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Parents of newborns who died weeks after birth question lack of Strep B testing

Online Niel October 29, 2024

The parents of a newborn who died a week after birth questioned why the UK was not screening for group B strep, a fatality inquest heard.

Freya Murphy was born on 21 July 2018 in Queen Elizabeth University Hospital (QEUH) in Glasgow but died a week later in the neonatal intensive care unit, a fatal accident inquest (FAI) at Glasgow Sheriff Court was told.

In a victim impact statement, mum Karen Murphy and her husband Martin said they were “devastated by the failings in her care” and “missed out on a lifetime of memories with our precious daughter”, while their other children “suffer daily without their big sister”.

They added: “We are disturbed that most developed countries sample for group B strep but not in the UK.”

Mrs Murphy, then 32 and a first-time mother, was deemed to be a ‘low-risk’ pregnancy and the induction was planned for July 20, 2018, however she asked to be delayed by three days, according to a press release. of approved evidence read to the court.

Fiscal depute Amanda Allan told the court that on July 19, Freya’s heartbeat was recorded at 150 beats per minute (bpm) and Mrs Murphy, a teacher from Cambuslang, South Lanarkshire, started contractions later that day.

The following evening, Ms Murphy arrived at QEUH with her fetal heartbeat recorded as 144bpm and was transferred to the labor unit at around 10.20pm and at 6.30am on July 21 she was advised to start pushing, they heard investigate.

At around 7.20am, a midwife noticed that Mrs Murphy’s pulse was elevated and informed Dr Felicity Watson, who carried out a vaginal exam and advised Mrs Murphy that she could rest from pushing for an hour, which he refused to do. do, Ms Allan told the court.

Midwife Helen Kidd reported at 8.45am that a CTG (cardiotocograph) was showing signs of “deceleration”, however Dr Amy Sinclair and Dr Marieanne Ledingham left to attend to another woman, Patient A, the court heard .

At the time, 12 women were on the ward, including seven in labour, and Dr Ledingham returned to examine Mrs Murphy and noted ‘deceleration’, however, Dr Sinclair advised her that Patient A required delivery surgical.

The court heard Dr Sinclair and Mrs Kidd delivered baby Freya at 9.30am “covered in thick and copious meconium”.

Mrs Allan said: “It was noted that Freya was born in a poor condition, requiring resuscitation and CPR continued for 17 minutes.”

Freya was then transferred to the Neonatal ICU and was suspected to have suffered a brain injury, the inquest heard.

Mrs Allan added: “It was agreed that continued intensive care treatment was not in Freya’s best interests and she was unlikely to survive.”

Freya died just before 10pm on July 28, aged one week, and her cause of death was global hypoxic ischemic brain injury associated with acute chorioamnionitis, according to a post-mortem examination.

A significant clinical incident investigation review was carried out in 2019 with six recommendations, and an external review was commissioned by Dr Michael Munro, a neonatal specialist who wrote in a report that “group B strep amnionitis remains the most likely cause of Freya’s brain. the injury as there does not appear to be anything else to cause it’, and noted that after the birth, ‘care was given to (a) high standard’, the court heard.

Giving evidence via videolink, Dr Munro said: ‘The trajectory of the decline is really impossible to be sure of, there are no studies that I’m aware of of the specific circumstances that Freya was in. The process of that beginning and the child. death can take less than 30 minutes.”

Dr Munro said he believed group B strep – an infection passed from the mother’s body to the baby through the amniotic fluid – was “the most likely cause because there is nothing else in the notes that I have seen that explains what it happened”.

He said, “It can cause stillbirth, so what we’re dealing with here is stillbirth right before Freya’s heart tragically stops.”

He agreed that an earlier birth would have helped, but added: “I don’t think it’s possible to say, ‘if Freya had been born at this time, she would have avoided brain damage or survived.’

Dr Munro told the court the mortality rate (of group B strep) was “around 5%, it’s a minority of babies who succumb” and Freya was “close to being recorded as (a) stillbirth”. , because her heart rate was so slow.

He added: “Many women are carriers of group B strep, about a third – it results in a very small number of babies, either causing stillbirth or giving birth to a baby in a very poor condition.”

Dr Munro said screening for group B strep had been carried out in America since 2002 and 15,000 babies born in Scotland in 2023 could potentially be affected by the infection.

He said the “risk of exposing many babies to antibiotics they don’t need” was a major consideration for doctors, but added: “I would like universal screening. One of the most advanced healthcare systems in the world does this and you have to wonder why the UK doesn’t.”

Under cross-examination from Alan Rodgers, representing the Murphy family, Dr Munro said “the most common sign was a fever in the mother and the heart rate may be going faster”, the inquest heard.

Neonatal pathologist Dr Paul French gave evidence and said the placenta was examined before Freya’s death and was stained with meconium, indicating the baby had been “stressed” before birth – but said this s -would have happened “hours or days” before and that Strep. B was present in the swabs.

The investigation continues before Sheriff Barry Divers.