Nurse tells inquest into baby's death of oxygen concerns

RTÉ News​

02-07-2025

A nurse has told a reopened inquest into the death of a boy days after his birth at the Midland Regional Hospital in Portlaoise that she was concerned the oxygen in equipment being used to resuscitate him was "off or at a low level" for the first 11 minutes of his life.
Elaine Sheehy, a paediatric nurse, said she also expressed concern that an oxygen mask placed on Aaron Cullen during efforts to resuscitate him was too big.
He suffered a lack of oxygen to the brain when delivered by emergency caesarean section in the hospital on 4 May 2016.
Aaron died five days later at the Coombe Hospital in Dublin after being transferred there for specialist care.
Ms Sheehy told the second day of the inquest, at Dublin District Coroner's Court, that she had subsequently become "extremely upset and concerned" that she needed to increase the oxygen flow when she arrived in theatre 11 minutes after the birth.
She said she was concerned that the oxygen from the Neopuff resuscitator being used was "off or at a low level."
She added: "I am certain that I needed to increase the oxygen flow but I am not certain if this was from off or low flow."
However, an expert witness who reviewed the case said he believed it was most likely that the gas flow to the Neopuff was turned on because the baby's condition improved with ventilation via a mask as well as from the recollection of staff treating him.
Consultant neonatologist, Colm O'Donnell, said it would have ensured the equipment was delivering a minimum concentration of 21% of oxygen or "room air."
Prof O'Donnell said he did not believe that Aaron would have survived given the severity of his condition at birth and his lack of response to intensive care.
However, he acknowledged that it was not possible to say the relative effect that an increased gas flow (regardless of oxygen concentration) and the change of mask would have had.
Prof O'Donnell said the baby was "extraordinarily sick" from birth but there was no acute event which would explain why he was so unwell.
The consultant said intubation would have been more preferable at an earlier stage but he said it was not surprising it was not done earlier.
He said it was also unsurprising that a registrar had made two unsuccessful attempts at intubation as up to 45% of first attempts at urgent intubation do not work.
Aaron was successfully intubated by an on-call consultant paediatrician, Muhammad Tariq, 21 minutes after his birth.
In reply to questions from Coroner Myra Cullinane, Prof O'Donnell said he did not believe any rate of flow of gas to the Neopuff would have been sufficient due to the condition of the patient's lungs.
He said the earlier delivery of a higher concentration of oxygen might have had some effect but he believed it would have still been "unsatisfactory".
The inquest was reopened on direction of the Attorney General to allow new evidence be heard that was not before the original hearing that concluded in March 2019 with a narrative verdict.
The fresh inquest had been sought by Aaron's mother, Claire Cullen, after she obtained additional material from the Portlaoise hospital in relation to concerns about oxygen levels during resuscitation under a Freedom of Information request after the conclusion of the original hearing.
Ms Sheehy gave evidence that she had been made aware while on duty earlier about a woman with a high-risk pregnancy with an increased likelihood of her child requiring admission to the hospital's special care baby unit.
The nurse said she received another call a short time later that the baby was going to be delivered by caesarean section imminently.
Ms Sheehy said that she was subsequently called to attend the operating theatre urgently and arrived there 11 minutes after Aaron's delivery.
She recalled that resuscitation on the baby was already in progress, but no respiratory effort was noted and his heart rate was reported to be just 30 beats per minute.
In reply to questions from the coroner, Ms Sheehy said she was concerned that the he was not responding to resuscitation efforts and she changed the size of the oxygen mask being used to a smaller one for pre-term babies.
She became tearful when she outlined her belief that Aaron was not getting better, despite the efforts of medical staff.
"I found that very upsetting," Ms Sheehy remarked.
The nurse admitted that she had thought a lot about what happened that day.
"It is difficult to envisage that for 11 minutes the oxygen could have been completely off," she said.
Cross-examined by counsel for Ms Cullen, Fiona Gallagher, the nurse said the baby was "flat, unresponsive and very pale" when she first saw him.
Interim Director of Midwifery at the Midland Regional Hospital in Portlaoise, Maureen Revilles, said that Ms Sheehy told her about her concerns on 9 May 2016 because she wanted to prevent issues arising with resuscitations in the future.
However, Ms Revilles said the claim of oxygen being off was deemed incorrect at a senior incident management team meeting on 19 May 2016 as staff present from the start of the resuscitation "had a clear recollection of the oxygen being on to deliver pressures via the Neopuff device".
Based on Ms Sheehy's information, Ms Revilles said it was agreed that the oxygen flow was increased.
The inquest was adjourned and will resume tomorrow.