Parents of newborn who died week after birth question lack of Strep B testing

The parents of a newborn who died a week after birth questioned why the UK is not screening for Group B strep, a fatal accident inquiry heard.

Freya Murphy was born on July 21, 2018 in the Queen Elizabeth University Hospital (QEUH) in Glasgow, but died a week later in the neonatal intensive care unit, a fatal accident inquiry (FAI) at Glasgow Sheriff Court was told.

In a victim impact statement, mother Karen Murphy and her husband, Martin, said they have been “left devastated by failings in her care” and “missed a lifetime of memories with our precious daughter”, while their other children “suffer daily without their big sister”.

They added: “We are disturbed by the fact that most developed countries swab for Group B strep but not in the UK.”

Mrs Murphy, then aged 32 and a first-time mother, was deemed to be a “low-risk” pregnancy, and induction was planned for July 20 2018, however, she requested it be pushed back by three days, according to a statement of agreed evidence read to the court.

Fiscal depute Amanda Allan told the court that on July 19, Freya’s heartbeat was recorded as 150 beats per minute (bpm), and Mrs Murphy, a teacher from Cambuslang, South Lanarkshire, began contractions later that day.

The following evening, Mrs Murphy arrived at the QEUH, with the foetal heartbeat noted as 144bpm and she was transferred to the labour unit at about 10.20pm, and at 6.30am on July 21, she was advised to start pushing, the inquiry heard.

At about 7.20am, a midwife noted that Mrs Murphy’s pulse was elevated, and informed Dr Felicity Watson, who had carried out a vaginal examination and advised Mrs Murphy that she could have a “rest from pushing for an hour”, which she declined to do, Ms Allan told the court.

Midwife Helen Kidd reported at 8.45am that a CTG (cardiotocograph) was showing signs of “deceleration”, however, Dr Amy Sinclair and Dr Marieanne Ledingham left to attend another woman, Patient A, the court heard.

At the time, 12 women were on the ward, including seven in labour, and Dr Ledingham returned to review Mrs Murphy and noted “deceleration”, however, Dr Sinclair advised her that Patient A needed surgical delivery.

The court heard that Dr Sinclair and Ms Kidd delivered baby Freya at 9.30am “covered in copious thick meconium”.

Ms Allan said: “Freya was noted to be born in poor condition, she required resuscitation and CPR continued for 17 minutes.”

Freya was then transferred to neonatal ICU and was suspected to have suffered a brain injury, the inquiry heard.

Ms Allan added: “It was agreed that continuing intensive care treatment was not in Freya’s best interests and she was unlikely to survive.”

Freya died just before 10pm on July 28, aged a week old, and her cause of death was global hypoxic ischaemic brain injury associated with acute chorioamnionitis, following a post-mortem examination.

A significant clinical incident investigation review was carried out in 2019 with six recommendations, and an external review was commissioned by Dr Michael Munro, a neonatal specialist who wrote in a report that “amnionitis caused by Group B strep remains the most likely cause of Freya’s brain injury as there appears to be nothing else to cause it”, and noted that after birth, “care was delivered to (a) high standard”, the court heard.

Giving evidence by videolink, Dr Munro said: “The trajectory of the decline is really impossible to be certain of, there are no studies I’m aware of, of the specific circumstances Freya found herself in. The process of that starting and the baby dying can be just less than 30 minutes.”

Dr Munro said he believed Group B strep – an infection passed from the mother’s body to the baby via amniotic fluid – was “the most likely cause as there’s nothing else from the notes I’ve seen to explain what happened”.

He said: “It can cause stillbirth, therefore, what we are dealing with here is stillbirth just before Freya’s heart tragically stopped.”

He agreed that earlier delivery would have helped, but added: “I don’t think it’s possible to say, ‘had Freya been delivered at this time point she would have avoided brain injury or survived’.”

Dr Munro told the court the mortality rate (of Group B strep) is “round about 5%, it’s a minority of babies who succumb” and Freya was “close to being recorded as (a) stillbirth” as her heartrate was so slow.

He added: “A lot of women carry Group B strep, around a third – it singles out a very small number of babies, either causing a stillbirth or a baby to be born in very poor condition.”

Dr Munro said screening for Group B strep has been carried out in America since 2002, and 15,000 babies born in Scotland in 2023 would have been potentially affected by the infection.

He said the “risk of exposing lots of babies to antibiotics they don’t need” was a major consideration for medics, but added: “I would like universal screening. One of the most advanced healthcare systems in the world is doing it and you have to question why the UK is not.”

Under cross-examination from Alan Rodgers, representing the Murphy family, Dr Munro said the “most common sign was a fever in the mother and the heart rate can go faster”, the inquiry heard.

Neonatal pathologist Dr Paul French gave evidence and said the placenta was examined before Freya’s death and was stained with meconium, indicating the baby had been ‘stressed’ prior to birth – but said this would have occurred ‘hours or days’ before, and that Strep B was present in swabs.

The inquiry continues in front of Sheriff Barry Divers.