Coroner finds 'gross' failings by medical staff at Royal Derby Hospital concerning baby's death

  • Phil Brewster reports live outside Chesterfield Coroner's Court

A coroner has found there were "gross" and "total and complete" failings by medical staff at a hospital just 14 hours after his birth.

Zachary Taylor-Smith was born in November 2022 weighing 6 pounds and 3 ounces.

Soon after labour, Zachary contracted an infection which led to various problems, including breathing difficulties.

His condition began to deteriorate and he stopped breathing. His parents say he was then fighting for his life in the neonatal unit at Derby Hospital.

Baby Zachary died aged just 14 hours old from a life-threatening condition called Group B Strep. The condition is a type of infection and is common for pregnant women but can be very serious for newborn babies.

However, the inquest heard how Zachary’s parents Hannah and Tim Taylor-Smith had not been made aware of it until their son had died.

The final moments of baby Zachary’s inquest saw Coroner Susan Evans conclude there had been "gross" and "total and complete failures" in relation to basic care.

The coroner also stated there had been several "missed opportunities" by staff which could have prevented Zachary’s death.

Coroner Evans said hospital staff should have provided antibiotics to Hannah during labour and Zachary while he was alive. If they had done so Zachary may have survived, she said.

She added staff should have responded sooner to Zachary’s deteriorated health on the morning of November 17, 2022, when risk factors were in play and should have carried out immediate reviews on his condition at key points during his short life.

The coroner said she would file a report for the prevention of future deaths.

The University Hospitals of Derby and Burton NHS Foundation has fully accepted the findings of baby Zachary's inquest and said it is "deeply sorry" for its failures in his care before he died in November 2022 following breathing difficulties.

In a statement, University Hospitals of Derby and Burton NHS Trust said: "The loss of a baby is devastating & we are sincerely and deeply sorry for the failings in Zachary's care, which we fully accept.

"We should have provided antibiotics & responded differently to changes in Zachary's condition.

"Our thoughts very much remain with Hannah and Tim, who have suffered immense pain, and we're absolutely determined the changes we have made will remain embedded to improve the care we give to babies, parents & their families."

What is Strep B?

  • Group B strep is a type of bacteria called streptococcal bacteria.

  • It affects two to four women in 10.

  • It is normally harmless and most people will not realise they have it.

  • It's usually only a problem if it affects pregnant women as it could spread to the baby. It can also make young babies very ill. It can cause serious infection in elderly people.

  • There is no routine screening during pregnancy for GBS in the UK, unlike in other countries.

According to Group B Strep Support, up to two-thirds of GBS infection in babies are of early onset (showing within the first 6 days of life).

What are the symptoms of early onset GBS?

  • Grunting, noisy breathing, moaning, seems to be working hard to breathe when you look at the chest or tummy, or not breathing at all.

  • Being very sleepy and/or unresponsive

  • Inconsolable crying

  • Being unusually floppy

  • Not feeding well or not keeping milk down

  • Having a high or low temperature, and/or be hot or cold to the touch

  • Having changes in their skin colour (including blotchy skin)

  • Having an abnormally fast or slow heart rate or breathing rate

  • Having low blood pressure

  • Having low blood sugar

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