Hospital Discharges Unstable Mother of Twin Infants

This case involves the birth of two twin babies who had no prenatal care and were born prematurely to a mother who experienced significant medical complications during the delivery. The mother is a single parent with a low IQ and was scheduled to receive aid and instructions from social services before her discharge. The aid and instructions, however, never occurred. The mother and the infants were released from the hospital to a women’s shelter that was later determined to be an unfavorable environment to care for newborn children.  Subsequently, the mother had trouble feeding the newborns, as they would not tolerate formula or breast milk. As a result, they became very malnourished and one of the twins died three weeks after birth. The mother has subsequently been charged with murder and attempted murder due to alleged starvation. Two days before the infant’s death, a social service’s visit had declared the boys to be in good health and ended the social service’s relationship with the mother.

Question(s) For Expert Witness

Expert Witness Response E-001149

The evaluation of preterm and term infants with complex conditions requires the involvement of professionals from multiple medical, rehabilitative, psychological, and social service subspecialties. Follow-up of extremely low-birth-weight infants (ELBW), who have a birth weight of less than 1,000 grams, is required to prevent subtle neurodevelopmental problems. A retrospective analysis of information on ELBW infants from the National Institutes of Child Health and Human Development revealed that these patients benefit by using special outpatient services, but efforts to improve these services are needed. A stable and consistent home environment almost always improves the infant’s outcomes. In the process of discharge planning and follow-up, providers should stress the uncertainty of outcomes for specific neurologic risks in the extremely low-birth-weight (ELBW) infant. In any event, the mother and twin infants should not have been discharged until the mother underwent psychiatric evaluation for suitability as a caregiver and not until a stable home was identified for the new family.

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