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Neonatal hypoglycaemia: learning from claims
  1. Jane M Hawdon1,
  2. Jeanette Beer2,
  3. Deborah Sharp3,
  4. Michele Upton4
  5. On behalf of NHS Improvement Patient Safety Programme ‘Reducing Term Admissions to Neonatal Units’
  1. 1Women's and Children's Health, Barts Health NHS Trust, London, UK
  2. 2Safety and Learning Lead (Obstetrics), National Health Service Litigation Authority, London, UK
  3. 3University of Hertfordshire, UK
  4. 4NHS Improvement, London, UK
  1. Correspondence to Dr J M Hawdon, Women's and Children's Health, Barts Health NHS Trust, Executive Offices, Newham University Hospital, Glen Road, London E13 8SL, UK; jane.hawdon{at}bartshealth.nhs.uk

Abstract

Objectives Neonatal hypoglycaemia is a potential cause of neonatal morbidity, and on rare but tragic occasions causes long-term neurodevelopmental harm with consequent emotional and practical costs for the family. The organisational cost to the NHS includes the cost of successful litigation claims. The purpose of the review was to identify themes that could alert clinicians to common pitfalls and thus improve patient safety.

Design The NHS Litigation Authority (NHS LA) Claims Management System was reviewed to identify and review 30 claims for injury secondary to neonatal hypoglycaemia, which were notified to the NHS LA between 2002 and 2011.

Setting NHS LA.

Patients Anonymised documentation relating to 30 neonates for whom claims were made relating to neonatal hypoglycaemia. Dates of birth were between 1995 and 2010.

Interventions Review of documentation held on the NHS LA database.

Main outcome measures Identifiable risk factors for hypoglycaemia, presenting clinical signs, possible deficits in care, financial costs of litigation.

Results All claims related to babies of at least 36 weeks’ gestation. The most common risk factor for hypoglycaemia was low birth weight or borderline low birth weight, and the most common reported presenting sign was abnormal feeding behaviour. A number of likely deficits in care were reported, all of which were avoidable. In this 10-year reporting period, there were 25 claims for which damages were paid, with a total financial cost of claims to the NHS of £162 166 677.

Conclusions Acknowledging that these are likely to be the most rare but most seriously affected cases, the clinical themes arising from these cases should be used for further development of training and guidance to reduce harm and redivert NHS funds from litigation to direct care.

  • Neonatal hypoglycaemia
  • Litigation
  • Infant Feeding

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Correction notice This paper has been amended since it was published Online First. One correction submitted by the author was not implemented by the production office. In the section 'Likely deficits in care', in the first bullet point it should be 27 babies and not 24.

  • Contributors JMH and JB devised and carried out the review of documents and drafted the paper. MU and DS made subsequent comments and amendments.

  • Competing interests JMH receives occasional expenses and honoraria for invited articles and chapters and speaking at conferences on the subject of neonatal hypoglycaemia, and receives fees for expert reporting on litigation claims, some of which relate to neonatal hypoglycaemia, the latter being carried out outside of NHS hours. JMH is a member of the board of trustees of the charity Bliss and a member of the NICE guideline development committee, ‘Intrapartum care for high-risk pregnancy’.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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