Cause of death of Aibha Conroy (6) yet to be established, coroner told

Inquest hears girl suffered brain damage after collapse in Galway hospital

A six-year-old girl developed severe brain damage within hours of being admitted to the emergency department at Galway University Hospital (GUH) suffering from low blood sugar, an inquest has heard.

Aibha Conroy from Gowla, Cashel in Connemara, Co Galway died at Temple Street children's hospital on December 14th, 2011, four days after she was admitted to GUH with a history of vomiting, weakness and suffering from hypoglycaemia (low blood sugar).

Dublin Coroner’s Court heard she initially responded to treatment on admission to GUH at 12.45am on December 11th but within 90 minutes she had to be resuscitated following respiratory arrest. The underlying cause of her death has not been established.

On the third day of the inquest, GUH consultant paediatrician Dr Mary Herzig said Aibha went into respiratory arrest 10 minutes after an episode of vomiting. She attended to her at 2.30am when Aibha had already been ventilated. She was subsequently transferred to intensive care. Dr Herzig said her impression was the respiratory arrest was caused by inhaling vomit. She suspected a possible metabolic abnormality and requested blood tests. There were no signs of brain damage at this point.

At 3.55am, Aibha’s pupils became unequal and Dr Herzig ordered a CT brain scan. The consultant radiologist’s report was non-specific, she said, showing “poor differentiation between white and gray matter” raising the possibility of an “infarct” or blocked blood vessel to the brain. The transfer to Temple Street was arranged.

Aibha's mother Kathleen Conroy previously gave evidence GUH staff told the family she would be 'okay' and was being transferred because Temple Street has a paediatric intensive care unit. However, when they arrived at Temple Street they were shocked to learn that Aibha was dying. Dr Herzig said she told them that Aibha was "vividly unwell" prior to the transfer.

Dr Ciara McDonnell, consultant paediatrician on call at Temple Street at the time, said when Aibha was admitted she was “very unwell”.

When the Temple Street radiologist examined the brain scan, she said, they concluded that Aibha had suffered a “massive cerebral insult” related to hypoxia or oxygen deprivation. “The examination findings and radiology findings suggested the odds were against her,” she said.

She described the fact that Aibha’s pupils were “fixed and dilated” on arrival as “ominous”. They proceeded to normalise her biochemistry and assess her again but she did not recover. Tests carried out over the next two days confirmed brain death.

The reason for the hypoxia was unclear, said Dr McDonnell. Because Aibha came into hospital with hypoglycaemia "it is fair" to link it to the arrest, she added. Under questioning from the family's solicitor Damien Tansey about the possibility of an underlying hormone deficiency, Dr McDonnell said they had been unable to establish a diagnosis.

Dr Herzig later gave evidence that it was not possible to say what caused the brain damage.

“The level of hypoxia was very short-lived but we do not know, and no-one can say, if that was what had caused subsequent neurological abnormalities on its own, whether the hypoglycaemia caused it on its own or a combination of the two,” she said.

The coroner previously heard Aibha was admitted to GUH on two previous occasions with hypoglycaemia resolved by administering intravenous fluids. Mrs Conroy gave evidence she believed her daughter would be alive today if she had been referred to Our Lady’s Children's Hospital, Crumlin for further testing.

The inquest continues.