A baby who was deprived of oxygen at birth and later developed cerebral palsy fitted the criteria for head-cooling treatment under national guidelines but was not provided with same after birth, a medical council fitness-to-practise inquiry has heard.
Paediatrician Dr Mohammad Ilyas Khan has been accused of poor professional performance for allegedly failing to order a head-cooling treatment for the baby, who was subsequently left with brain damage.
Dr Khan was working as a locum consultant paediatrician at South Tipperary General Hospital in June 2012 when the alleged incident occurred.
Brain damage
Head-cooling treatment is used to lessen the chance of brain damage resulting from oxygen deprivation during birth. Current protocols require cooling to begin within a maximum of six hours after birth and suggest that cooling as early as possible is the ideal.
A lack of oxygen around the time of birth can result in cerebral palsy, learning disabilities and epilepsy.
It is alleged Dr Khan failed to put an adequate plan in place for the treatment of the baby’s diagnosis of hypoxia (lack of oxygen at birth) after he was born.
It is also alleged he failed to arrange for the transfer of the baby to another hospital for cooling treatment.
The baby is now two years old and has cerebral palsy. He attends the Central Remedial Clinic and receives occupational, physical and speech therapy.
Ruptured uterus
The baby's mother, Noelle Tobin, suffered a ruptured uterus, which deprived the baby of oxygen at birth. The baby was brought to the special care unit of South Tipperary General Hospital in Clonmel after he was born and given anti-seizure medication.
Ms Tobin requested the cooling treatment but Dr Khan did not think the baby was a suitable candidate, the inquiry heard.
The baby was transferred to Holles Street maternity hospital, Dublin, where doctors told the parents he might die or be left with a disability.
The inquiry heard testimony on Monday from expert witness Dr Kevin Connolly, a former consultant paediatrician who had worked in Crumlin, Temple Street, Holles Street and Portiuncula hospitals until he retired in 2010.
Dr Connolly said there is “compelling evidence” of the benefits of cooling treatment on a baby if done within six hours of the child being born, which “significantly mitigates” the adverse effects of a lack of oxygen on the brain.
Risk reduced
He said if cooling treatment is done within six hours the risk of the child dying or developing a severe disability is reduced by 25 per cent.
Dr Connolly said this baby fitted the criteria for cooling under the national neo-natal transport guidelines and said the guidelines are “gold standard”.
“It would be difficult to go against these guidelines because there is compelling evidence for them,” he said.
He said the guidelines are approved by the World Health Organisation and the National Institute for Health and Care Excellence (NICE) in the UK.
Dr John Walsh, consultant paediatrician at South Tipperary General Hospital who provides ongoing care to the child, assessed him in April of this year and said he has "evolving cerebral palsy".
He said it is “impossible to predict” how the child will fare physically and mentally in the years ahead.
Motor skills
He said he is walking well but has problems with his fine motor skills and may face problems when trying to hold a pen or open a zip, for example.
He said he has some speech and can put some words together, but his expressive language is delayed for a child of his age.
The inquiry continues on Tuesday.