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NOTHING could have been done to save the life of a baby girl who died in Altnagelvin Hospital six days after she was born, the Coroner’s Court has heard.
Aoibheann Cusack, first-born daughter of Sean and Sarah Cusack of Cashelmore Park in Londonderry, was born with a rare condition in which her lungs failed to function after she was delivered on November 17, 2017.
Paediatric pathologist Dr Daniel Hurrell told the inquest that the change in pressure that usually occurs in a baby’s body during delivery that starts the lungs working did not happen in her case.
This caused persistent pulmonary hypertension (PPHN) which made resuscitation difficult after she was delivered and contributed to brain damage caused by a lack of oxygen (hypoxic ischaemic encephalopathy).
Coroner Joe McCrisken found it was not possible to pinpoint the exact time the baby was deprived of oxygen or what caused it, because the placenta which could have provided Dr Hurrell with answers was not retained by Altnagelvin Hospital.
Retaining the placenta and umbilical cord for examination in cases where a baby needs to be resuscitated is now normal procedure at Altnagelvin.
The inquest heard that while Mrs Cusack was in labour from 8am to 5.30pm on November 17, a cardiotocography (CTG) — which monitors a baby’s heart
Delivery: Altnagelvin Hospital
rate during labour — showed Aoibheann’s heart went above a normal rate of 160 beats per minute a number of times.
The medical team caring for Mrs Cusack decided at 5.30pm to deliver Aoibheann by emergency Caesarean section, when her heart rate rose to a very high rate.
Dr Hurrell explained that the PPHN could have been as a result of an infected placenta, an abnormality in the placenta, or the stress of the delivery itself.
Delivery staff carried out resuscitation of Aoibheann before transferring her to the paediatric intensive care unit where Paediatric Consultant Dr Damien Armstrong took over.
He said it was clear Aoibheann was very ill and needed “maximum support” which included being placed on a ventilator and having her body temperature lowered to try and reduce swelling on her brain.
Dr Armstrong said he twice discussed withdrawing treatment from Aoibheann with her parents but that “they made it clear they didn’t want that” and “wanted to give Aoibheann every chance”.
Dr Armstrong explained to Mr and Mrs Cusack that if their daughter continued to deteriorate, “there was nothing else to do”.
Mr McCrisken asked Dr Armstrong if treating the baby with nitric oxide — which is available in Belfast but not Altnagelvin — would have helped.
Dr Armstrong said it may have made a difference to the baby’s lung function but would not have made any difference to the damage to her brain, although she was too ill to move.
In his findings, Mr McCrisken said failure to retain the placenta and umbilical cord for examination was accepted by everyone as “not satisfactory to say the least”, because “this could have provided the family with vital answers” and that this was something he “would not expect to happen again”.
Mr McCrisken also said he was “satisfied everything had been done that could have been done” and that he had “no concerns” about the midwifery or medical treatment given to Mrs Cusack on the day Aoibheann was born.