A seven-year-old died within hours of leaving hospital despite having “looked well” when he was discharged, an inquest has heard.
Adam Soeb Bapu was rushed to Royal Bolton Hospital on his seventh birthday because he was “struggling to breathe”.
He had also felt lethargic and suffered a slight cough and vomiting before being taken to hospital at around 9.30pm on April 1, Bolton Coroner’s Court was told.
Emergency clinician Dr Shanmugam saw Adam on the Accident and Emergency ward and told the court that his vital signs were all normal, while he found no laboured breathing or other causes for concern such as tracheal tug.
Having diagnosed Adam with a viral respiratory tract infection, Dr Shanmugam discharged him and recommended a Beconase nasal spray to help alleviate his symptoms.
Adam’s mum Tosifa Bapu noticed that his breathing was “noisy” when they returned to the family home in the Halliwell area of Bolton and let Adam sleep in her king size bed with her that night, so she could keep an eye on him.
However, when she woke up at around 2.45am on the morning of April 2 she discovered that Adam was not breathing.
The Manchester Evening News reports that he was rushed back to hospital but despite the attempts of his dad and paramedics to resuscitate him, Adam was pronounced dead at 4.03am.
Senior coroner Timothy Brennand asked Dr Shanmugam whether he would have done anything differently with the benefit of hindsight.
He responded: “This is a question I keep asking myself and I have asked senior [doctors] and they said they would have done the same thing I did. I certainly don’t think I would do anything different, no.”
Pathologist Dr Melanie Newbould carried out a post mortem on Adam’s body and recorded the cause of death as sudden death in a child with laryngotracheobronchitis – more commonly referred to as croup.
“We can tell that Adam definitely did have a significant respiratory tract infection affecting his airways at the time of his death,” she told the hearing.
Dr Newbould added that there was no evidence that Adam had developed sepsis, pneumonia or any other bacterial infection at the time of his death.
“Everything seems to point to the fact he was a child with a very serious respiratory tract infection who suddenly collapsed and died,” she said.
Paediatric consultant Jessica Watson wrote a serious incident investigation report into the care that Adam received at Royal Bolton Hospital.
She described his death as a “very rare and unfortunate set of circumstances”, adding that there were “many examples of excellent practice” and that Dr Shanmugam made “thorough” notes throughout his consultation.
Ms Watson said: “He would not have met the criteria of any intervention, medication, a prolonged period of observation or admission to hospital on the findings of his first attendance”.
During the hearing, Adam’s dad Soeb Bapu described his son as a “lovely” boy, who was “healthy” and “full of life”. He added: “He was very energetic and always asking questions.”
Recording a narrative conclusion, Mr Brennand said: “I’m of the view that his diagnosis was not unreasonable in the circumstances of the case, notwithstanding the benefit of hindsight.
“It appears to me that this was a judgement call based on the clinical presentation of Adam to the doctor, deploying what I can only describe as best practice in the auspices of his training and experience.
“He was of the view, and his clinical notes are nothing short of excellent, that this did not warrant, nor did the clinical presenting symptoms necessitate an admission onto ward for ongoing observation or escalated care.”
Mr Brennand added: “I don’t think anything more could or should have been done by the parents in terms of what happened when he got back home.
“It was obvious they were taking the best care that they could offer to him. No parent could have done any more than those two did.”