This article is from the source 'bbc' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at http://www.bbc.co.uk/news/uk-wales-south-west-wales-26352931

The article has changed 3 times. There is an RSS feed of changes available.

Version 0 Version 1
Rohan Rhodes baby inquest: 'Lost opportunities' says coroner Rohan Rhodes baby inquest: 'Lost opportunities' says coroner
(about 4 hours later)
There were "lost opportunities" to give a severely premature baby from Pembrokeshire earlier medical care before he died, a coroner has said.There were "lost opportunities" to give a severely premature baby from Pembrokeshire earlier medical care before he died, a coroner has said.
Rohan Rhodes, who was born 15 weeks early, should have had blood tests on three occasions in the hours before he died at a hospital in Bristol, Maria Voisin told an inquest.Rohan Rhodes, who was born 15 weeks early, should have had blood tests on three occasions in the hours before he died at a hospital in Bristol, Maria Voisin told an inquest.
She said tests "may have resulted in Rohan receiving earlier medical care". A narrative conclusion was recorded at Flax Bourton Coroner's Court.
A narrative verdict was recorded at Flax Bourton Coroner's Court. The hospital trust said a safety check system has been introduced.
Ms Voisin said the tests may have resulted in Rohan receiving earlier medical care.
'Extremely premature''Extremely premature'
Rohan, from Narberth, was born at Singleton Hospital in Swansea in August 2012, but was transferred five weeks later to St Michael's Hospital in Bristol for specialist surgery to his heart.Rohan, from Narberth, was born at Singleton Hospital in Swansea in August 2012, but was transferred five weeks later to St Michael's Hospital in Bristol for specialist surgery to his heart.
The "extremely premature baby" died there aged just 36 days old.The "extremely premature baby" died there aged just 36 days old.
The inquest into Rohan's death has heard how he deteriorated soon after a ventilator was removed without the consent of his parents or senior hospital staff.The inquest into Rohan's death has heard how he deteriorated soon after a ventilator was removed without the consent of his parents or senior hospital staff.
Medical staff wept as they told the three-day hearing how the baby's condition dramatically worsened.Medical staff wept as they told the three-day hearing how the baby's condition dramatically worsened.
The inquest heard the baby was not allowed to die in his mother's arms despite her wishes because staff were unable to remove lines from his body.The inquest heard the baby was not allowed to die in his mother's arms despite her wishes because staff were unable to remove lines from his body.
Rohan had been transferred to St Michael's Hospital for a surgical assessment after a heart duct which usually closes at birth had remained open.Rohan had been transferred to St Michael's Hospital for a surgical assessment after a heart duct which usually closes at birth had remained open.
His parents Alex and Bronwyn Rhodes told the coroners' court on Monday about concerns they had about their son's treatment.His parents Alex and Bronwyn Rhodes told the coroners' court on Monday about concerns they had about their son's treatment.
They said that Rohan's feeding tubes were inserted "aggressively" and caused him pain.They said that Rohan's feeding tubes were inserted "aggressively" and caused him pain.
Bryony Strachan, of the University Hospitals Bristol NHS Foundation Trust, apologised that opportunities to carry out tests on Rohan were missed, and said safety systems have been introduced.
"The coroner has confirmed that what those results would have been remains unknown, but we are very sorry that those three checks were missed, within continuous monitoring of Rohan's critical condition within NICU (neonatal intensive-care unit)," she said.
"We have already put in place clear requirements for blood gas measurements in babies on respiratory support and have implemented a system of safety checking shared by both medical and nursing staff looking after individual babies," she added.
On Tuesday the court heard from medical staff at the hospital who said the plan had been to keep Rohan on the ventilator.On Tuesday the court heard from medical staff at the hospital who said the plan had been to keep Rohan on the ventilator.
However, the hearing was told advanced neonatal nurse Amanda Dallorzo took the "autonomous" decision to extubate (remove a tube from the airway), remove the baby from the machine, and apply a breathing mask instead.However, the hearing was told advanced neonatal nurse Amanda Dallorzo took the "autonomous" decision to extubate (remove a tube from the airway), remove the baby from the machine, and apply a breathing mask instead.
Rohan's condition dramatically deteriorated and he died the following day.Rohan's condition dramatically deteriorated and he died the following day.
Mrs Rhodes said: "We were terrified and were watching all this in horror. He was so pale and lifeless during this time, we were terrified we were losing him."Mrs Rhodes said: "We were terrified and were watching all this in horror. He was so pale and lifeless during this time, we were terrified we were losing him."
Dr David Harding, Rohan's consultant, told the inquest that the weekend Rohan died was the "busiest and worst weekend of his career".Dr David Harding, Rohan's consultant, told the inquest that the weekend Rohan died was the "busiest and worst weekend of his career".
The court also heard that there were fewer nurses on the ward that weekend than there should have been.The court also heard that there were fewer nurses on the ward that weekend than there should have been.
A "root cause analysis" report looking at the cause of Rohan's death concluded the ward was understaffed too. A "root cause analysis" report looking at the cause of Rohan's death concluded the ward was understaffed.