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Concentrated feeding and fluid balance assessment of baby (12HDC00115)

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(12HDC00115, 11 June 2014)

District Health Board ~ Paediatrics ~ Rotavirus gastroenteritis ~ Fluid balance ~ Hypernatraemia ~ Concentrated feeding ~ Continuity of care ~ Multidisciplinary team ~ Rights 4(1), 4(5)

An 11-month-old child was electively admitted to a public hospital for monitoring and management of ongoing issues with vomiting, oral aversion and poor weight gain. She was under the care of a multidisciplinary team, which included a paediatrician and a dietician. During her admission, she received concentrated feeds. After initially gaining weight, the child then developed diarrhoea and increased vomiting. She was diagnosed with rotavirus gastroenteritis, which she had contracted as an inpatient. Concentrated feeds were continued.

The following day, the paediatrician and the dietician attended a multidisciplinary team meeting to discuss the child's discharge planning. Neither of them read the progress notes and therefore were not aware of and did not discuss the rotavirus diagnosis. Concentrated feeds were continued. The extent of the child's fluid loss and degree of dehydration were not monitored effectively, and the development of hypernatraemia was not detected. The child developed a fever and a medical review did not take place. She was then found unresponsive with acute renal failure and severe hypernatraemia, and died.

It was held that the DHB failed to provide services with reasonable care and skill in breach of Right 4(1), by continuing concentrated feeding following the rotavirus diagnosis, by failing to assess and monitor the child's fluid balance properly following the diagnosis despite ongoing fluid losses, and by not reviewing the child medically on the night prior to her collapse.

It was also held that the DHB failed to ensure the continuity of services provided in breach of Right 4(5), in that members of the multi-disciplinary team failed to communicate adequately with one another regarding the rotavirus diagnosis.