Medics could not have saved child with sepsis, expert says

Doctors could not have saved a six-year-old who died of sepsis while battling a rare kidney condition even if they had been more aggressive in their course of treatment, an independent expert has said.

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

She was initially discharged only to be readmitted overnight on July 26 when her symptoms worsened.

Coco was eventually transferred to the Bristol Royal Hospital for Children, where she later died.

Blood tests showed Coco had “overwhelming sepsis” by the time she was transferred.

An inquest sitting in Truro is considering whether a different course of treatment may have saved her life.

A review published in September 2018 found Treliske staff “missed opportunities” in Coco’s care, including by failing to recognise Coco was in shock and administering an inadequate fluid management plan.

It further found there had been a delay to starting antibiotics overnight on July 27 when Coco’s test results showed she had developed sepsis.

Dr Yincent Tse, a consultant paediatric nephrologist at Great North Children’s Hospital in Newcastle Upon Tyne said on Thursday he did not believe Coco could have been saved.

The inquest previously heard Coco had developed haemolytic uraemic syndrome (HUS) – a rare condition triggered by E.coli that causes the destruction of red blood cells.

Giving evidence to the inquest, Dr Tse explained that HUS is caused by the toxins given off by the bacteria that get into the blood stream and causes the platelets to clot in the small blood vessels.

It mainly impacts the kidneys but can also affect other organs, including the brain – particularly in children – causing them to become confused and, in some cases, cause seizures.

HUS can also cause tissue death in the brain, resulting in serious brain damage.

There is no proven treatment for the condition, Dr Tse said, but there is evidence it is “self-limiting”, meaning it can run its course on its own.

Antibiotics are not recommended, the inquest heard, because they can cause the E.coli bacteria to release its toxins, worsening the disease.

Left to itself, there is the possibility the E.coli might pass out naturally.

The inquest also heard doctors decided to give Coco half the level of fluids recommended by the National Institute of Care Excellence (NICE) because of concerns about kidney damage.

Dr Tse said: “I think it is a reasonable course of action because while you can give half (fluids) you can’t take away half, and if there is kidney shutdown there is a worry that the lungs will start filling up with fluid if you give too much.”

He said it was reasonable for doctors to have given Coco half the levels of fluid and then reassess her, adding: “I think that’s quite good practice.”

Dr Tse was asked if it would have changed the outcome if Coco had been admitted on July 25 and given “optimal fluids” instead of being sent home.

He replied: “Unfortunately, because there is no treatment for the HUS toxin or the disease itself, I don’t think that would have made a difference.”

There was also a delay moving Coco from a general paediatric ward to the intensive care unit.

Dr Tse again did not believe this would have saved her life.

“Although her perfusion (blood flow to organs) wasn’t very good, she eventually, after a few hours of delay, got the treatment that she needed,” he said.

“But despite that, over the next few days in (intensive care) with maximum support, she continued to deteriorate.”

He continued: “I think, sadly, this was going to happen.”

Dr Tse was asked whether he believed medics should have given antibiotics at the point it was clear Coco had sepsis.

He replied: “I would share the hesitation in giving antibiotics, however I think that if at the time (colleagues) think giving antibiotics might be helpful because of developing sepsis, I think that any nephrologist would go along with that.”

Another failing identified by the independent review into Coco’s death was that her blood pressure was not taken until 36 hours after she was admitted to hospital.

The inquest heard that Coco, who was autistic and had limited speech, had become very distressed at having the cuff placed on her and nurses had been unable to take a reading.

It has emerged the hospital’s specialist learning disability and autism service were never called upon to help.

The inquest will hear the final evidence on Friday, with Coroner Andrew Cox due to deliver his conclusions on a date yet to be set.