Babies in special care nursery will be monitored continuously from now, says KKH after infant’s death
Sign up now: Get ST's newsletters delivered to your inbox
The hospital's move comes after a baby died from a brain injury in April 2021.
ST FILE PHOTO
SINGAPORE – KK Women’s and Children’s Hospital (KKH) will now continuously monitor the vital signs of babies who require admission to its special care nursery, following a review of processes
State Coroner Adam Nakhoda had noted in a report that for a period of time after the baby’s birth, his vital signs were not recorded, and described this lack of continuous documentation as not ideal.
In response to queries from The Straits Times, Associate Professor Chan Yoke Hwee, chairman of KKH’s division of medicine, said on Friday that the hospital has reinforced continuous documentation of babies’ vital signs, in line with the coroner’s findings.
“Following the incident, we had taken immediate steps to further strengthen our processes for monitoring babies who require admission to the special care nursery, including continuous monitoring of the vital signs of babies,” said Prof Chan.
“The continuous monitoring enables our clinical staff who are always present to be immediately alerted in the event of any abnormalities, as triggered by the system.”
The special care nursery looks after infants following their stabilisation in the neonatal intensive care unit, and also prepares them to be discharged. It accommodates preterm infants, as well as infants with minor medical problems requiring medical attention or observation.
The hospital is committed to continually reviewing its processes to enhance its standard of care, said Prof Chan, who is also chairman (designate) of KKH’s medical board.
“KKH is deeply saddened by the passing of this baby. We are in touch with the family to support them through their loss,” she said.
In his report, State Coroner Nakhoda ruled out foul play and said the baby had died of natural causes.
After the baby was born at about 4.30am, he was found to have three tight loops of umbilical cord around his neck. The cord was removed immediately and he was placed on a resuscitator.
As his vital signs were noted to be less than optimal, he was given assisted ventilation for two minutes, which helped improve his heart rate and the oxygen level in his blood.
However, at three minutes after birth, his blood oxygen level was noted to be borderline, and he was given medical help until his vital signs improved.
The baby was observed to be moving vigorously and had a good cry, and State Coroner Nakhoda noted that nothing amiss was observed.
But when the baby was taken to the viewing room so that his father could see him, it was apparent that his condition had begun to deteriorate, the coroner said.
The father and a nurse noticed that he was giving weak cries and appeared limp.
When this became more pronounced and the baby did not show spontaneous limb movements and was not breathing spontaneously, the nurse took him back into the operating theatre.
His vital signs were not recorded from the seventh minute after birth until he was taken back into the operating theatre at about 5.20am.
The nurse put him back on the resuscitator, reattached a probe that allowed for measurement of his blood oxygen level and heart rate, resumed the assisted ventilation and then activated a Code Blue emergency alert, which is used when a patient is in cardiac or respiratory arrest.
The baby was transferred to the neonatal intensive care unit and connected to a ventilator.
But his condition continued to deteriorate. An ultrasound found indications of swelling of the brain, and there was suggestion of severe brain disease.
By the fifth day after the baby was born, his condition had worsened further, and his parents agreed to withdraw care after discussion with the medical staff and careful consideration.
The baby was pronounced dead on April 12, 2021, at about 12.30pm.
State Coroner Nakhoda noted that the cause of death was certified to be a brain injury that occurs when the organ experiences a decrease in oxygen or blood flow.
He added that it was unlikely that the wrapped umbilical cord had played a part, as there was a period when the baby was well and breathing independently.
A senior consultant at KKH’s department of neonatology stated in a medical report that there was no documentation of continuous monitoring of the baby’s vital signs, considering his initial stable status.
The consultant added then that upon review of this, the hospital was working to ensure that documentation of a newborn’s vital signs would be maintained until the newborn was handed over to other teams in the hospital.
