Baby deaths prompt heart tube ban

Babies in intensive care might be fed this way

Doctors have been told to stop using a common way of feeding desperately-ill babies after fears it could be killing some of them.

The Department of Health has issued new guidance following an investigation into the deaths of four babies in the Greater Manchester area over the last two years.

The method involves sliding a tiny tube directly into the baby's heart so that liquid nutrients can be injected into the strongest flows of blood.

It is a controversial practice - many doctors support it, but others say that it is better to place the tube in the main vein passing back into the heart instead.

Expert medical opinion has been genuinely divided on which technique will give a seriously ill baby the best chance of survival

Chief Medical Officer Professor Liam Donaldson

Two experts who investigated the safety of the two methods have told ministers that more research is needed to examine the safety of the practice.

However, as a precaution in the meantime, they concluded that the catheter tube should not be placed directly into the heart.

England's Chief Medical Officer, Professor Liam Donaldson said: "The field of care reviewed in this report is at the leading edge of complex, high technology medicine.

"Many of the the 12,000 sick babies treated in intensive care each year are quite literally clinging to life.

"Expert medical opinion has been genuinely divided on which technique will give a seriously ill baby the best chance of survival.

"This report points the way to establishing the best approach in future."

Danger fluid

Daniel's story:

Daniel was born by emergency Caesearean section at about 30 weeks

His heart rate was slow, and he wasn't breathing

Resuscitation was successful, but Daniel subsequently developed lung disease

After five days he was not tolerating food doctors suspected he had developed necrotising enterocolitis, an inflammatory condition that can destroy the bowel

Daniel initially responded well to intravenous feeding

However, after five days of treatment he suddenly began to deteriorate and died

All the babies died of a condition known as cardiac tamponade - fluid between the membrane surrounding the heart and the organ itself.

Because the membrane cannot stretch, if there is enough fluid, it will stop the heart expanding and contracting to push blood around the body.

Some doctors belive it is best to insert it directly into the heart because blood flow there is strongest and the highly-concentrated nutrients need to be well diluted.

They say that putting the catheter into the weaker flows of the vein might even lead to blockages caused by the syrupy nutrients.

In the case of the four babies who died, the catheter was found to be inside their hearts although it is possible that in some cases the tip had moved into the heart from the vein.

The reason why this led to the dangerous fluid build up is still unclear, although it is possible that the tip of the catheter irritated the lining of the heart, and triggered the deadly reaction.

Rare complication

The complication only affects a maximum of 2% of babies who undergo the procedure.

It is difficult to recognise and none of the clinicians involved had come across it before.

The doctors who wrote the report stressed no blame could be attached to any of the doctors involved.

Professor Donaldson warned that the culture of "naming and shaming" which had developed in the NHS was counterproductive.

He said: "Ultimately, it will drive good quality underground as people will become afraid to admit their mistakes.

"We have to be allowed to create a culture that, while not free of accountability, is free from blame."

The review was carried out by consultant paediatrician Dr Unni Wariya, from the Royal Victoria Infirmary, Newcastle, and consultant anaesthetist Dr David Hallworth, from the Royal Hospital for Sick Children in Glasgow.

Among 14 recommendations it called for a wide-ranging audit to look at complications that can result from all methods of feeding babies in hospital.

Department of Health officials are to hold talks with catheter manufacturers about including the advice in their sales literature.