Newborn baby died of a serious brain injury at Blackpool Vic after being deprived of oxygen for more than 40 minutes
A newborn baby died of a serious brain injury after being deprived of oxygen for more than 40 minutes after he was born.
Finnley Morris was born in a poor condition at Blackpool Victoria Hospital at 00.22am on October 1 last year. Staff immediately attempted to revive him and he was eventually stabilised 42 minutes later following a series of delays.
By this time, the newborn had suffered a serious brain injury due to lack of oxygen.
At his inquest at Blackpool town hall yesterday, dad Adam Morris said: "Finnley appeared to struggle to breathe. He hadn't cried and it looked as though he was trying to take a breath but couldn't."
He said that, at around 3am, a consultant informed him and his wife, Emma, that Finnley 'had been 50 minutes without oxygen' and 'as a result of a lack of oxygen for such a long time, Finnley had suffered a brain injury and that his brain was unlikely to recover'.
Finnley was transferred to Royal Preston Hospital later that morning, where an MRI scan on October 5 showed severe brain swelling due to lack of oxygen and no signs of activity. He died at 6pm that day.
The court heard that there was a lack of clear leadership present as doctors, nurses and midwives attempted to revive Finnley, and that there had been a number of delays.
Midwife Rachel Sellers said: "Because of the extent of the resuscitation, it was difficult to say whether there was clear leadership because it changed throughout from one doctor to another doctor."
A clamp was missing from a tube on the resuscitaire, resulting in a delay of around half a minute while a new clamp was located. Midwife Marie-Laure Longy, who was responsible for checking the machine, said she did not check the machine herself, but observed a colleague do so and that "everything was in working order".
When asked by Victoria Beel, representing Mr Morris, whether she had ever been at another resuscitation where equipment was missing, she replied: "No, never."
Concerns were also raised that the oxygen mask was not properly placed on Finnley's face, or that the infant was not in the right position to receive oxygen, around 10 minutes after resuscitation attempts began, when nurse Hayley Knighton entered the room and noticed the pressure on the machine was low.
An on-call consultant, Dr Sunitha Peiris, who arrived at the hospital around 30 minutes after Finnley was born, asked the doctors why he hadn't already been intubated.
However, it took a further 12 minutes to succesfully intubate him. The court heard the process was delayed by 'a matter of minutes' as Dr Peiris had misplaced her reading glasses.
Ms Knighton said: "There was a discussion about trying to source some glasses for her."
After intubation, Finnley's condition stabilised, allowing him to be transferred to Preston later that morning.
Mr Morris said: "After Finnley had been delivered and taken for resuscitation, we remained theatre for the next period of the waiting process, and then we were taken back to the delivery suite where we were kept several hours without any update about what was happening to FInnley, which was, as you can imagine, extremely distressing.
"We asked numerous times for updates while we were in theatre and we could see the resuscitation going ahead prior to the boards being brought across the doorway. We could see the resuscitation happening, which looked chaotic.
"Once we were taken back to the suite we asked for an update, which didn't come."
Pathologist Dr Melanie Newbould said Finnley died of severe hypoxic-ischemic encephalopathy, where the nerve cells in the brain die as a result of a lack of blood supply and oxygen.
She said: "This means that Finnley must have been subjected to a long period of lack of oxygen supply to his brain.
"This is one of the most severe complications that can occur in babies in the early stages of life. It can cause death, and is a life-limiting condition.
"It results in impaired blood supply to the brain. Once this injury has occurred the initial insult causes the brain to swell, and that further causes lack of oxygen supply. It's a vicious cycle... where ultimately the brain becomes so swollen that the brain stem is suppressed, and once that happens life can't continue."
The inquest continues.