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Concentrated feeding and fluid balance assessment of baby (12HDC00115)
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District Health Board ~ Paediatrics ~ Rotavirus
gastroenteritis ~ Fluid balance ~ Hypernatraemia ~ Concentrated
feeding ~ Continuity of care ~ Multidisciplinary team ~ Rights
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.
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