Premature baby died of feeding complication, inquest hears

A PREMATURE baby died from an extremely rare complication associated with a special feeding tube used widely on premature babies, an inquest heard yesterday.

Assistant State Pathologist Dr Margaret Bolster told Cork Coroner’s Court that although the complication was well recognised in the medical literature, it was the first time she had ever come across such a case. She described the case as “very tragic”.

Baby Devin James Enright, whose parents Stephanie and Donal have an address at 29 Sandhill Road in Ballybunion, Co Kerry, was born by Caesarean section 12 weeks premature on March 20, 2006.

He died 12 days later, on April 1, in the Special Baby Care Unit at Cork’s Erinville Hospital.

Dr Bolster, who carried out a post mortem on the body, told the inquest that baby Devin weighed just 724 grammes — just under two pounds.

His organs, particularly the liver and lungs, were very immature, she said.

And because he was so premature, he was unable to digest food through his stomach, the inquest heard.

Doctors inserted a special feeding tube into his arm which ran through his blood vessels to a point just above the vena cava, the main vein into the heart.

This feeding method — total parenteral nutrition — is widely used to deliver high concentrations of nutrients, including sugars and fats, directly into the systems of premature babies.

However, the milky fluid from Devon’s feeding tube leaked into his pericardial sack, the membrane around his heart, through a process known as osmosis.

The fluid gathered in the sack and put so much pressure on his heart that it eventually stopped beating.

Devin was checked by doctors at 3pm on April 1 and everything seemed fine.

But when he was checked again at 3.15pm, he had turned blue and had a weak heartbeat. Resuscitation attempts were unsuccessful.

The cause of death was recorded as cardiac tamponade — compression of the heart caused by the accumulation of fluid in the sack.

Dr Bolster said although it is a known complication of total parenteral nutrition, she said this was the first time she had seen such a case.

“It is a very, very rare complication. I have never come across this,” she said.

Devin’s mother, Stephanie, asked Dr Bolster during the inquest if the tube had been positioned correctly above her son’s heart.

Dr Bolster said it appeared that the tube had been in the right place. But there is a tiny margin for error in babies so small and the distance could be measured in millimetres, she said.

“Everything is tiny and the catheter can shift,” she said.

Although the baby was sedated, any movements could cause the feeding tube to move, the inquest heard.

The Unified Maternity Services (UMS) in Cork offered their deepest condolences to Devin’s parents.

“Dr Brendan Murphy, consultant neonatalogist, has offered to meet with the parents to discuss the findings of the inquest,” a Health Service Executive spokesperson said.