Missed chances to diagnose baby Phoebe’s tumour
SHE SHOULD HAVE HAD FOLLOW-UP SCAN, INQUEST TOLD
AN inquest into the death of a baby has found there were “missed opportunities” to have diagnosed a brain tumour.
Phoebe Cowlishaw was born on February 9, 2020, already with a growth on her brain, which turned out to be an aggressive brain tumour that eventually killed her under a year later.
Healthcare professionals at the Queen’s Medical Centre diagnosed it as something else to begin with.
She died on February 6 last year, three days before her first birthday, having been admitted to Nottingham Children’s Hospital after deteriorating rapidly.
An inquest concluded at Nottingham Coroner’s Court at the Council House yesterday.
Assistant Coroner Elizabeth Didcock found there were “missed opportunities to follow up with measurements of head circumference and scans”.
Phoebe had a first MRI scan on January 6, 2020, just over a month before she was born, which found a small lump on her brain – diagnosed as a benign hematoma.
Her head circumference was measured three times in the first five weeks of her life, which were found to be consistent, but the next measurement was not until January 14, 2021, just under 10 months on.
Mother Jackie, who was not present at the inquest, called the QMC on March 23, 2020, to see if she could take Phoebe in, but was turned away because of the start of the Covid pandemic, which Ms Didcock described as “a key opportunity missed”.
She said Phoebe should have had a follow-up and scan when she was six months old to review the size of the lump.
There were no symptoms to suggest Phoebe had a brain tumour, and no concerns were raised by medical professionals about her head circumference or growth of the tumour, but the growth itself was still there.
Ms Didcock concluded it was likely to be an “immature teratoma”.
On February 1 last year, Phoebe started to suffer from lethargy, vomiting and high blood pressure.
After being admitted to Nottingham Children’s Hospital, she collapsed while having a CT scan, and died on February 6 after suffering a brain injury.
She was found to have a high-grade tumour on her brain, the teratoma, which was confirmed to be the cause of her death.
Ms Didcock delivered a narrative verdict.
She said: “A planned follow-up to measure head circumference at six months, along with scans, did not occur.
“The tumour was large and caused secondary effects on Phoebe’s brain.”
Before hearing the evidence, father Sam Cowlishaw said: “They should have known and checked Phoebe with more scans. They should have kept going.
“She was fine on the Sunday (January 31, 2021) – we were in the park on the swings. She was really happy, but the next day she was not well.”
Her aunt, Nicola Pinnock, said: “There were no signs we could have picked up on, and we wanted someone with knowledge to have picked up on it.”
Ms Didcock agreed it was “difficult to understand”.
During proceedings, Simon Howarth, consultant adult and paediatric neurosurgeon, and Dr Patrick Davies, consultant in paediatric intensive care at Nottingham Children’s hospital, who both cared for Phoebe, gave evidence.
Mr Howarth said: “It’s clear this should have been followed up more closely, and on the balance of probabilities, this could have yielded an MRI scan, which would have found an increase in the size of the tumour and space of the brain.
“On the balance of probabilities, she would not have succumbed, but the treatment required would have been high risk with high mortality.”
Dr Davies cared for Phoebe when she was on the paediatrics intensive care unit and collapsed.
During proceedings, he said: “She needed a scan and to have the fluid drained urgently – so she went into a CT scan, but she collapsed while her head was in the machine.
“Surgery cannot be done before the scan. That’s what she needed, and the problem was things moved more rapidly than could be anticipated.
“She had too much fluid which caused pressure, and there were time constraints of any intervention – it’s very quick to go from first signs to full collapse in 30 minutes.”
Mr Cowlishaw and Ms Pinnock both paid tribute to staff on the paediatrics intensive care unit.