May 20, 2022

Doctors who delayed giving antibiotics to child with sepsis feared kidney damage

Doctors treating a six-year-old who died of sepsis have delayed prescribing antibiotics for fear of worsening her chronic kidney problem, an investigation has found.

Coco Rose Bradford, who was autistic, died on July 31, 2017 after being admitted to Royal Cornwall Hospital, known as Treliske Hospital, with severe vomiting and diarrhea on July 25.

His family said the staff were “dismissive, rude and arrogant,” and an independent investigation in 2018 found that several opportunities had been missed that could have changed the course of treatment.

Dr Laura Guilder, who was the night shift clerk at Treliske when Coco was first referred to the pediatric ward on July 26, said the little girl was diagnosed with bacterial gastroenteritis.

They couldn’t give me that assurance and they wanted to discuss it with a consultant

Dr Laura Florin

She said during an investigation in Truro that Coco had an elevated heart rate and was “on the verge of shock” and had paid special attention to her fluid levels to ensure an infusion – adequate blood flow – to her organs. .

Dr Guilder said she had been “careful and measured” in her approach to the administration of intravenous fluids, lest the patient would develop kidney problems.

The witness said she was also concerned that if the fluids were delivered too quickly, Coco’s blood vessel might collapse and a new cannula would have to be inserted.

Dr Guilder said she knew the patient was at risk of developing hemolytic uremic syndrome (HUS) – a rare condition triggered by E. coli that causes red blood cells to be destroyed.

She said that at the end of her shift, Coco’s condition improved, adding that when she returned the next evening, the child appeared “brighter” and had no symptoms of sepsis. .

The investigation learned that antibiotics can facilitate the development of HUS, but that they could still be considered based on the advice of specialists in nephrology and microbiology.

(Paul Armiger / AP)

(AP Archives)

Dr Guilder said that due to the continued rise in the child’s heart rate and temperature, senior colleagues said antibiotics should be considered if there was no evidence of HUS during the night.

But at 11 p.m. on July 27, blood tests revealed that Coco’s blood cells were fragmenting.

When asked why at that time she had not used antibiotics, the witness said, “Our reasoning for not covering antibiotics was that we were concerned that we would not make HUS worse.

“We would have been happy to give it to them if the kidney team felt it wouldn’t make matters worse, but they couldn’t give me that assurance and they wanted to discuss it with a consultant.”

She said that “looking back” she still wondered why she hadn’t asked the nephrology team for an answer about antibiotics when she hadn’t had an answer after a few. time.

Dr Guilder added that she would “still wonder” if Coco’s life would have been saved had antibiotics been prescribed earlier, but at that point her kidney condition rather than sepsis was the main concern.

She said the possibility of sepsis had been considered “at all stages” of Coco’s treatment.

Coroner Andrew Cox also asked the witness if the delay by Treliske staff in moving Coco to a highly dependent pediatric ward in Bristol was an example of a cultural issue within the hospital.

Mr Cox asked if, due to his remoteness, Treliske staff felt “we have to fend for ourselves because we can’t rely on anyone else”.

But Dr Guilder said she believes doctors have always been able to seek support and advice from other hospitals when needed.

Among the missed opportunities identified by the investigation was the fact that Coco’s blood pressure had not been taken for 36 hours after she was admitted to the hospital.

Nurse Sophie Griffith told the inquest that she repeatedly tried to take Coco’s blood pressure and tried to adjust the cuff around her arms and leg, but the little girl had become distressed and had taken it away.

In her notes, she described the patient as “uncooperative” – ​​for which Coco’s family sharply criticized the hospital.

Rachel Bradford said in a statement that staff blamed her daughter for her mistakes, adding that Coco was upset and “was in terrible pain and was dying before our eyes.”

Nurse Griffith apologized for her use of language in her notes.

The investigation, which is scheduled to last until December 10, is continuing.