Failure To Treat Kernicterus Bilirubinaemia

Baby Wesley, Lancaster

Wesley was the second of twins delivered prematurely at 35 weeks by C-section. He was a breech delivery and was a low birth weight. His Apgar scores were low but not critical. There was only one placenta (uniovular) and twin-to-twin transfusions syndrome was present. 

Wesley was the donor twin (in twin-to-twin transfusion one baby receives the majority of the blood supply and one twin ‘donates’ their share of the blood supply) and he was pale and floppy at birth. Wesley’s brother Tom weighed a little more and his Apgar scores were much higher. Tom had a good haemoglobin level of 23, but Wesley’s level was only 7 (low).

Wesley was very unwell. A Dextrose infusion was started, anti-biotics were given, and a blood transfusion started. By the next day Wesley was noted to be jaundiced and his bilirubin level was raised. Phototherapy was commenced however his bilirubin continued to rise.  

It was recognised that exchange transfusion may well be needed in order to prevent Wesley's bilirubin level increasing to the point where he developed irreversible Kernicterus, and sustained brain injury. That night he was developed a blotchy purple rash on his body and limbs. The next day Wesley remained unwell. He was floppy, pale and jaundiced, and the rash remained. His bilirubin continued to rise.  

By the third day after his birth, Wesley’s condition had deteriorated to the point where he was stiff and arching his back. This indicated he was entering the second stage of Kernicterus. Babies treated in the first stage of Kernicterus have a good prognosis, but the prognosis is less favourable for those who reach the second stage, a high proportion of whom sustain permanent brain damage. 

Wesley developed brain damage as a result of Kernicterus, which left him with mild dystonic athetoid cerebral palsy, severe hearing impairment, mild learning difficulties and some visual problems.  

JMW Solicitors alleged that the care afforded to Wesley was negligent in several respects. Firstly, it was alleged that the hospital failed to monitor Wesley’s bilirubin levels, had they monitored his bilirubin level appropriately during this period they would have seen that it was continuing to increase.   

The hospital also failed to take sufficient account of Wesley’s particular vulnerability to developing Kernicterus. In particular, he was premature, he was seriously unwell, having suffered the consequences of being a donor of a twin-to-twin transfusion, he only weighed 2kgs at birth, he was anaemic and he developed jaundice within the first 24-hours of life.  

The hospital also failed to take into account that phototherapy was failing to reverse Wesley's increasing bilirubin level or to take heed of the fact that he was becoming very floppy with upward rolling and jerky movements of his eyes.   

Finally, the hospital failed to obtain blood in good time so as to be able to undertake an exchange transfusion before the second stage of Kernicterus developed.  

Shortly before the case was to go to trial the Hospital made a formal admission of liability (negligence) on a 100% basis. The case was settled and Wesley received a total of £5.5 million compensation to assist with the cost of treatment, transport and adaptations to his home.