Newborn died at Cork maternity hospital after mother had epileptic seizure and fell on top of him inquest hears

A four-day-old baby boy sustained an irreversible brain injury after his mother had an epileptic seizure collapsing out of her bed and pinning the child underneath her, an inquest in Cork has heard.

Marie and Darragh Downey of Knockanevin, near Kildorrery, Co Cork passed away within 33 hours of each other after tragedy unfolded in March, 2019 at Cork University Maternity Hospital (CUMH).

Marie, who had an uncomplicated pregnancy, suffered from epilepsy and had a seizure possibly whilst breastfeeding her infant in her hospital bed in her private room. The 36-year-old was found dead on the floor of her hospital room shortly after 8am on March 25th, 2019.

Dr Keelin O’Donoghue, Consultant Obstetrician/Gynaecologist at CUMH, treated Mrs Downey for all three of her pregnancies. During Marie’s first pregnancy she suffered a seizure at 30 weeks and decided to go back on medication for her epilepsy prescribed for her by her neurologist Dr Peter Kinirons. Marie had gone off her medication for a period as she was concerned about taking it during pregnancy.

Dr O’Donoghue said they had discussed the risks of her not being on anti convulsant medication. They were both happy with her returning to her medication and she was diligent about taking her tablets. Marie took the medication through her subsequent two pregnancies.

APPOINTMENT

Dr O’Donoghue said she had experience in dealing with women who suffer from epilepsy and their care during pregnancy. She stated that during Marie’s third pregnancy in 2018 she told her at her 12-week appointment that she had an appointment with Dr Kinirons in January of 2019. Tragically, Marie did not make the appointment arising out of important family events.

Dr O’Donoghue said that she regretted not asking Marie if she had attended the appointment and conceded that it was an “oversight’ for her not to have written to the neurologist about the care of her patient. She said that she “made the assumption” that Marie had attended the appointment. She and was shocked when it subsequently emerged that the neurologist had not even been aware of the third pregnancy.

Dr O’Donoghue said that she was conscious that fatigue and stress were “precipitators for seizures” in Mrs Downey and that breastfeeding could also have been stressful for her.

She described what occurred to mother and baby as “shocking and unexpected” and again extended her condolences to Kieran Downey the widower of Mrs Downey.

She told the Coroner’s Court that prior to the tragedy unfolding Ms Downey was breastfeeding, doing well and “keen to get back home”. Ms O’Donoghue recalled starting her rounds on the morning of March 25th, 2019. When she went in to Mrs Downey’s room shortly after 8am she was shocked to find that she was “half out of the bed”.

“Her legs remained on the bed, with her upper body on the floor. She was in an unnatural position, with her neck twisted up and to the left, facing the door, up against the corner of the bathroom door and wall.

“I quickly moved over to Ms Downey and felt her neck for a pulse. I immediately rang the emergency bell in the room and called out into the corridor. Both an SHO and midwife attended very quickly.

“The SHO rechecked for a pulse, touched Ms Downey, and confirmed there was no pulse. Others attended, including the CNM2 ward manager and a staff midwife. As we started to move Ms Downey, the ward manager noted that baby Darragh was lying underneath Ms Downey, on her right side and thus concealed initially from our view. The midwife brought him to the nursery and the neonatal emergency team was called.

“I was not involved in the treatment of Baby Darragh. I asked the midwifery duty manager for the day to contact Mr Downey and tell him that Ms Downey was suddenly very unwell and to come in without delay.

“I telephoned the Coroner and spoke to him.

“I informed him of the situation and that a post-mortem-was indicated. He confirmed he would make the arrangements and I gave him the necessary details.

“The ward manager stayed with Ms Downey until her family arrived.

“At 9:40am Mr Downey and his father arrived. I met them on the ward. I explained what had happened and brought them to room 17. Dr Brian Walsh, Neonatology, then attended and spoke to Mr Downey.

“I brought the Downey family to the NNU (with Dr Walsh) at approximately 10.30am. We made arrangements to clear the ward and closed it off to provide the family with privacy.

“We provided them with a designated room and made arrangements for Ms Downey’s parents to get to the hospital.”

'THERE WAS NO SUFFERING'

Meanwhile, Dr Brendan Murphy, a Consultant Neonatalogist at CUMH, said that baby Darragh suffered a hypoxic ischamemic encephalopathy after his mother collapsed on top of him. He told the inquest that when baby Darragh was found under his mother by paediatric staff every effort was made to resuscitate him. He received comprehensive medical intervention including intubation, received adrenaline and fluid and chest compressions. When his oxygen saturation improved he was transferred to the neo natal intensive care.

Doctors determined that Darragh was “clinically comatose” having sustained an “irreversible brain injury.”

Dr Murphy offered his condolences to Kieran Downey, the father of baby Darragh emphasising that the infant was comatose from the moment he was found.

“He (Darragh) never regained consciousness. He was unaware of (medical intervention). There was no suffering.”

Dr Murphy added that Darragh was a perfectly healthy baby at birth who tragically sustained irreversible brain injury when his mother collapsed from her bed with the four day old going underneath her body.

Darragh suffered a lack of blood supply and oxygen to the brain and was unable to breathe on his own. Intensive care support was withdrawn following consultation with the family and Darragh passed away at 5pm on the 26th of March, 2019. Kieran Downey and his two young sons were given the opportunity to spend time with Darragh in a family room prior to his death.

Dr Murphy said that he knew from the outset that Darragh’s prognosis was bleak but that they gave him “every opportunity’ for signs of recovery. He lived for 33 hours after his mother was found dead. He knew that the prospects for Darragh was hopeless.

“I was under no doubt, from his admission to the unit that his prognosis was bleak and that he was unlikely to survive, but I wanted to satisfy myself and the family that we had given him every chance of recovery.”

Dr John O Mahony, Senior Counsel for the Downey family, said that they were aware that every effort was made by doctors to assist the baby.

A statement from Dr Hannah Glynn, a junior obstetrics registrar was also read into evidence. She said that at 8.03am on the 25th of March 2019 a midwife ran to the nurses station and said that a mother had collapsed in room 17. She went to the room and met two midwives who were running as fast as they could. Dr Glynn said that she overheard one midwife say that “I think the baby is gone and the mother could be too”.

When Dr Glynn entered the room she noted the presence of Dr Keelin O’Donoghue and Dr Sam Hunter with the latter kneeling on the floor.

She said that Mrs Downey was on the floor with her head at an “unusual angle”. She states that it was her thought that Mrs Downey may have been breastfeeding prior to the tragedy given that her right breast was exposed. She felt that Mrs Downey had suffered a “possible seizure and a possible neck trauma”. Dr Glynn added that CPR was not administered as tragically Mrs Downey was already dead.

The inquests continues tomorrow.