Failure to Detect Irregular Cord Blood Gasses Causes Lifelong Neurological Damage

This is a very interesting case with a diagnosis that was clearly delayed. By doing so, a window of opportunity for therapeutic interventions (whole body cooling, physical and occupational therapy, etc) was likely missed, impacting the long term use of his right arm/hand, gait, or other areas of the child’s development. A base deficit of >16mEq/L is biochemical evidence of birth asphyxia, thereby warranting further diagnostic tests in the neonatal period, especially if there are other concerning factors (an acute perinatal event, low apgar scores, respiratory distress, any slightly abnormal neuro exam, etc.). Additional tests might include arterial blood gas, lactate, LFTs, electrolytes, cranial ultrasound, brain MRI. Certainly, when problems in his motor development became apparent (arm use/positioning, abnormal gait, etc) an MRI and/or a thorough evaluation by a pediatric neurologist, developmental pediatrician, or NICU follow-up specialist should have been done.