Newborn given overdose of anti-seizure drug

A baby was born by Caesarian section on Sept. 7, 2002, at 38 weeks gestation, after three days of labor induction due to difficulties in the pregnancy.

Two days later, the baby developed seizures with episodes of apnea and was transported to a separate hospital’s neonatal intensive care unit.

Over the next two days, the newborn continued to have multiple seizures with tongue rolling, lip smacking, jerky uncoordinated movements of all extremities and apnea, despite treatment with the anti-seizure drug Phenobarbital. Doctors decided to administer a second medication, Dilantin, in hopes of controlling the seizures.

On Sept. 11, a nurse administered the medication to the baby by vein rather than intramuscularly, as had been ordered by the doctor. The baby developed apnea, mild bradycardia, distant heart sounds, weak peripheral pulses, poor tone, poor perfusion and cold extremities.

He was intubated and placed on a ventilator. His arterial blood gases reflected moderate metabolic acidosis. He received saline for his hypovolemia and hypoperfusion and medications to increase his blood pressure. He responded with an increase in his heart rate and blood pressure. His color, perfusion and oxygen saturation improved as well.

Blood tests showed an elevated level of Dilantin, which gradually went down over a few days. The baby was then taken off the ventilator and was able to breathe on his own, and he was noted to have normal heart, kidney, liver and lung function.

Over the course of the next seven years, the child went on to demonstrate residual cognitive impairment and was diagnosed with autism. The parents claimed the injuries were a result of the Dilantin overdose.

The defense conceded that the baby had been given too much Dilantin but contended that it cleared quickly and the baby suffered no resultant harm. They further contended that the baby was brain-damaged long before the Dilantin episode, as evidenced by abnormal head studies performed prior to the overdose, and that his current condition was entirely unrelated to the Dilantin.

The case settled for $6 million.

Type of action: Medical malpractice

Injuries alleged: Cognitive defects due to overdose of Dilantin

Date: January 2010

Submitted by: Andrew C. Meyer and William  J. Thompson, Lubin & Meyer, Boston