A premature baby born at 22 weeks died after doctors in the United Kingdom (UK) refused to provide life-saving treatment.
Key Takeaways:
- Mojeri Adeleye was born prematurely at 22 weeks after his mother suffered premature rupture of membranes.
- During the emergency, mom and baby were transferred to a different hospital, where the gestational date was written incorrectly, labeling Mojeri as less than 22 weeks gestation.
- UK guidelines only recommend medical care for premature babies who are born at or after 22 weeks gestation.
- Though Mojeri’s mother notified medical staff about the error, they didn’t believe her, and allowed the baby to die.
The Details:
According to a coroner’s report, Mojeri’s mother had been seen for most of her pregnancy at her local hospital in Grimsby. But when she began to experience complications, she was transferred to another hospital: Jessops Wing in Sheffield.
However, a mistake was made in the referral notes, and Mojeri’s mother was registered as being less than 22 weeks gestation. National guidelines only recommend that life-saving treatment be provided to preemies born at or after 22 weeks gestation, and though Mojeri’s mother repeatedly tried to tell staff the correct gestation, they didn’t believe her.
When the mother went into labor, staff refused to provide any life-saving care for Mojeri. He was, in fact, just over 22 weeks gestation, as his mother had insisted.
But because doctors did nothing, Mojeri died.
The coroner wrote in the report:
During the course of the inquest the evidence revealed matters giving rise to concern. In my opinion there is a risk that future deaths could occur unless action is taken.
In the circumstances it is my statutory duty to report to you. The MATTERS OF CONCERN are as follows.
– The lack of regard towards Mojeri’s mother’s knowledge of her own pregnancy and the estimated due date for Mojeri.
The lack of discussion with Mojeri’s parents about the possible measures that could be taken in the event of premature labour before the 22 week mark.
Andrea Galimberti, Deputy Medical Director at Sheffield Teaching Hospitals NHS Foundation Trust, said the hospital has changed its guidelines to ensure something like this does not happen again:
We express our sincere condolences to Mojeri’s family for his death and the distress that it has caused. We can assure them that we have taken this case very seriously and since it occurred in 2022 we have taken actions with the aim of ensuring that nothing similar can happen again.
We have revised our policies to ensure that where there is any conflicting information with regard to due dates, the findings of a validated dating scan are checked and communicated with the mother to ensure they are correct. We have also undertaken work and training with nationally recognised maternity organisations to support a culture of listening and engagement to ensure the patient voice is heard.
Although in Mojeri’s case knowing the correct gestational age would not have altered the treatment given, we have introduced specific training regarding the management of extreme prematurity to support staff to advocate effectively for women in this situation and provide appropriate care.
Why It Matters:
British Association of Perinatal Medicine (BAPM) guidelines from 2019 had recommended that if babies were born alive at 22 weeks, “survival focused” care should be given; previously, the guidelines said babies born before 23 weeks should not be resuscitated.
After these guidelines were put into place, the number of premature babies who survived at 22 weeks tripled.
Before that, premature babies deemed “too young” were simply left to die.
It has been estimated that 60-70% of babies can survive being prematurely at 24 weeks gestation. However, up to 71% of premature infants, even those born before 24 weeks, can survive if they are given active care instead of just palliative care. And increasingly, babies are surviving even as young as 21 weeks.
The Bottom Line:
Not every baby will be able to survive extreme prematurity, but they at least deserve to be given the chance.
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