Baby L - Non-inquest findings

<1y · Female·Group B Streptococcus meningitis and sepsis

An 18-day-old baby died from late-onset Group B Streptococcus (GBS) meningitis and sepsis. She was born at a regional private hospital after labour complicated by maternal fever (37.6°C), foetal tachycardia (160-170 bpm), and neonatal fever (39.5°C at birth). Despite these signs suggestive of chorioamnionitis, a paediatrician was not notified at birth. The baby appeared well post-delivery and was discharged home on day 3. She deteriorated at day 13 with feeding changes and irritability, presenting to hospital septic. Late-onset GBS cannot be prevented by intrapartum antibiotics. However, the coroner identified suboptimal care: the baby should have been assessed by a paediatrician at birth given maternal fever and neonatal fever, departing from Queensland guidelines. The hospital implemented significant system improvements including mandatory paediatric review within 24 hours, escalation protocols for febrile neonates, and enhanced documentation processes.