which affect arousal and initiation of activity. Without support, the child can slip beneath the radar at school, thereby failing to achieve their potential, and may become socially isolated.
  • Anger and aggression come from impairment of the brain’s ability to control behaviour and from frustration or struggling to cope emotionally with their injury.
  • Obsessive behaviour and lack of flexibility impede a child’s ability to adapt to different situations, including socially.
  • Disinhibition and sexually inappropriate behaviour in which the older child has no insight into the consequences of their behaviour. This exposes them to added risk of harm, causing friction with parents and teachers, and isolates them from friends who find them embarrassing.

These behaviours can arise from neurological damage to the brain impeding the child’s ability to regulate their own behaviour but also from the child’s psychological reaction to their illness and its impact on their life, their former activities, friendships and independence. Cognitive impairment makes it difficult for the child to communicate their frustration and everything is made worse by fatigue, anxiety and confusion. The child’s pre-injury personality and the dynamics and stresses within the family will also affect the child’s behaviour. Medication, such as anti-convulsants, also affect the child’s tiredness, behaviour and learning capability.

At Boyes Turner we understand that following meningitis or a brain injury the damage may go far beyond the physical. We work with educational, clinical and neuropsychologists, and child psychiatrists to assess the full effect of the injury and to secure the funding necessary to provide rehabilitation, therapy and ongoing support.

Our clinical negligence lawyers also work closely with our Special Educational Needs team to ensure that the child receives appropriate SEN assistance, whether that is in a mainstream or specialist school. By ensuring that we fully understand the child’s needs we are able to secure for them higher levels of compensation.

If you are caring for a child who has suffered a brain injury as a result of negligent medical care please contact us on 0118 952 7219 or email us on mednegclaims@boyesturner.com.

#MayMayhem 2018 - Support Meningitis Now this May

Here at Boyes Turner, #MayMayhem is underway as our brain injury lawyers ‘unleash the mayhem’ in support of leading meningitis charity, Meningitis Now.

Whilst our office antics will raise a smile, along with funds for Meningitis Now’s valuable work in the prevention and alleviation of suffering from meningitis, we’re deadly serious about this devastating disease.

What damage can meningitis cause?

Meningitis can kill within hours. Its survivors can be left with severe disability, including amputation and the serious after-effects of acquired brain injury. These will vary depending on which area of the brain has been affected by the disease.

Where incorrectly treated or late diagnosed meningitis has led to permanent brain damage in a child, it is important that the nature of the injury and the full extent of its impact is understood to ensure that the child is properly compensated for the lifelong pain, suffering and financial loss that they will incur. Different types of injury give rise to different problems in different areas of a child’s life, so we work hard to ensure that the child’s needs, now and continuing into adulthood, are properly assessed and recovered as part of their claim.

What physical symptoms can I expect my child to suffer after an acquired brain injury from meningitis?

Meningitis Now’s fact sheet on the physical effects of acquired brain injury refers to some of the physical problems faced by children after brain injury from meningitis:

  • Impaired movement and coordination

    Where meningitis injures the child’s brain in the neonatal period around or shortly after the time of birth, this can lead to cerebral palsy.

    Brain injury at any age can cause difficulty with movement and coordination, affecting posture, control over gross motor skills such as walking and running, or fine motor skills such as writing or manipulating objects with the hands.

    Muscle tone might be too tight or too loose, affecting the ability to hold the body in certain positions or sit upright, and can cause dizziness, problems with balance and coordinated movements.
     
  • Seizures (fits) and epilepsy

    Seizures are both a sign of meningitis and an after effect of brain injury.
     
  • Headaches and fatigue

    Headaches and extreme tiredness are common effects of acquired brain injury, but can also be caused by anti-epileptic medication. They can also affect the child’s behaviour and ability to function at home and at school.
     
  • Hydrocephalus

    Hydrocephalus is a build-up of cerebro-spinal fluid on the brain when the normal flow of fluid around the brain and spinal cord is restricted. The additional pressure on the brain is sometimes alleviated by  surgical insertion of a shunt to help the fluid drain into another part of the body, such as the abdomen.
     
  • Incontinence

    Impaired control of bowel and bladder function can follow severe brain injury.

The physical disability arising from a brain injury affects every aspect of the life of the sufferer who may need lifelong assistance with mobility and independence, personal care, education, accessibility and adapted accommodation and will suffer financial losses from their inability (or reduced ability) to work.

Boyes Turner’s specialist brain injury solicitors work with experts in a wide range of disciplines including neurology and paediatrics, occupational therapy and physiotherapy, disabled housing and nursing care to assess our clients’ needs. Our expertise enables us to recover top level damages awards to meet their lifelong needs for therapies, equipment, accommodation, education and care.

If you are caring for a child with serious disability arising from negligent medical care of meningitis please contact us on 0118 952 7219 or email us on mednegclaims@boyesturner.com.

Meningitis in babies - new warnings from latest research

A new research study into the characteristics of bacterial meningitis in babies below the age of three months has identified potentially dangerous flaws in the way meningitis is currently diagnosed.  

The Meningitis Research Foundation, which funded the St George’s Hospital research team study, Clinical Characteristics and Risk Factors for Poor Outcome in Infants Less Than 90 Days of Age with Bacterial Meningitis in the United Kingdom and Ireland, has warned that doctors relying on the classic sign of fever to trigger further medical investigation may be missing the opportunity to diagnose meningitis in this exceptionally high risk age group.

Whilst babies under the age of three months are 70 times more likely to contract bacterial meningitis than adults, the study found that only 54% of the 263 meningitis babies studied were reported to have a temperature above 38°C. Fever was more commonly reported in older babies, whereas, in the  younger age group, the common but less specific symptoms, such as poor feeding, lethargy and irritability could more commonly be mistaken for mild illness.

Fever is not the only sign of meningitis but is regarded as a key feature. The NICE Guideline: Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management (at paragraph 1.1.1) warns that fever is ‘not always present, particularly in neonates’. Newborn babies (also known as neonates) are the highest risk age group for meningitis.

The study found that other specific features of meningitis, such as bulging fontanelle (the area on top of the head where the baby’s skull bones have not yet fused), seizures, coma and neck stiffness were far less common in infants under three months. Seizures were reported in 28%, bulging fontanelle in 22%, coma in 6%, and neck stiffness in only 3%.

The incidence of bacterial meningitis in babies hasn’t changed since the 1980s. Early diagnosis and rapid treatment remain the key to avoiding the devastating consequences of this deadly disease.

Fever can no longer be relied upon as a reliable main symptom of meningitis in babies under three months old. To assist in recognition and diagnosis, The Meningitis Research Foundation have now updated their symptoms information for parents. The charity has also created a teaching package for clinicians, reflecting the findings of the recent research.

As specialists in clinical negligence claims of the utmost severity, Boyes Turner’s meningitis experts have acted for many children and adults who have suffered permanent brain damage, severe disability and amputation arising from delayed diagnosis and treatment of meningitis.

We support the efforts of charities such as the Meningitis Research Foundation and Meningitis Now and the breakthroughs in awareness and positive change that arise from studies such as this. We now look forward to seeing this awareness reflected in changes to guidelines and clinical practice in the hope that fewer lives will be affected by this devastating disease.

If you are caring for a child with serious disability arising from negligent medical care of meningitis please contact us on 0118 952 7219 or email us on mednegclaims@boyesturner.com.

 

Epilepsy medicine Valproate linked to birth defects

The Medicines and Healthcare products Regulatory Agency (MHRA) has changed the licensing rules controlling the prescription of valproate drugs for women and girls of childbearing age with epilepsy. The new contraindication of drugs such as Epilim in pregnancy, follows evidence that up to 10% of babies born to mothers prescribed the drug have serious birth defects, with as many as 40% suffering developmental problems.

Birth defects associated with valproate in pregnancy

Birth defects suffered by babies of valproate-medicated mothers during pregnancy include congenital malformation of the spine (spina bifida), face and skull (such as cleft palate), limbs and organs including the heart, kidneys and sexual organs.

The long-term effects of the developmental problems suffered by valproate babies are not yet fully understood but include delayed walking and talking, reduced intelligence, impaired speech and language and memory problems.

Children exposed to valproate in the womb also have an increased risk of autism and attention deficit hyperactivity disorder (ADHD).

Valproate – little change despite warnings

“Valproate is a common treatment for epilepsy and bipolar disorder and is prescribed to thousands of women. The drug was introduced in 1974 and its product information for doctors has always included a warning that it carried a potential risk of birth defects.”

Over time, as more information has been gathered in Europe about the drug’s association with congenital malformations and developmental impairments, the MHRA’s warnings to doctors and pharmacists about the risks to the medicated woman’s unborn child have been strengthened. However, the MHRA’s latest alert confirms that despite the strengthened warnings that they issued to prescribers in 2015 and 2016 against prescribing valproate medicines in girls and women of childbearing age unless other treatments are ineffective and they are using effective contraception, one in five women taking valproate remain unaware of its risks in pregnancy. Without such information, women are unable to make informed decisions about their treatment. They risk becoming pregnant with high risk of serious injury to their child. MHRA’s previous communications appear to have had little impact on prescribing practice.

New regulation of valproate prescription from April 2018

In March 2018, after further research revealed the extent to which previous warnings had not been heeded, the European Medicines Agency, CMDh (Coordination Group for Mutual Recognition and Decentralised Procedures – Human), recommended tougher regulation of the prescription of valproate medicines. The new regulations will come into force at the end of April 2018 and will be backed up by amended guidance from The National Institute for Health and Care Excellence (NICE).

Valproate medicines are now contraindicated in women and girls of childbearing potential unless the conditions of a specified Pregnancy Prevention Programme are met, and only if other treatments are ineffective or not tolerated, as judged by an experienced specialist. The Pregnancy Prevention Programme also applies to female patients who are not sexually active unless there are compelling reasons to indicate that there is no risk of pregnancy.

Compliance with the Pregnancy Prevention Programme means that all female patients taking valproate medicines:

  • have been told and understand the risks of pregnancy and have signed a risk acknowledgement form.
  • are on highly effective, user-independent contraception -  such as long acting reversible contraceptive, a copper intrauterine device (coil), progesterone implant or levonorgestrel intrauterine system – or using two complementary forms of contraception including a barrier method and undergo regular pregnancy testing
  • see their specialist for review and re-evaluation at least once every year.

GPs must now identify and recall all valproate-medicated women and girls of childbearing potential to give them the patient guide, check that they have been reviewed by a specialist within the last year and are on highly effective contraception.  

Specialists are required to review and re-evaluate their patients at least annually, provide clear explanations and complete and sign the risk acknowledgement form which must be copied to the patient or their carer and sent to the patient’s GP.

Pharmacists must ensure that where valproate medicines are dispensed to women and girls of childbearing potential the (ideally whole) packs must bear a pre-printed warning label or the pharmacist must place a warning sticker on the pack.  Pharmacists are also required to discuss the risks in pregnancy with female patients each time they dispense their valproate medicines, and to check that they have the Patient Guide and have discussed their treatment and contraception with their GP or specialist.

I’m on valproate. What do I do now?

All women and girls who are prescribed valproate should now contact their GP and arrange to have their treatment reviewed. Meanwhile, MHRA emphasise that it is important women don’t stop taking valproate without first discussing it with their doctor.

Boyes Turner’s specialist birth injury and cerebral palsy lawyers have decades of experience of helping families whose children have suffered severe disability as a result of inappropriate medical care. We welcome the recent action taken by MHRA and NICE to enforce responsible prescribing practice in the hope that fewer babies will suffer the devastating disability caused by in-utero exposure to valproate drugs.

If you are caring for a child with serious disability arising from negligent medical care please contact us on 0118 952 7219 or email us on mednegclaims@boyesturner.com.

GIRFT Cardiothoracic surgery

Getting It Right First Time (GIRFT) has published its latest report into NHS adult cardiothoracic surgery in England. The GIRFT programme aims to help improve the NHS by identifying variations in practice and procurement, sharing and supporting the implementation of proven best practice with health professionals and hospital managers across the country, thereby improving patient care and saving costs. It does so with funding and support from the Department of Health and is jointly overseen by NHS Improvement and the Royal National Orthopaedic Hospital NHS Trust.

In keeping with previous reports, Cardiothoracic Surgery GIRFT Programme National Specialty Report, makes 20 recommendations which, if implemented could save the NHS up to £52 million a year. The report contains a statement of support from The Society for Cardiothoracic Surgery (SCTS) which also produced a joint response with the Royal College of Surgeons urging the NHS to act upon the recommendations.

The term cardiothoracic surgery relates to surgical treatment of disease in the heart, lungs and major blood vessels in the chest. 7 million people in England have cardiovascular disease which accounts for 27% of all deaths. 28,250 cardiac surgery operations and 69,000 thoracic surgery operations are performed each year. 

Only 31 units in England perform this major, technically demanding surgery in which success depends on highly skilled, multidisciplinary teamwork. Although low-volume compared to many other areas of surgery, cardiothoracic surgery is high cost and often high risk with a measurable mortality rate. Patients needing these sorts of operations have life-threatening diseases and are amongst the most ill that the NHS faces. Since survival rates and clinical outcomes in adult cardiac surgery have been published, they have improved such that the UK’s survival rate for cardiothoracic surgery is currently ranked as one of the best in the world.

The GIRFT cardiothoracic surgery report recommends changes which will improve experience and outcomes for patients which go beyond mortality or survival rates. Delays (which increase risk), cancellations and unnecessarily long stays in hospital will be reduced by a series of measures including:

  • Routine day-of-surgery admission
  • Ring-fencing of ward and ITU beds for elective cardiothoracic surgery
  • Pooling of non-elective cases so that patients are operated on in the next available theatre session with the next available appropriate surgeon
  • Ensuring that every patient is seen by a consultant both pre and post-operatively, seven days a week (to avoid delays in waiting for discharge if no consultant can review at the weekend)

Patients’ risk and outcomes (including risk of stroke and deep sternal wound infection) will be improved by measures including:

  • Ensuring that conditions needing highly specialised treatment, such as aortovascular surgery and mitral valve surgery, are only operated on by surgeons with specialist skills in that condition.
  • Specialist surgeons will operate on higher numbers of cases, as variations in practice,  outcomes and mortality strongly suggest that higher volume is associated with better outcome.
  • Minimum activity requirements for surgeons. 
  • Major trauma centres to have rotas to cover both thoracic and cardiac trauma surgery rather than relying on cardiac surgeons to provide emergency thoracic surgery cover. (There are only 27 cardiothoracic surgeons in England, with 182 cardiac-dedicated surgeons and 92 purely dedicated to thoracic surgery).
  • Centralised and reduced numbers of lung cancer multidisciplinary teams with a thoracic surgeon present on every team.

During their visits the GIRFT team found that because clinicians and providers knew very little about the litigation claims that were being made against them, very few lessons had been learned from claims. The Department of Health has stated its goal to turn the NHS into a learning organisation but unless clinical staff are given information about litigation claims and proper analysis of claims is carried out at local and national levels, opportunities are being missed to improve patient care. GIRFT recommended implementation of their five point plan to reduce litigation costs - including detailed analysis and review of all claims as serious untoward incidents (SUI)  -  to ensure that lessons are learned to save costs and improve patient care.

If you or a family member have suffered serious injury as a result of medical negligence during cardiothoracic surgery call our specialist medical negligence solicitors on 0118 952 7219 or email mednegclaims@boyesturner.com.

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