Inquest Into Death Of Baby Boy In Laois Hears Of Nurse's Concerns Over Oxygen Equipment

Aaron Cullen lost his life in 2016 after being delivered in Midlands Regional Hospital Portlaoise.

A nurse has told a reopened inquest into the death of a baby boy a few days after his birth at the Midlands Regional Hospital that she was concerned that the oxygen in equipment being used to resuscitate him was “off or at a low level” for the first 11 minutes of his life.

Paediatric nurse, Elaine Sheehy, said she also expressed concern that an oxygen mask placed over the baby during efforts to resuscitate him was too big.

Aaron Cullen suffered a lack of oxygen to the brain when delivered by emergency caesarean section in the hospital on May 4, 2016 but died five days later at the Coombe Hospital in Dublin where he had been transferred for specialist care.

Ms Sheehy told the second day of the inquest at Dublin District Coroner’s Court yesterday, that she had subsequently become “extremely upset and concerned” that she needed to increase the oxygen flow when she arrived in the theatre 11 minutes after the baby’s birth.

The nurse said she was concerned that the oxygen from the Neopuff resuscitator being used was “off or at a low level.”

She added: “I am certain that I needed to increase the oxygen flow but I am not certain if this was from off or low flow.”

However, an expert witness who reviewed the case said he believed it was most likely that the gas flow to the Neopuff was turned on because the baby’s condition improved with ventilation via a mask as well as from the recollection of staff treating him.

Consultant neonatologist, Colm O’Donnell, said it would have ensured the equipment was delivering a minimum concentration of 21% of oxygen or “room air.”

Prof O’Donnell said he did not believe that Aaron would have survived given the severity of his condition at birth and his lack of response to intensive care.

However, he acknowledged that it was not possible to say the relative effect that an increased gas flow (regardless of oxygen concentration) and the change of mask would have had.

Prof O’Donnell said the baby was “extraordinarily sick” from birth but there was no acute event which would explain why he was so unwell.

The consultant said intubation would have been more preferable at an earlier stage but he said it was not surprising it was not done earlier.

He said it was also unsurprising that a registrar had made two unsuccessful attempts at intubation as up to 45% of first attempts at urgent intubation do not work.

Aaron was successfully intubated by an on-call consultant paediatrician, Muhammad Tariq, 21 minutes after his birth.

In reply to questions from the coroner, Myra Cullinane, Prof O’Donnell said he did not believe any rate of flow of gas to the Neopuff would have been sufficient due to the condition of the patient’s lungs.

The expert said the earlier delivery of a higher concentration of oxygen might have had some effect but he believed it would have still been “unsatisfactory.”

The inquest into the death of baby Aaron was reopened on direction of the Attorney General to allow new evidence to be heard that was not before the original inquest which concluded in March 2019 with a narrative verdict.

The fresh inquest had been sought by Aaron’s mother, Claire Cullen, after she obtained additional material from the MRH in Portlaoise in relation to concerns about oxygen levels during resuscitation under a freedom of information request after the conclusion of the original hearing.

Ms Sheehy gave evidence that she had been made aware while on duty earlier about a woman with a high-risk pregnancy with an increased likelihood of her baby requiring admission to the hospital’s special care baby unit.

The nurse said she received another call a short time later that the baby was going to be delivered by caesarean section imminently.

Ms Sheehy said she subsequently was called to attend the operating theatre urgently and arrived there 11 minutes after baby Aaron’s delivery.

She recalled that resuscitation on the baby was already in progress but no respiratory effort was noted and his heart rate was reported to be just 30 beats per minute.

In reply to questions from the corone, the nurse said she was concerned that the baby was not responding to resuscitation efforts and she changed the size of the oxygen mask being used to a smaller one used with pre-term babies.

Ms Sheehy became tearful when she outlined her belief that Aaron was not getting better, despite the efforts of medical staff.

“I found that very upsetting,” she remarked.

The nurse admitted that she had thought a lot about what happened that day.

“It is difficult to envisage that for 11 minutes the oxygen could have been completely off,” said Ms Sheehy.

Cross-examined by counsel for Ms Cullen, Fiona Gallagher BL, the nurse said the baby was “flat, unresponsive and very pale” when she first saw him.

The interim director of midwifery at MRH at Portlaoise, Maureen Revilles, said Ms Sheehy told her about her concerns on May 9, 2016, because she wanted to prevent issues arising with resuscitations in the future.

However, Ms Revilles said the claim of oxygen being off was deemed incorrect at a senior incident management team meeting on May 19, 2016 as staff present from the start of the resuscitation “had a clear recollection of the oxygen being on to deliver pressures via the Neopuff device.”

Based on Ms Sheehy’s information, Ms Revilles said it was agreed that the oxygen flow was increased.

The inquest was adjourned and will resume on today.