‘Major vulnerabilities’ in Temple Street neonatal critical care, doctors warn management

There are “major vulnerabilities” in the critical care arrangements for newborns admitted to Temple Street hospital, meaning the service is “failing to meet the specific needs” of these infants, doctors have told hospital management.

Dublin’s three maternity hospitals and Cork University Hospital each have a neonatal intensive care unit (NICU) for premature and very ill newborns, managed by neonatology consultants.

However, for babies who are transferred to one of the dedicated children’s hospitals for surgery or specialist review within days or even hours of their birth, there is no equivalent specialised life support there.

Staffing and facilities in a paediatric ICU (PICU) are not designed for up-to-date, specialist care of low birth weight and preterm infants and a level-four surgical NICU is planned for the new national children’s hospital in Dublin.

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In February, PICU staff in Temple Street highlighted safety concerns about the continued use in the hospital of an outdated system of care for premature and extremely low birth weight infants.

In a letter seen by The Irish Times, six paediatric intensive care doctors in CHI Temple Street warned CHI management about “major vulnerabilities” in the critical care arrangements for newborns admitted there for treatment, stating “we are failing to meet the specific needs” of these infants.

“We believe that the current model of care has passed a threshold of foreseeability for adverse outcome,” the letter said.

With a high morbidity and mortality rate to be expected among these babies, they said, “an inquiry into an adverse outcome may identify deficiencies in the process of care”.

[ Doctors express concerns about care of newborn babies who undergo surgery at Dublin hospitals ]

Furthermore, consultant Dr Ann Hickey told Children’s Health Ireland (CHI) earlier this month she could no longer continue as neonatology lead due to the “absolute failure” of the CHI executive to support the development of a NICU and “more recently to ensure that we are safely staffed to provide care to non-ICU neonates [infants aged under 28 days]”.

In a letter shared with colleagues and seen by The Irish Times, she blamed “neglect and apathy” on the part of the CHI executive for stalling over the setting up of a NICU in one of the existing children’s hospitals, in advance of the move to the new national children’s hospital.

David Cullinane, Sinn Féin’s health spokesman, said “the absence of adequate neonatal facilities and ICU facilities obviously does raise concerns”.

“We don’t know when the national children’s hospital is going to be completed, we’re told it could be October or November. If you have clinicians working in this area raising concerns then obviously that is very significant and needs to be responded to by the department, by the Minister and by the Chief Medical Officer.”

In a statement to The Irish Times, Children’s Health Ireland said it currently provides paediatric intensive care services at both Crumlin and Temple Street hospitals and was committed to delivering the highest standard of clinical care possible.

“We cannot comment on the status or remarks of individual employees. However, we remain fully committed to the opening of a neonatal ICU at the new children’s hospital and planning continues to support this development,” it said.

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